Rush Medical College.

Abstract

Curriculum Management and Governance Structure ♦ The dean of Rush Medical College and the associate dean for Medical Student Programs (MSP) provide the strategic leadership in managing the educational program and in developing policies and procedures of the college. ♦ The dean and associate dean work closely with basic science and clinical department chairs, course directors, and faculty to implement innovations in education as the practice of medicine changes. ♦ The dean and associate dean provide guidance to the Curriculum Committee (CC), the Committee on Student Evaluation and Promotion (COSEP), and the Committee on Educational Appraisal (CEA). ♦ The CEA evaluates all courses yearly. ♦ Each of these committees has elected faculty and student members. ♦ The CC recommends modifications of the curriculum based on proposals from faculty and students, survey results, and evaluations by the CEA. ♦ All curricular changes are approved by the CC prior to implementation. ♦ The newly appointed acting dean of the college is also the senior vice president of medical affairs at Rush—Presbyterian—St. Luke's Medical Center (RPSLMC). This dual oversight strengthens the cooperation between the medical college and the medical center. ♦ The associate dean for MSP works with the other associate deans of the medical, surgical, and basic science departments and of the graduate medical education and continuing medical education programs. ♦ The dean and executive dean provide resources to departmental chairmen for the education program. ♦ The Office of Medical Student Programs (OMSP) was established in 1978 to support the educational program. ♦ The associate dean for MSP with the assistance of four appointed assistant deans oversees management of day-to-day activities in the clinical and preclinical disciplines and ensures that educational standards are met for internal and external reviews. ♦ The associate dean also oversees the college's admission office, the resident match, medical student minority affairs, and specialized programs that include the academic skills and tutoring program and the adviser program. ♦ The positions of assistant dean for minority affairs and director of specialized student services were recently added. ♦ An additional area of oversight is the OMSP centralized medical student database, supported by an on-site computer consultant. This database captures the demographic and undergraduate academic data for matriculating students, medical student performance data, and residency selection choices. This database is a useful resource for clinical and basic science faculty for research in medical education. It recently tracked the choices of primary care specialties of graduating seniors as influenced by their participation in community-service activities. This database provides quick and accurate retrieval of student academic records needed for internal review committees associated with oversight of the educational programs. Office of Education ♦ Since Rush Medical College has no institutional office of medical education, the de facto support of the educational program rests in the Office of MSP and the dean's office. ♦ In response to the 1997 LCME survey, a Task Force on Faculty Development in Teaching (1998-1999) was convened. ♦ Task force recommendations, including the creation of an Office of Medical Education, are being considered at the senior vice president and associate dean's level for institutional implementation. Budget to Support Educational Programs ♦ The executive dean's budget supports the operational needs of seven professional staff and nine support staff in the Office of MSP. ♦ The budget also pays departments for teaching based on an institutional formula that recognizes faculty contributions for didactic lectures and small-group and problem-based learning experiences. ♦ Teaching contributions are reviewed annually by the dean's office. ♦ The OMSP manages a separate budget for the educational program and administration of the alternative curriculum (AC). The AC program ended in summer 2000. ♦ Program requirements are now being defined in the preclinical years for the development and implementation of a proposed unified curriculum (UC). Valuing Teaching ♦ Department chairs identify recognized teachers to be course directors and teaching faculty and are responsible for balancing their departmental duties with their teaching activities. ♦ Faculty are recognized for teaching excellence through several awards. ♦ Graduating seniors honor outstanding teachers with awards for preclinical, clinical, and best-resident teacher, and a special award designation, the “doctoral hooder” at the graduation ceremony. ♦ The Mark H. Lepper, MD, Society of Teachers of the college elects faculty members yearly to this society for teaching excellence by reviewing faculty and student nominations. ♦ The Rush Chapter of AOA now recognizes the best Resident Teacher of the Quarter and the best Volunteer Faculty. ♦ In April 1999, a Task Force for Faculty Development as Teachers recommended institutional-level recognition of teachers, the development of courses in teaching for faculty, residents, and senior students, and the development of a mentoring program. These proposals are under review for implementation. CURRICULUM RENEWAL PROCESS Learning Outcomes ♦ Course directors (preclinical and clinical) define learning objectives for specific courses. ♦ The associate dean for MSP, the CC, and the CEA review learning outcomes for existing courses with course directors. ♦ The identification and use of outcome measures in specific preclinical and clinical courses is unevenly implemented. ♦ The UC planning task forces will standardize this process during curricular renewal, incorporating the school-defined institution-specific objectives of the medical college experience that the successful student must demonstrate prior to graduation. ♦ Outcome measures at the institutional level are being defined. ♦ Currently, learning outcomes are measured in clinical clerkships using National Board of Medical Examiners (NBME) mini-boards. In addition to faculty and resident evaluations, all second-year students must pass the USMLE Step 1 prior to progressing to the clinical clerkships and all students must take the USMLE Step 2 prior to graduation. Changes in Pedagogy ♦ The parallel alternative curriculum track was offered to entering students from 1984 until 1998. ♦ Only the traditional curriculum (TC) track will be offered during the curricular renewal process. ♦ There has been an increase in small-group learning experiences using problem-based learning (PBL) cases to introduce basic science concepts within the TC. ♦ The college reported the results of a comprehensive survey of graduates (1974-1989) about the adequacy of their medical school experience to prepare them for the practice of medicine. ♦ Use of standardized patients began in 1996 within the interviewing and communication course and was also found in the Consortium examination (1996-1999). ♦ The changes in the practice of medicine and the increase in the use of small-group experiences in the TC prompted the recent curricular renewal effort (May 1998). Examples of changes during the last decade are briefly reviewed. ♦ Alternative curriculum track (AC): 1984-2000 In 1984, the college began a parallel track to the preclinical TC in order to teach basic science content using a Socratic, problem-based method. This AC track enrolled approximately 24 volunteers from a class of 120 entrants. These students met twice weekly in small groups (six students per group). Facilitators trained in the case-based PBL approach encouraged student groups to solve problems through hypothetico-deductive reasoning. Early implementation of this innovative track made Rush one of five medical schools to adopt this approach within the preclinical years (with Bowman Gray, Michigan State, New Mexico, and Southern Illinois; three of the schools had instituted similar tracks prior to Rush). In 1986, an Evaluation Advisory Committee composed of basic science and clinical department chairs compared the efficacies of retention of scientific knowledge by the individual cohorts of AC and TC students during their clinical clerkships. Areas evaluated were personal responsibility for learning, clinical problem solving, doctor—patient relationships, inter-personal skills, faculty satisfaction, student psychological well-being, cost effectiveness, evaluation of program implementation, diffusion of ideas from the AC to the TC, and comparisons of scores on the NBME Part II. The committee's report in 1990 recommended expansion of problem-based learning into the clinical years, as well as more teaching exposure in ethics, community medicine, and preventive medicine. It also endorsed the development of more computer-assisted problem-solving exercises. An evaluation of outcomes between the AC and the TC tracks, published in 1991, compared NMBE Part I and NBME Part II scores and scores on an oral exam. The AC track ended in the spring quarter of 2000. ♦ Traditional curriculum (TC): 1991—present In response to a 1991 LCME survey, a Pre-clinical Task Force addressed the didactic and lecture burdens in the TC and in the basic science curriculum. It evaluated opportunities for increased academic interactions between the two tracks such as sharing of course content and faculty. In response, some TC basic science course directors (physiology, neuroscience, and immunomicrobiology) increased the number of small-group workshops in traditional and computer-assisted laboratory sessions. Over the last five years, preclinical small-group learning experiences increased in the ethics, behavioral science, microbiology, pathophysiology, and interviewing and communication courses. The task force also developed strategies for curricular innovation in biomedical ethics, nutrition, geriatrics, cell and molecular biology, embryology, and medical informatics. Preclinical course directors also identified areas of redundancy in content. The UC task forces (see below) are incorporating these recommendations into the curriculum renewal process. ♦ Generalist curriculum preceptor program (GCPP): 1992—present Planning for this required two-year preclinical program began in 1992, with implementation in 1996. This program provides students with first-hand experience in ambulatory primary care practice. Community physician—preceptors act as role models to nurture student interest in primary care. Concurrent curricular restructuring involved the teaching of basic interviewing and physical diagnosis skills to both first-year and second-year students using classical didactic and workshop formats. These courses develop skills to improve a student's level of understanding and participation during preceptorship sessions. The program allows better integration of basic science course work with a “hands-on” clinical experience. Standardized patients are used in both years of the Interviewing and Communication course. During the same time period, the Primary Care Task Force defined strategies and the resources needed to increasingly move to a generalist ambulatory setting in pediatrics, internal medicine, and family medicine. An important recommendation in their 1997 report was to enhance and preserve the GCPP during the preclinical years. A complementary clinical experience for student volunteers is the Rush Community Service Initiatives Program (RCSIP). This grant-funded program reinforces the GCPP by allowing interested students, accompanying faculty volunteers working in interdisciplinary settings, to participate at community health clinics and homeless shelters. This program, formalized in 1991, reinforces those behaviors and values medical students need to further enrich their medical school experience. ♦ Unified curriculum (UC): Under development The Curriculum Renewal Committee (CRC) was activated in May 1998 and included clinical and basic science course directors and department chairs. The themes for curricular change include a patient-centered curriculum based on a demonstration of competency; integration of clinical and basic sciences in the preclinical years; the use of teaching methods to encourage self-directed learning; the expansion of the generalist approach that stresses ambulatory care, continuity of care, preventive medicine, and evidence/ outcome-based medicine; a decrease in the number of didactic content hours; and an increase in the number of small-group, interactive experiences. The curricular renewal process intends to incorporate the best features of the AC and the TC in the preclinical years. The objectives of the UC include (a) an integrated organ-system approach to the basic sciences developed by basic science and clinical faculty, (b) an increased number of small-group, active-learning experiences for all students, (c) a reduction of student contact hours, and (d) integrated PBL sessions. In the fall of 1999, the first-year planning and PBL task forces submitted their proposals for CC review. The CC in January 2000 approved timelines to review the first-year proposals for content, educational soundness, and administrative support. ♦ An institution- and department-level review process is now evaluating the teaching demands of the proposal and the resources needed for implementation. The year two planning task force was identified. Application of Computer Technology ♦ Students are not required to have computers. ♦ Course directors, who are early innovators, include computer technology applications in their courses. ♦ Rush University, under oversight of the Rush University Library, opened the McCormick Educational Technology Center in 1997. This center supports independent study and self-enrichment through the use of audiovisual and computer hardware and software. There is a 40-workstation computer classroom with 45 computers available 24 hours a day in addition to electronically connected small-group rooms and nine multimedia classrooms. ♦ In 1998, the medical center created a Center for Advanced Technology and International Health to promote the use of information technology in education, research, and health care delivery. ♦ The medical center recently designated a Section of Medical Informatics to promote the clinical use of information technology among affiliated institutions. ♦ All first- and second-year medical students were surveyed in 1999 to assess current computer skills and to identify their future educational needs. ♦ Specific courses using computer technology are physiology, histology, pathology, immunomicrobiology, and neurobiology. ♦ In neurobiology, students use computers in problem-based exercises, make PowerPoint presentations, do library and Internet searches, use CD-ROM programs for independent study, and use computer cases as surrogate facilitators. In the same course, students use an interactive Image-browser Atlas, use “Slice of Brain” videodisks, and participate in a “boards-style” testing module and on-line testing. ♦ Neurobiology course directors are pilot testing computer-facilitated case studies for Medical Student Grand Rounds. ♦ A graduate-level Rush University course in medical ethics is offered on the Web. Changes in Assessment ♦ The Chicago Clinical Skills Consortium Examination was given to all spring-quarter second-year GCPP students from 1997 to 1999, using standardized patients to assess their competency in taking a history and doing a physical examination. ♦ In the preclinical years, the basis for student assessment is the written and practical examination; in the clinical years, both objective examinations and faculty observation are used. ♦ The use of computers and the use of standardized patients are described above. Clinical Experiences ♦ In addition to the GCPP and RCSIP previously described, nine required clerkships (medicine, surgery, pediatrics, obstetrics—gynecology, psychiatry, family medicine, surgical selectives [subspecialties], neurology, and a subinternship provide clinical experience. ♦ The clerkships provide inpatient and ambulatory rotations at the Rush—Presbyterian—St. Luke's Medical Center, Cook County Hospital, and Illinois Masonic Medical Center (currently being phased out). ♦ Eighteen additional weeks of elective courses must also be completed. ♦ The Dean's Summer Fellowships, through partial funding, provide an additional clinical opportunity for first-year students to work under direct supervision of staff in community service, primary care, and international health projects. Curriculum Review Process ♦ An important challenge to develop and implement the UC relates to an institutional commitment to adequately fund the administrative infrastructure and to provide operating funds to support educational goals and to measure outcomes of the educational process. ♦ Of equal concern is the limitation of faculty time to develop the new curriculum while teaching current courses. ♦ Provisions must be made to accommodate increases in small-group learning sessions and support the teaching faculty as they balance research and clinical-practice priorities. ♦ Department chairmen are discussing the increased teaching demands in the face of institution-wide budget reductions and the pressure to obtain more externally funded research grants. ♦ An educational researcher and computer program consultant will collaborate with the planning task forces during the developmental stages of the UC. The elements of program design and content will be incorporated into the existing MSP database. For example, it is expected that courses, modules, and discipline grading, as well as outcome measures for the preclinical program, will be defined and tracked using this database. ♦ The CEA is evaluating a proposal to incorporate a quality-improvement process in course reviews. This is expected to decrease the turnaround time for CEA review, provide more timely reports for course directors to make improvements in course content or presentation, and develop a more standardized format to be used for on-line evaluations. ♦ The CC is discussing a proposal to adopt the problem-oriented-system (POS) approach to train medical students in PBL cases beginning in the first year. The POS approach may lend itself to a more objective evaluation of student knowledge. ♦ The unified curriculum (UC) proposals are undergoing extensive review at this time. You may obtain further information about the UC via e-mail to 〈[email protected]〉. (Joan T. Zajtchuk, MD, Specialist in MSA, associate dean, Medical Student Programs, Rush Medical College.)