Temple University School of Medicine

Abstract

Curriculum Management and Governance Structure ♦ The curriculum committee is a standing committee of the School of Medicine, whose membership includes 13 faculty (including basic science and clinical faculty, 3 representatives from our academic affiliates, and the chairperson), 4 students (1 from each class), and the associate deans responsible for the curriculum (Figure 1).FIGURE 1:: Curriculum Management and Governance Structure♦ Duties of the curriculum committee include: establishing and updating the curricular competencies and monitoring where students learn, practice, and are evaluated on the competencies reviewing and evaluating the design, quality, and effectiveness of the curriculum and assigning responsibility for curricular content areas to appropriate faculty reporting its findings and recommending modifications, as needed, to the dean, dean's advisory committee, and medical faculty senate informing the students and faculty about the curriculum and interpreting the curriculum ♦ The recommendations of the curriculum committee must be addressed by the dean in a timely manner. ♦ Two subcommittees, one consisting of Year 1 and 2 block directors and the other of Year 3 and 4 clerkship directors, are responsible for ensuring that the curriculum meets the school competencies and that appropriate integration is maintained among the basic science disciplines and between the basic science and clinical disciplines. Office of Education ♦ The Office of Medical Education (OME) consists of senior associate (0.75 FTE) and assistant (0.25 FTE) deans for education, associate (0.25 FTE) and assistant (1 FTE) deans for clinical affiliates, a director (1 FTE) of curriculum, faculty directors (0.25 FTE and 0.2 FTE) of clinical simulation, 2 full-time simulation support staff, and 10 curricular support staff. An assistant dean (0.2 FTE) for faculty development and an assistant dean (0.2 FTE) for affiliate faculty development functionally support the OME. ♦ The responsibilities of the office include management of the curriculum; initiation of the curriculum review processes; implementation of curriculum revisions; coordination of faculty development in education; and coordination of use of simulations and standardized patients in the curriculum. Financial Management of Educational Programs ♦ The dean meets regularly with his senior staff to ensure that the school has the necessary resources (in faculty, facilities, equipment, and support staff) essential to the school's missions of education, research, and clinical care. ♦ Sources of contributions to the clinical and educational missions of the school have remained stable. Valuing Teaching ♦ In November 2008, the school established the Temple Institute for Medical Education (TIME) to provide leadership in the medical school's efforts for excellence in the educational programs through faculty development, mentoring of new faculty, training of students and residents as teachers, innovations and research in medical education, and recognition of faculty for excellence in medical education. ♦ The school has developed performance matrices for all basic science and clinical faculty that serve as a management tool to monitor and evaluate the quality and quantity of faculty contributions to the school's missions of education, research, and service. The matrices are used in guiding annual faculty activities and compensation and are used in tenure and promotional decisions. ♦ Evaluations by students, residents, and peers of individual faculty contributions to education are also used in faculty management and in the tenure and promotion process. ♦ The school's mission-based management system ensures the availability of clinical faculty to staff our Doctoring courses. ♦ The school is developing a formal prototypic teaching portfolio for implementation in the fall 2010. Curriculum Renewal Process ♦ A curriculum renewal process was initiated in September 2003. ♦ The key objectives for the curriculum renewal were to review the medical school objectives in developing a competency-based curriculum better integrate basic science knowledge with clinical medicine better integrate the basic sciences provide earlier exposure to clinical medicine emphasize professional attitudes and behaviors throughout the curriculum develop learning objectives and educational strategies to meet the competencies enhance the use of case-based and other interactive learning methodologies evaluate methods for assessing student performance and program effectiveness provide appropriate faculty development for educational initiatives ♦ The curriculum renewal process is outlined below: September 2003: dean charged basic science and clinical task forces with establishing goals and objectives February 2004: task forces submitted draft reports to the dean Spring 2004: task forces presented recommendations at faculty forums June 2004: a curriculum retreat was held for faculty and student representatives July 2004: medical school recommendations were completed and submitted to the provost August 2005: the new curriculum was introduced to incoming first-year students, with one additional year of the new curriculum introduced annually until it was completely in place in 2008-09 (Chart 1)CHART 1: The CurriculumJune 2005-10: annual retreats held to review progress of the new curriculum and introduce any necessary modifications Learning Outcomes/Competencies ♦ The school has developed overall curricular competencies, last modified in June 2008, that are used as a framework upon which to establish curricular objectives. ♦ The competencies are based broadly upon the six ACGME competencies, reflecting the continuum in medical education: Knowledge, Patient Care, Interpersonal and Communication Skills, Professionalism, Practice-Based Learning and Improvement, and Systems-Based Practice. ♦ Each course and clerkship has developed specific competencies and an evaluation plan based on the school's overall competencies. New Topics in the Curriculum Since 2000 ♦ Doctoring courses in Years 1 and 2: to teach basic history-taking and physical examination skills, medical ethics, and professionalism in a community learning environment ♦ Doctoring courses in Years 3 and 4: to teach evidence-based medicine, use of medical literature in clinical decision making, and professionalism ♦ Enhanced academic and career advising through the Doctoring courses ♦ Case-based learning in all blocks of the first biennium to enhance integration and team learning ♦ Clinical simulations in Doctoring 1 and 2, to teach clinical techniques and to enhance integration of basic science and clinical medicine ♦ Clinical simulations in clerkships, to reinforce clinical skills and emphasize a team-based approach in the care of patients and to enhance patient safety ♦ Use of standardized patients for the teaching and evaluation of clinical skills throughout the curriculum Changes in Pedagogy ♦ Reduction in the total number of lecture hours in the first biennium ♦ Increased use of case-based learning in basic science blocks ♦ Team-based learning in basic science blocks, piloted in Spring 2010 ♦ Increased use of standardized patients for teaching and assessment of clinical skills, including interviewing, physical examination skills, and professionalism ♦ Use of online learning in Doctoring 3 and 4, to teach/evaluate evidence-based medicine Changes in Assessment Curricular initiatives, based on the curriculum renewal process, have included ♦ expanded use of standardized patients ♦ addition of end-of-year summative clinical skills examinations in Years 1–3 ♦ use of computerized NBME blueprinted examinations ♦ use of computerized internal examinations beginning in August 2010 ♦ electronic monitoring of clinical procedures and patient encounters with ongoing faculty review ♦ required pass score in all clerkship NBME subject examinations Clinical Experiences ♦ Years 1 and 2: preceptorships in hospital and community physicians' offices and inpatient hospital services ♦ Years 3 and 4: inpatient experiences in a university hospital, academic community hospitals, and academic medical centers in urban and rural communities; outpatient experiences in physicians' offices and hospital-based clinics ♦ Challenges include ensuring comparability of clinical experiences across sites ensuring comparability of student evaluations across clinical sites faculty development in education at clinical affiliates ♦ Outcomes include: equivalent performance in outcomes measures (USMLE Step 2CK and 2CS; end-of-third-year Clinical Skills Assessment; subject examination performance) across clinical sites increasing student selection of residency programs at clinical campuses Regional Campuses ♦ The school has three clinical campuses, at which a specified number of students (16 at 2 of the campuses and 24 at the third) take all required clinical clerkships of the third and fourth years. Beginning in August 2011, one the campuses will be expanded to a regional campus at which 30 students will study at the campus for curricular years 2–4. ♦ The students are accepted to a specific clinical campus during the admissions process. ♦ The students are placed in campus-specific Doctoring course communities for Years 1 and 2 to form a cohesive group and to meet faculty from those campuses, who participate in the Doctoring courses. ♦ Nonclinical campus students may take individual clinical clerkships at the clinical campuses, selected through a lottery system. Highlights of the Program/School ♦ Strong commitment of the faculty and students to community service and school's mission of giving to and caring for the underserved community. ♦ Strong student-faculty and student-administration relationships. ♦ Excellence in clinical training throughout the curriculum. ♦ New state-of-the-art medical education building, with a new simulation and skills center.