Texas A&M University College of Medicine.

Abstract

Medical Education Program Highlights Since 2010 and its subsequent 2012 LCME accreditation review, Texas A&M University College of Medicine (TAMU-COM) continues to strive for excellence in rural and population health, military medicine, and innovation. Institutional restructuring and growth: 2011: The Dallas campus opened and is currently the largest regional clinical campus. 2013: The Texas A&M Health Science Center, including TAMU-COM, moved under TAMU administratively and functionally. Notably, TAMU is 1 of only 17 institutions in the nation to hold the triple designation of a land-grant, sea-grant, and space-grant university. 2014: The Houston campus was established, bringing the regional campus number throughout Texas to 5. 2016: The Texas A&M Health Office of Interprofessional Education and Research was established to create and sustain a culture of collaborative learning among the health care professions of the Health Science Center. 2017: TAMU-COM partnered with Darnall Army Medical Center to expand military medicine education opportunities. 2018: TAMU-COM partnered with the U.S. Air Force to establish the Air Force’s 59th Medical Wing as a clinical training site for medical students. Curriculum development and implementation: 2013: The A&M integrated medicine (AIM) track inaugural cohort began on the Bryan-College Station campus. This was the first longitudinal integrated clerkship program in Texas. 2015: The medical education program shifted to a shortened 18-month preclerkship curriculum and an expanded 30-month clinical curriculum. 2017: The health systems science (HSS) track inaugural cohort began on the Round Rock campus. 2017: The Practice of Medicine course series began and now spans all 4 years. In addition to clinical skills training, the courses provide important training in humanities, ethics, altruism, and leadership. 2019: The engineering medicine (EnMed) track inaugural class began on the Houston campus, becoming the nation’s first fully integrated engineering and medical education curriculum, allowing graduates to receive both the MD degree and a master’s in engineering in 4 years. Curriculum Curriculum description TAMU-COM has a traditional curriculum and 3 tracks. This curriculum spans 18 months of preclerkship and 30 months of clerkship and electives. The traditional curriculum uses a primarily lecture-based preclerkship approach and a block model clerkship. See Supplemental Digital Appendix 1—Curriculum Model—at https://links.lww.com/ACADMED/A907. Curriculum changes since 2010 Preclerkship period was redesigned to 18 months, creating expanded elective opportunities in all 4 years, including a period of career exploration during the third year Increased utilization of nonlecture-based learning experiences, including faculty-facilitated small groups, simulation, online learning modules, and case-based (traditional curriculum) and team-based learning platforms (EnMed) Inclusion of earlier clinical training experiences, for example, the first week of medical school is now devoted to training in taking a basic medical history and measuring vital signs; clinical correlations are highlighted in learning experiences, such as case synthesis and integrations exercises during preclerkship organ-system courses Improved horizontal and vertical curricular integration of key curricular content, including clinical skills training, medical ethics, societal problems, communication, and interprofessional education Evolving interprofessional education curriculum, including Disaster Day, the nation’s largest student-led interprofessional emergency response simulation Established the Medical Student Research Scholars Program supported by the Office of Medical Student Research With the addition of the Dallas and Houston campuses, increased capacity to accommodate up to 200 students per year; availability of 5 campuses allows TAMU-COM to offer full preclerkship curriculum on 2 campuses, partial on 2, and 3 parallel curricular tracks Assessment Medical education program objectives are described in outcome-based terms, allowing the assessment of medical students’ progress in developing the competencies the profession and the public expect of a physician. (2020–2021 LCME Standard 6.1 or 2020–2021 CACMS Standards 6.1). Texas A&M COM does not use a single framework; rather, the program objectives are organized into knowledge-based (K) and skill-based (S) areas, as well as attitudes and behaviors (AB). Each objective is mapped to ACGME competencies and Core EPAs. Attitude and behavior objectives reflect the Aggie core values of respect, excellence, leadership, loyalty, integrity, and selfless service. See Supplemental Digital Appendix 2—Program Objectives and Assessment Methods—at https://links.lww.com/ACADMED/A907. Assessment changes since 2010 There is an increased reliance on objective structured clinical examinations for both formative clerkship and summative clinical skills assessment. Physical Examination Teaching Assistant skill competencies were added, as well as increased use of small-group facilitator assessment, implementation of NBME customized examinations, and introduction of a value-based portfolio system for assessment of attitudes and behaviors. Parallel curriculum or tracks A&M AIM: The integrated medicine track is designed to provide students with a longitudinal patient experience and integrated clerkship content. This track focuses on longitudinal patient care and 1-on-1 relationships with faculty preceptors. Students learn to manage patients in multiple disciplines during the track. There are no additional medical education program objectives for this track. HSS: The HSS track is designed to produce students with enhanced skills for navigating and leading in an evolving U.S. health care system. This track emphasizes the intersection of science and health care delivery, where systems thinking, innovation, and evaluation can improve the quality, safety, and value of health care. In 2020, TAMU-COM will expand the HSS track from a single campus to multiple regional campuses as a part of planned future integration into the traditional curriculum. EnMed: The EnMed track is designed to incorporate engineering and medicine within 1 track. Students enter the track with an undergraduate degree in engineering and expand on these skills while completing their medical degree. EnMed focuses on knowledge, skills, and experience to develop new therapies, devices, algorithms, and diagnostic or treatment processes. The track includes concurrent curricula, resulting in 2 degrees: MD and Master of Engineering (MEng). Students have dual enrollment in both TAMU-COM and TAMU College of Engineering. EnMed’s goal is to produce a new kind of doctor, the “physicianeer,” who is capable of transforming health care through innovation. Three-year MD degree programs: At this time, Texas A&M does not offer a 3-year MD degree program, nor is one planned for the future. Pedagogy The following pedagogical approaches are used throughout the curriculum: case-based learning, clinical experiences (ambulatory and inpatient), discussion (large and small group), laboratory, lecture, preceptorship, self-directed learning, simulation, standardized patients, team-based learning, and video/podcast. AIM track: Clerkship objectives are achieved primarily through longitudinal clinical experiences in each core specialty. Other modalities include small-group discussion, lectures, self-directed learning, and simulation. HSS track: Track objectives are achieved through core curricular courses, electives, and a capstone course. The foundation course is primarily interactive with limited didactics. For students in clerkships, courses are small groups and case-based discussions. Electives are self-directed learning projects with faculty mentors. The capstone course is a multisemester, longitudinal project with a faculty mentor. Additional modalities include online modules, videos, and journal readings. EnMed track: Preclerkship learning objectives are achieved primarily through team-based learning with integrated engineering content. Clerkships are completed as traditional block clinical experiences. The bulk of the 30-credit-hour engineering degree is achieved through a prematriculation course (discussions, laboratory) and during the elective time, which is used to complete a capstone design and innovation project. Changes in pedagogical approaches: Increased active learning modalities, including large- and small-group discussion, case-based learning, and clinical and basic science integration experiences Specific course for all students to teach self-directed learning skills, with additional self-directed learning integrated into courses A fourth-year capstone course that integrates several active learning modalities to ensure residency readiness A longitudinal clerkship track that was implemented, as well as team-based learning (primarily in the EnMed track) Clinical experiences Wide geographic distribution of the 5 regional campuses across Texas provides opportunity for students to gain clinical experience across the full spectrum of clinical care from rural to specialty care. One or more major health care affiliates at each site provide inpatient experience with exposure to residents and fellows. Required longitudinal experiences Bryan-College Station regional campus offers students a longitudinal clerkship curriculum. Clinical experience first encounter Nonsimulated clinical experiences for students begin in the third semester, preclerkship, as a preceptorship and are completed at a variety of community-based clinics. Required and elective community-based rotations TAMU-COM does not have its own teaching hospital; thus, it relies on a variety of clinical affiliates to provide community-based rotations across regional campuses. These experiences are supplemented by strong relationships with both military and VA medical centers, which provide partial clerkship experiences and electives. Challenges in designing and implementing clinical experiences for medical students There are 2 major challenges to the design and implementation of clinical experiences: Maintenance of comparable learning experiences within a complex multicampus and multitrack model Regional competition for clinical experiences due to a growing number of medical schools in the state; areas of particular need are inpatient pediatrics and inpatient psychiatry Curricular Governance The Curriculum Committee (CC) governs the curriculum, sets educational policy, and provides direction. 5 standing subcommittees report to the CC: Preclerkship, Clinical, Elective, Interprofessional Education, and Student. The CC also receives reports from task forces assigned to address specific issues. The executive dean for education and academic programs provides management support for the curriculum through the Office of Medical Education (OME). Budget for teaching, assessment, and academic support is managed centrally. See Table 1—Curriculum Governance and Management.Table 1: Curriculum Governance and ManagementEducation Staff Medical education leadership The OME leads and supports all aspects of the medical education process at TAMU-COM. The primary medical education staff and administrative faculty are housed under the OME organization umbrella. Administrative and academic support for curriculum oversight, delivery, monitoring, and management is achieved primarily through the offices of Academic Affairs and Evaluation and Assessment. See Figure 1—Office of Medical Education.Figure 1: Office of Medical Education.Department of Medical Education The Department of Medical Education (DME) serves as the centralized source for development and promotion of faculty medical educators through professional mentoring, career development, and collaborative scholarly research opportunities. The mission of the department is to promote and nurture those key faculty dedicated to the improvement and advancement of both undergraduate and graduate medical education. The DME is home to the medical college’s volunteer faculty and faculty with primarily administrative roles. The organizational structure was designed to support faculty at the 5 campuses and 4 teaching sites. The DME is led by a department head with assistance from an associate department head. The associate campus deans and associate site deans serve as divisional team leads. Faculty Development and Support in Education The Office of Faculty Development provides the primary support for teaching faculty. A variety of live and web-based resources supporting instructional methodology, student assessment, and curriculum development are delivered to faculty across all campuses and sites. The office also delivers a Medical Educator Program certificate focused on developing learning objectives and linking those objectives to formative and summative assessments as well as the appropriate teaching methods to assist students in meeting those objectives. Individual faculty development is available through an instructional consultation program. Role of teaching in promotion and tenure Both annual faculty reviews and promotion/tenure decisions include consideration of educational activities such as educational scholarship, quantity and quality of teaching, and service on curricular-related committees. Teaching academy The Academy of Distinguished Medical Educators (ADME) includes faculty members who have demonstrated excellence in teaching and scholarship throughout their career. The ADME is committed to promoting excellence in medical education by: Supporting teaching excellence through coaching and mentorship Developing and delivering faculty development workshops Advancing curriculum and instruction through promoting innovative practices Facilitating educational research and scholarship Regional Medical Campuses See Table 2—Regional Clinical Campuses.Table 2: Regional Clinical CampusesEducational experiences across sites Comparable learning experiences across the regional campuses are ensured through: Identical program learning objectives for required clinical experiences, including patient encounters and procedure logs Clear organizational reporting lines for faculty course leadership and course coordinators Executive clerkship director position with oversight over all teaching sites Centrally monitored student feedback, inpatient/outpatient proportions, use of alternate learning experiences, timeliness of grades, and duty hours Equitable assessment of students across the regional campuses is ensured through: Identical written assessment Standardized objective structured clinical examination Centrally monitored campus performance metrics