The Progress of Medical Education

Medical Student Education

Council on Medical Student Education in Pediatrics

A healthy lifestyle is fundamental for the prevention and treatment of cardiovascular disease and other noncommunicable diseases (NCDs). Investment in primary prevention, including modification of health risk behaviors, could result in a 4-fold improvement in health outcomes compared with secondary prevention based on pharmacological treatment. The American Heart Association (AHA) emphasized the importance of lifestyle in its 2020 goals for cardiovascular health promotion and disease reduction. In addition to defining “cardiovascular health” based on criteria for blood pressure and biochemical markers (lipids and glycemia), the AHA Strategic Planning Committee further identified lifestyle characteristics of central importance: nutrition, physical activity, smoking, and maintenance of a healthy body weight.1 The World Health Organization estimated that ≈80% of NCDs could be prevented if 4 key lifestyle practices were followed: a healthy diet, being physically active, avoidance of tobacco, and alcohol intake in moderation.2 To support healthy lifestyle initiatives, major changes are necessary at the societal level to improve population health. Numerous strategies might help to create a culture that promotes and facilitates healthy behaviors, including creating laws and regulations, mounting large-scale public awareness and education campaigns, implementing local community programs, and providing individual counseling.3 Physicians are uniquely positioned to encourage individuals to adopt healthy lifestyle behaviors: Approximately 80% of Americans visit their primary care physician at least once a year. Physicians directly communicate with their patients during clinical encounters across numerous settings, and research indicates that patients highly value recommendations provided by their physicians.4,5 However, data further indicate that lifestyle counseling does not routinely occur in physicians’ offices, thereby representing a lost opportunity. Physicians report that they perform lifestyle counseling during ≈34% of clinic visits.4 Patients, in turn, report an even lower frequency of physician lifestyle counseling. For example, obese patients reported receiving physical activity and …

Educationists are professionals who develop and design educational policies and conduct research on different aspects of education. Some of them also teach ‘Education’ as a subject. Education is being more streamlined and accepted as a separate entity in medical education, with more and more doctors opting for courses in medical education such as certificates, diplomas and masters in medical education (Tekian, Roberts, Batty, Cook, & Norcini, 2014). Hence, a discussion often ensues regarding the definition of medical educationists, educators, and teachers. Literature does not discriminate clearly between these three terms. In this editorial, I will share my perspective on these terminologies based on my experience and supportive evidence from the literature. A clinician needs a license to practice, so it is unfair to consider a doctor as a teacher by default, without a license to teach. Hence, to be considered a medical teacher, a prerequisite of obtaining a certificate, diploma, or masters in medical education should be fulfilled. At the least, courses or workshops in different aspects of medical education should be completed by the doctors. Regarding medical education, faculty in medical and dental colleges in Pakistan can be divided into three categories: (1) Doctors with basic medical education (MBBS or BDS) and a postgraduate degree in medical education (e.g. MHPE or MME, etc). These professionals are usually concerned with medical education as a discipline and work in the department of medical education (DME) and can be called ‘Medical Educationists’. (2) Doctors with a post-graduate degrees in their primary discipline (such as Physiology or Surgery etc ) but an additional post-graduate degree in medical education. These professionals teach their primary disciplines but at the same time work actively with DME in a collaborative or leadership role. They can be considered as ‘Medical Educators’. (3) The third type of faculty confines them to teaching their own subjects who can be considered as ‘Medical Teachers’. They either have a license to teach (CHPE, Diploma or Masters) in addition to a postgraduate qualification in their own discipline or have learned the art and craft of teaching through experience and self-training. However, in this day and age when teaching is no more delivery of knowledge (Harden & Crosby, 2000), it is difficult to be a medical teacher without a formal degree and training in teaching. All these professionals define and shape the structure and role of medical education departments or units. In Pakistan, where medical education departments are still in infancy in the majority of the medical schools, it is important to understand how these departments should be run (Batool, Raza, & Khan, 2018; Davis, Karunathilake, & Harden, 2005). Department of medical education may be headed by either a medical educationist or medical educator, but the gist is that they should have a basic degree in medical education. In the author’s experience, it is better to have all three types of professionals in the DME or related to it. Each has its own benefit. The medical educationist is focused on administrative and research areas related to educationists, the medical educator can act as a bridge between DME and other disciplines, and the medical teacher is the brace of DME, ensuring the implementation of the educational program. Successful collaboration between these three types of professionals is important for the effective implementation of the curriculum. The nomenclature of medical educationists, educators, and teachers do not have strict boundaries and are being interchangeably used in practice. It would be interesting to define them empirically and describe the roles and responsibilities for each one of them separately.
 --------------------------------------------------------------------------
 References
 Batool, S., Raza, M. A., & Khan, R. A. (2018). Roles of medical
 education department: What are expectations of the faculty?
 Pakistan Journal of Medical Sciences, 34(4). https://doi.
 org/10.12669/pjms.344.14609
 Davis, M. H., Karunathilake, I., & Harden, R. M. (2005).
 AMEE Education Guide no. 28: the development and role of
 departments of medical education. Medical Teacher, 27(8), 665–
 675. https://doi.org/10.1080/01421590500398788
 Harden, R. M., & Crosby, J. O. Y. (2000). AMEE Guide No
 20 : The good teacher is more than a lecturer - the twelve roles
 of the teacher. Medical Teacher, 22(4), 334–347. https://doi.
 org/10.1080/014215900409429
 Tekian, A., Roberts, T., Batty, H. P., Cook, D. a, & Norcini, J.
 (2014). Preparing leaders in health professions education.
 Medical Teacher, 36(3), 269–271. https://doi.org/10.3109/01421
 59X.2013.849332

The authors present an overview of the educational programs, infrastructure to support them, and the assessment strategies of 128 medical schools in the United States and Canada, based on reports submitted by those schools and published in this supplement to Academic Medicine. The authors explore many important changes that have occurred since the publication of the Flexner Report in 1910 as well as the progress that is evident since a similar collection of medical school reports was published in September 2000, also as a supplement to Academic Medicine. Drawing on the reports, the authors summarize, among other topics, the advances that have taken place in the support for faculty, the funding of medical student education, changes in pedagogy and assessment, and the expansion of medical education to distributed models and regional campuses.The authors observe that the reports from the 128 schools illustrate that medical student education has undergone and continues to undergo substantive change, has advanced markedly since the reforms stimulated by the Flexner Report, and has continued to evolve during the past decade. The reports illustrate the strength of support for the educational programs, even in a time of financial constraints, and the increasing recognition of the scholarly contributions of faculty through teaching. The authors provide examples of the changes in pedagogy and new topics in the required curriculum in the past decade and describe selected highlights of the 128 educational programs.

Medical Student Education in Ophthalmology: Crisis and Opportunity

University of Missouri School of Medicine in Columbia

Curriculum Management and Governance Structure ♦ The Medical Educational Committee (MEC), comprising faculty, student, administrative ex officio members, and support staff, governs the undergraduate medical education program. Faculty members are appointed by the Dean. Student members are elected by their classmates (see Figure 1).FIGURE 1:: Curriculum Management and Governance♦ The MEC has primary responsibility for overall curriculum design course and clerkship oversight monitoring program implementation assessment of students, faculty evaluation of programs ♦ Since 1994, a vice chair is selected every two years, and the final selection alternates between a basic and clinical science faculty member. The vice chair serves for two years, advances to chair, and is past chair for two years. The senior leadership commitment for the Medical Educational Committee totals six years. ♦ There are four working subcommittees of the Medical Education Committee: Assessment Subcommittee Preclinical Subcommittee (responsible for years 1 and 2) Clinical Subcommittee (responsible for years 3 and 4) Special Programs Subcommittee ♦ In addition, the Module Directors Committee and the Clerkship Directors Committee meet regularly to implement programs approved by the MEC, address administrative issues about courses and clerkships, and review grade and student assessment data. Office of Education ♦ In 2008, the Office of Curriculum Development and Management became the Office of Undergraduate Medical Education (UME). ♦ The Senior Associate Dean for Medical Education oversees undergraduate medical education, medical student services, graduate medical education, and continuing medical education. ♦ The UME office is led by the Associate Dean for Undergraduate Medical Education and is composed of eight additional individuals, including three full-time educators (two with doctoral degrees in education) focused on curricular design and assessment and five support personnel focused on the implementation and scheduling of the curriculum. ♦ The UME office is responsible for the cohesiveness and continuity of educational programs on all three campuses. ♦ We encourage UME personnel to serve all academic departments and to share the common goals of undergraduate medical education. ♦ Personnel in the UME office strive to identify specific educational goals, anticipate the resources necessary to accomplish these goals, and then design, implement, and assess novel and existing medical education programs. Financial Management of Educational Programs ♦ Since 1994, a portion of the budget is earmarked for medical student education, including direct funding to departments for their educational efforts and their administrative needs to support medical student education programs. ♦ Funding comes from the Dean's office, utilizing state appropriations and tuition income. ♦ Departmental teaching contributions for all four years of medical school are tracked. ♦ Funds distributed to departments are allocated by the relative effort of each department toward the mission of teaching medical students. Funds used for competitive awards are derived from an endowment generated by the clinical practice plan fund. ♦ Because state appropriations have been prorated over the last several years, two part-time faculty positions in UME were absorbed by UME staff, and one half-time educational consultant was eliminated. ♦ Audio-visual technology support was consolidated into the office of Medical Education Information Support, allowing further economy. Valuing Teaching ♦ The school does not have a schoolwide academy for educators. ♦ During the 1990s, promotion and tenure requirements were modified to reflect the importance of faculty teaching. ♦ Educational excellence is one of the areas in which promotion and tenure may be granted. ♦ Several departments have incorporated teaching portfolios to capture, quantify, and assess the level of teaching for faculty members considered for promotion and/or tenure. ♦ High-quality teaching is part of regular faculty development seminars sponsored by the SOM, through the office of the Senior Associate Dean for Faculty Development, and the university. ♦ Since 1995, the Argus Society (comprising the entire student body) presents awards to deserving faculty, clerkships, courses, and departments at their annual award ceremony. Curriculum Renewal Process ♦ Curriculum renewal began in 2005/2006 to look into the incorporation of an integrated, organ-based curriculum. The project included the following elements: soliciting input from all levels of faculty, students, and staff review of all curriculum objectives, internal examinations, NBME subject examination performance, residency selection/matching, and student evaluations defining a vision, mission, and goals for the curriculum defining a curriculum that would meet the vision, mission, and goals identified ♦ The key objectives for this change to an integrated curriculum were three-fold: to develop a curricular structure in which basic science principles and clinical medicine were presented in an integrated and interdisciplinary format to promote student-centered active learning based on problem solving and development of decision-making skills to emphasize the importance of clinical and scientific investigation. ♦ Upon completion of the first iteration of the new curriculum courses and modules, student evaluation and grading data are presented to the individual module directors as well as to a committee comprising all the preclinical course and module directors. ♦ The Senior Associate Dean for Medical Education, the Associate Dean for Undergraduate Medical Education, and the Associate Dean for Students also review these data and participate in these meetings. ♦ Formal course and module evaluation is performed yearly by the Assessment Subcommittee of the Medical Education Committee. ♦ The purpose of the module review is two-fold: (1) to evaluate compliance with LCME standards, congruence with School of Medicine goals and objectives, and achievement of module objectives; and (2) to provide guidance for module improvement and to evaluate the impact of changes from the previous year, resulting in a continuous quality improvement process. ♦ This evaluation process is both summative and formative and involves development, distribution, and review of extensive self-study reports, which include module objectives and content, methods of instruction, student outcome data, and student evaluation data. ♦ A review team, including student members, meets and discusses the data, and a report is generated that is subsequently presented to the MEC and module/course directors. Learning Outcomes/Competencies ♦ In 1996, the Medical Education Committee created a list of clinical competencies essential for all graduates of the School of Medicine. Every medical student receives these upon entry, and the competencies provide the basis for the senior OSCE, which must be passed as a graduation requirement. ♦ The Core Clinical Competencies can be found on the SOM website: http://www.uab.edu/uasomume/mec/reports/corecomps.htm. ♦ The overall goals and objectives for the educational program leading to the MD degree can be found on the SOM website: http://www.uasom.uab.edu/depts/lcme/School-wide%20Goals%20and%20Objectives1.pdf. New Topics in the Curriculum Since 2000 ♦ The New Curriculum, launched in 2007/2008, is an integrated, organ-based curriculum. Included in it are opportunities for individualized scholarly activity for every student and increased immersion courses for all students. ♦ The following courses are included in our curriculum Patient safety: Patient safety is taught during a one-week elective immersion experience. It is also included in clinical clerkship education in which students are taught about medication reconciliation and proper ways to write orders and order medications. Quality improvement: While the SOM has no specific course, quality improvement is an entity that threads throughout the core clinical curriculum, including acting internships and clinical elective coursework. Team-based learning: In the preclinical curriculum, laboratory exercises, small group exercises, and independent learning projects are embedded in each module. During the core clinical clerkships, students are placed on teams that include interns, residents, faculty members, and ancillary personnel, including nurses, pharmacists, and social workers. Every student's performance is assessed based on ability to integrate him or herself into the clinical team framework. Simulations/training in new surgical techniques: Simulation is currently being piloted in two organ module courses in the preclinical curriculum. It is also used in the pediatrics clerkship on the Birmingham campus and in the surgery clerkship to teach basic surgical skills. There are several one- to two-week immersion courses in simulation, and several students are doing their required scholarly activities in aspects of simulation. Changes in Pedagogy ♦ The New Curriculum, introduced in 2007/2008, emphasizes integration of basic and clinical sciences across all four years decreased lecture time and more small group activities learner-centered pedagogical techniques more NBME-style exam questions an alignment of clinical skills education with organ module courses the use of simulation in preclinical education the use of audience response systems to engage the learner and assess understanding the importance of individualized scholarly activity for each student ♦ The success of these pedagogical changes will be measured by student performance on USMLE Step 1, Step 2 CK, and Step CS examinations student assessment on core clinical clerkships, including student communication skills, clinical readiness, and performance on USMLE shelf examinations the quality of students' scholarly activity as measured by abstracts, invited presentations, and publications the frequency of SOM graduates deciding to pursue research in future activities Changes in Assessment ♦ Prior to 1990, the educational program relied heavily on the traditional multiple-choice question (MCQ) examination format and clinical preceptor subjective assessments of students. ♦ The MCQ format is still in use, but the clinical preceptor evaluation is now a standardized template generated via a commercial electronic system (E-Value), which allows for more valid, reliable, and timely student assessment data. ♦ Courses have added assessment of small group participation and student presentations. ♦ Standardized patients have been incorporated in the assessment of all sophomores' and seniors' clinical skills. ♦ All second-year students must complete successfully an OSCE on all basic physical examination techniques in order to matriculate to the third year. ♦ Computerized testing has been implemented since 1997 in first- and second-year courses and is now a consideration for all courses in the first two years. ♦ As outlined above under the heading Curriculum Renewal Process, each module or course offered in the SOM curriculum undergoes an extensive assessment process. Clinical Experiences ♦ Clinical education occurs on the Birmingham campus and two regional campuses: Huntsville and Tuscaloosa. ♦ Medical students are active in a variety of clinical settings, including both inpatient and outpatient settings, and are exposed to a wide spectrum of medical diseases. ♦ In Birmingham, students perform clinical rotations at University Hospital (a 900+-bed tertiary care facility that includes organ transplant units, a trauma/burns unit, and eight intensive care units), the Birmingham VA hospital, Children's Hospital, and Cooper Green Hospital (which serves the Birmingham indigent population), and ambulatory clinics. ♦ In Tuscaloosa, students perform clinical rotations at DCH Regional Medical Center (a 580-bed hospital) and its associated ambulatory clinics, including rural medicine clinics in west Alabama. ♦ In Huntsville, students perform clinical rotations at Huntsville Hospital (an 800+-bed tertiary care facility) and its associated ambulatory clinics, including rural medicine clinics in north Alabama. ♦ Current challenges in the third and fourth years of the curriculum include the effective integration of the basic sciences into the core clinical coursework. ♦ A primary goal of the new curriculum is to develop a structure in which basic science principles and clinical medicine will be presented in an integrated and interdisciplinary format. ♦ Presently, the Associate Dean for Undergraduate Medical Education is working with clerkship directors and the Clinical Subcommittee of the Medical Education Committee to develop tools to integrate basic science principles into the core clinical curricular content. ♦ Considerations have included student participation in elective basic science courses in the fourth year, basic science content incorporated into existing clinical lecture series provided in the third year, and the introduction of a required “integration” module in the fourth year. ♦ To date, seven new elective courses (two or four weeks in length) have been developed that will allow third- or fourth-year students to revisit basic science via participation in existing preclinical courses. Specifically, these students will participate in supervised anatomic dissection and generate prosections, attend lectures in organ-based modules, serve as “teaching assistants” in the anatomy lab and possibly small group sessions, and generate brief presentations under the guidance of a preclinical faculty member. ♦ In addition, a pilot program is under development that will provide a monthly basic science integration session in the core clerkships. Regional Campus ♦ Regional campuses exist in Huntsville and Tuscaloosa with approximately 35 students from the third and fourth years being assigned to each campus. ♦ These campuses offer a comparable curriculum with the Birmingham campus. ♦ Both regional campuses emphasize the importance of primary care and require that their students do a clerkship in rural medicine. ♦ These campuses are the clinical homes of our rural scholars programs. ♦ Tuscaloosa is currently piloting a curriculum in rural medicine called the TERM program. Highlights of the Program/School ♦ TERM program: The Tuscaloosa Experience in Rural Medicine (TERM) program is a 17-week experience that introduces medical students to rural health issues from the perspective of practicing physicians and will provide students with clinical experiences at rural primary-care practices. TERM students receive integrated training in family medicine, rural medicine, obstetrics and gynecology, pediatrics, surgery, and internal medicine. Tuscaloosa-based medical faculty visit the sites and provide audio and video conferences, and students stay in touch with the medical faculty at the Tuscaloosa campus via telemedicine and Internet-based technology. ♦ Rural medicine programs: Both regional campuses have developed special programs to promote rural medicine. The Rural Medical Scholars Program is based in Tuscaloosa and conducted by the College of Community Health Science, a branch of the University of Alabama School of Medicine. The Rural Medicine Program is a jointly sponsored program between the University of Alabama School of Medicine (UASOM) and Auburn University's College of Sciences and Mathematics. Each Rural Program is a five-year program with a prematriculation year spent on the undergraduate campus of the program. ♦ Scholarly activity: The Scholarly Activity program builds on the research strengths of the UAB academic medical center. In the third year of the medical curriculum, students devote at least eight weeks to a research project under the direction of a faculty mentor. Upon completion of their projects, students are required to prepare a paper describing the results. Scholarly projects can be undertaken in the following areas of investigations: (1) laboratory-based research, (2) patient-based research, (3) medical humanities, (4) rural and community health, (5) global health and health policy, and (6) outcome-based research, quality improvement, and medical informatics. The goal of the Scholarly Activity is to foster the development of analytical thinking skills, rational decision making, and attention to the scientific method while enhancing students' communication skills and promoting self-directed learning. ♦ Integrated-organ-based curriculum: The class of 2011 entered the first year of the new integrated curriculum in August 2007. These students participated in the following required courses: Patient, Doctor, and Society (PDS); Introduction to Clinical Medicine; Fundamentals 1 (included components of anatomy, biochemistry, cell biology, genetics, and physiology); Fundamentals 2 (included components of pathology, pharmacology, and microbiology); and four five-week organ-based modules (Cardiovascular, Pulmonary, Gastrointestinal, Renal). In the second year of the curriculum, students will participate in the following required courses: Introduction to Clinical Medicine, Musculoskeletal/Skin Module, Neurosciences, Endocrine, Reproductive Health, and Integration. Each of these courses is directed by a clinician and basic scientist with expertise in the designated content area. The implementation and assessment of the curriculum occurs centrally through the office of Undergraduate Medical Education. In the new curriculum, the number and duration of the required, core clinical clerkships is unchanged but begins earlier in the calendar year. The class of 2011 began participation in clerkship rotations in May 2009. A primary goal of the curriculum is to develop a structure in which basic science principles and clinical medicine are presented in an integrated and interdisciplinary format throughout the entire curriculum. Presently, the Associate Dean for Undergraduate Medical Education is working with clerkship directors and the Clinical Subcommittee of the Medical Education Committee to develop tools to integrate basic science principles into the core clinical curricular content.

IntroductionWhile many medical schools provide opportunities in medical Spanish for medical students, schools often struggle with identifying a structured curriculum. The purpose of this module was to provide a flexible, organ system-based approach to teaching and learning musculoskeletal and dermatologic Spanish terminology, patient-centered communication skills, and sociocultural health contexts.MethodsAn 8-hour educational module for medical students was created to teach musculoskeletal and dermatologic medical communication skills in Spanish within the Hispanic/Latinx cultural context. Participants included 47 fourth-year medical students at an urban medical school with a starting minimum Spanish proficiency at the intermediate level. Faculty provided individualized feedback on speaking, listening, and writing performance of medical Spanish skills, and learners completed a written pre- and postassessment testing skills pertaining to communication domains of vocabulary, grammar, and comprehension as well as self-reported confidence levels.ResultsStudents demonstrated improvement in vocabulary, grammar, comprehension, and self-confidence of musculoskeletal and dermatologic medical Spanish topics. While students with overall lower starting proficiency levels (intermediate) scored lower on the premodule assessment compared to higher proficiency students (advanced/native), the postmodule assessment did not show significant differences in skills performance among these groups.DiscussionAn intermediate Spanish level prerequisite for this musculoskeletal and dermatologic module can result in skills improvement for all learners despite starting proficiency variability. Future study should evaluate learner clinical performance and integration of this module into other educational settings such as graduate medical education (e.g., orthopedic, rehabilitation, and dermatology residency programs) and other health professions (e.g., physical therapy and nursing).

Educational Curriculum, Assessment, Research and Outcomes: Past, Present and Future Directions

Contents: H.S. Barrows, Foreword. Part I:The Evolution of Medical and Surgical Education. S. Abrahamson, Medical Education: The Testing of a Hypothesis. R.H. Moy, Medical Education in the 20th Century. C.E. Engel, Medical Education in Australia, Great Britain, and New Zealand in the 21st Century. A. Tekian, Teaching and Learning in Medicine and Surgery in the 21st Century: Challenges to the Developing World. Part II:The Art and Science of Medical Education. G. Regehr, K. Rajaratanam, Models of Learning: Implications for Teaching Students and Residents. D.A. DaRosa, A. Derossis, Applying Instructional Principles to the Design of Curriculum. G.L. Dunnington, Adapting Teaching to the Learning Environment. A.K. Sachdeva, Large Group Teaching. R.G. Tiberius, Small Group Teaching. E.E. Reynolds, J. Ende, Feedback for Medical Education. K.B. Williamson, Instructional Technology in Medical Education. L. Wilkerson, Curriculum Evaluation and Curriculum Change. D.E. Simpson, Medical Faculty as Teachers: Implications for Faculty Development. J.R. Folse, Medical Education as a Continuum. R.G. Bing-You, J.C. Edwards, Residents as Teachers. N. Bennett, Muddy Problems, Compassionate Care: Continuing Medical Education in the 21st Century. Part III:Major Curriculum Movements. Q. Mast-Cheney, Major Curriculum Movements. L. Arnold, K. Roberts, U.S. Medical Schools' Combined Degree Programs Leading to the MD and a Baccalaureate, Master's, or Other Doctoral Degree. L.C. Perkowski, Standardized Patients. J.A. Colliver, M.H. Swartz, Reliability and Validity Issues in Standardized Patient Assessment. R.K. Reznick, K. Rajaratanam, Performance-Based Assessment. L.J. Morrison, Clinical Practice Examinations. H.S. Barrows, Authentic Problem-Based Assessment. E.L. Loschen, Implementing Problem-Based Learning in Medical Education. Part IV:Challenges for Medical Education. M.E. Whitcomb, Effects of Changing Health Care Environment on Medical Education. G. D'Elia, E.J. Constance, Medical Education and the Physician Workforce. J.H. Shatzer, M.B. Anderson, Supporting Medical Education. W.A. Anderson, Funding and Financial Support for Research and Development in Medical Education.

Strategies for Residents to Explore Careers in Medical Education.

Keck School of Medicine of the University of Southern California

Curriculum Management and Governance Structure ♦ There has been significant change in the past ten years. ♦ The offices of the chancellor and the dean were occupied by the same persons for most of the 1990s. Medical education was under the direction of a dean for medical education. The dean for medical education worked with the dean to develop the philosophy of the school; the curriculum committee functioned to develop courses. The curriculum was organized primarily around departments. ♦ In 1999, the dean created a new position of vice dean for education. The vice dean was given responsibility for medical student, graduate medical, graduate, continuing medical, and allied health sciences education and the medical library. The vice dean was given responsibility for developing the philosophy and integrating the operations of all education in the school of medicine. Office of Education ♦ The medical school is divided into divisions that include the Central Teaching Laboratory (CTL), established in 1968 for curricular support; and the Office of Medical Education Research and Development (OMERD), established in 1994. ♦ CTL provides support for setting up laboratory exercises administering course evaluations scoring tests supporting educational software ♦ OMERD is responsible for developing program and learner evaluation holding workshops on test-item writing and test development reinforcing educational models and theory as frame-works on which to build courses and learning experiences recruiting, training, and monitoring standardized patients for teaching and assessment collaborating with other faculty to compete for external funding working with faculty interested in scholarship in medical education Budget to Support Educational Programs ♦ Many discrete budgets fund part of medical student education. ♦ In 1997, the dean for medical education worked with department chairs, course directors, and medical school financial officers to establish a formula for the allocation of educational funds to basic and clinical science departments and specified the portion of a department's budget that is to support medical student education. These budgets are controlled through the dean's office. ♦ Other resources in departmental budgets support medical student education by purchasing faculty release time, but are not captured in a formal process. ♦ Each department receives a formal allocation to support medical student education, for which it is accountable. ♦ Resources to support medical student education come from the clinical practice plan, the hospital, the university, foundation support, and tuition. Valuing Teaching ♦ Faculty members who devote significant portions of their time to medical student education receive salary support from their departments, usually the medical school allocation. ♦ Medical student teaching is considered in promotion and tenure processes for all faculty. ♦ A tenure track has been developed for clinician educators. ♦ Students recognize faculty members with faculty teaching awards. ♦ Guidelines for promotion and tenure dossiers require evidence of teaching quality from all faculty. CURRICULUM RENEWAL PROCESS Learning Outcomes ♦ In 1994 medical school faculty accepted a set of core competencies that students must accomplish prior to graduation from medical school. These are under review (see Curriculum Review section). ♦ Student promotion is based primarily on successful completion of individual courses. ♦ Committees of first- and second-year course directors review each student's overall academic performance to determine the student's preparedness for the next year's work. Changes in Pedagogy ♦ Students in preclinical years are taught using case-based instruction, standardized patients, small-group learning, Web-based information, and lectures. ♦ There has been a significant decrease in lectures over the past decade. Application of Computer Technology ♦ All students are required to have laptop computers with certain specifications, which they own or they lease from the medical school. ♦ Faculty support for the design and creation of computer and Web-based educational materials is available from the CTL and Educational Media Services. ♦ Individual course directors integrate electronic teaching support into course work. ♦ Databases and common resources are either made available on-line or installed on each computer. ♦ A new (1998) electronic classroom with individual Internet and intranet connections serves as the main teaching theater for preclinical classes. ♦ Course evaluation forms are posted on the intranet. ♦ Official notices are sent via e-mail and some course tests are conducted over the intranet. Changes in Assessment ♦ Clinical skills of first-year, pre-clerkship, and post-clerk-ship students are evaluated using standardized patients. ♦ Assessment methods include standardized patients computers faculty observations the OSCE NBME shelf exams (used in some basic science courses and clerkships) computer-based testing (under development for several courses) ♦ Since 1993, a multi-station clinical performance examination has been used for comprehensive assessment of students following their clerkship year. ♦ One clerkship uses an oral examination. ♦ One clerkship requires a written project on a population health issue. ♦ All clerkships recently began implementing a common evaluation of students' professionalism. ♦ Plans are to develop an assessment strategy to determine how well students have mastered curriculum objectives in medical informatics. Clinical Experiences ♦ Students participate in clinical experience in both inpatient and ambulatory settings at Duke University Medical Center, the Durham VA medical center, and the clinics associated with the Duke Health System. ♦ Ambulatory experiences have been available since 1997 at AHEC sites, private practice sites, and international sites. ♦ Students have the opportunity to experience clinical practice in developing countries or underserved areas in the United States. Curriculum Review Process ♦ The curriculum has undergone two major reviews, with major and more modest changes occurring in the past ten years. ♦ The third major review was begun in fall of 1999 with the goal of examining all components of the curriculum and teaching approaches—to culminate in a comprehensive report. ♦ A curriculum organizing and review committee has been established to use the comprehensive report; innovations from the medical education literature and collegial contacts are consulted by the committee. ♦ The process will lead to modifications in both content and pedagogy over the next three years. ♦ The current review utilized faculty and students to review the effectiveness of current teaching approaches. ♦ The committee is developing a plan for central control of the curriculum, which may result in an organ-based curriculum. ♦ The major issues are to utilize resources more effectively and to secure financial support for clinician—student contact time.

Medical education in the Republic of China.