The University of Vermont Larner College of Medicine.

Abstract

Medical Education Program Highlights Larner College of Medicine (LCOM) is a 4-year academic curriculum, the goals of which are to educate a diverse group of dedicated physicians to serve across all disciplines of medicine, be respected for innovative and outstanding teaching, advance medical knowledge through research, integrate education and research to advance the quality and accessibility of patient care, and engage with our communities to benefit Vermont and the world. LCOM is recognized for our inclusive approach and evidence-based innovation in medical education. Our location on the same campus as the main University and adjacent to a medical center affords tremendous opportunity for collaborative academic programming and research between colleges and disciplines. The Vermont Integrated Curriculum (VIC) offers students early access to broad clinical experience, firm grounding in the basic sciences, and opportunities to conduct research and engage in community service. Active learning has been shown to provide students superior benefits compared with lecture. We recognize the importance of this newer teaching/learning pedagogy for retention of knowledge, engagement, and collaboration among learners and educators. We strive to deliver 100% of required teaching sessions with active learning. To effectively do so, Medical Education, Information Technology, and the Teaching Academy collaborated on developing the Larner Learning Commons, a laboratory for teaching designed to support leading-edge medical education. Faculty development is integral to the success of our transition to active learning. In 2014, the college established the Teaching Academy, providing resources to support all faculty to become better educators and improve the efficiency and quality of medical education. The Teaching Academy fosters a community of educators that leads educational innovation and scholarship by promoting faculty members’ pursuits of education excellence and scholarship. Curriculum Curriculum description The educational program comprises 3 levels: Level 1: development of fundamental science knowledge in a clinically relevant context and acquisition of clinical skills Level 2: core clerkships emphasizing basic principles and practices of clinical medicine Level 3: additional opportunities for application of medical knowledge with increased student responsibilities in caring for patients See Supplemental Digital Appendix 1—Curriculum Diagram—at https://links.lww.com/ACADMED/A935. Curriculum changes since 2010 Enacted commitment to active learning Updated selection of longitudinal topics: social determinants of health, evidence-based medicine, health systems science, point-of-care ultrasound (POCUS), interprofessional education (IPE), and opioid epidemic management Established a branch campus in Connecticut that hosts our global health program, offering global health experiences in countries including Uganda, Russia, Vietnam, and Zimbabwe Development of a Longitudinal Integrated Clerkship (LIC) at 2 sites in rural Vermont and New York. LIC students are embedded in family practice offices where they develop their own panels of patients and have “burst” weeks of intensive exposure to inpatient medicine Class size changes since 2010 LCOM has made modest incremental changes in class size. Class size increased in 2016 from 115 matriculating students to 120. The addition of 4 seats in 2019, with 2 seats reserved for students from Vermont, brought our class size to 124 with 30 seats for Vermonters. Assessment The medical education program objectives are based on the Accreditation Council for Graduate Medical Education domains of competence. LCOM has made the following assessment changes since 2010: Changed grading in the foundations level in 2016, from a pass/fail/honors to a pass/fail system Completed inclusion of a clinical skills exam (CSE) in all clerkship courses Continued to explore use of CSEs at the conclusion of the medicine acting internship to provide a standardized assessment of knowledge, skills, and behaviors required of medical students in the inpatient setting, to add to inpatient observations Pedagogy Classes are delivered in a variety of active learning modalities. Each modality is different, and expectations vary. Attendance is required for all active learning class sessions. LCOM employs best practices in simulation-based education and assessment in the clinical skills curriculum, which is vertically and horizontally integrated in the VIC. Human (standardized/simulated patients) and nonhuman (manikins, task trainers, virtual reality) simulation modalities are integrated into courses and clerkships and linked to course/clerkship objectives. See Chart 1—Teaching Modalities.Chart 1: Teaching ModalitiesThe following pedagogical changes have been implemented since 2010: Enacted commitment to increase the amount of active learning in the curriculum, striving for 100% active learning activities Developed a prematriculation curriculum delivered online or in person with a goal of improving student success Clinical experiences Vermont campus: The University of Vermont Health Network serves Vermont and northern New York through 6 hospital locations, large multispecialty outpatient clinics, and satellite facilities with more than a million patient visits each year. All clerkships are offered at the University of Vermont Medical Center. Saint Mary’s Medical Center, located in West Palm Beach, Florida, offers a broad spectrum of medical care. Clerkship rotations include pediatrics, obstetrics–gynecology, and surgery. Connecticut campus: Students at the Connecticut campus complete clerkships at the Danbury and Norwalk locations. Danbury Hospital is a regional medical center and university teaching hospital. Norwalk Hospital is a community teaching hospital with a wide range of clinical programs. The patients served represent a remarkable cross section of economic, ethnic, racial, and linguistic backgrounds. All clerkships are offered at the Connecticut campus. LIC sites: Central Vermont Medical Center is a hub for regional health care delivery. Hudson Headwaters Health Network is a not-for-profit system of community health centers headquartered in Queensbury, New York. The primary care clinics are designated as Level 3 patient centered medical homes. Required longitudinal experiences Professionalism, Communication, and Reflection (PCR) is a yearlong course that meets in small groups with a faculty preceptor once a week. Important themes of the course include professionalism, self-awareness, communication skills with peers and colleagues about difficult subjects, understanding culture and diversity in medicine, and social and economic factors affecting health. Second-year PCR groups partner with local community organizations to apply their leadership, professional, and team skills to a public health project, which results in a required poster presentation at LCOM and optional scholarship at national conferences. These projects begin to develop the background in population-based medicine and prevention a physician needs to fully address a range of health issues. Doctoring in Vermont (DIV) is a course that spans the first and second years of the foundations level. Students spend 8 sessions in a primary care office observing direct patient care and practicing interviewing and examination skills. The LCOM clinical skills curriculum is horizontally and vertically integrated in the VIC. The curriculum includes professionalism, communication, medical interviewing, physical exam, and clinical reasoning (presentation and electronic health record), which are taught and assessed with the use of standardized/simulated patient methodology. Students are assessed in these domains with CSEs at the end of courses and clerkships. They are also required to pass an end-of-level CSE between foundations and clerkship to proceed to clerkship, as well as to pass a 12-station CSE at the end of clerkship to graduate. The 4-year integrated LCOM ultrasound curriculum is a comprehensive longitudinal POCUS course. The curriculum begins in the first weeks of medical school and continues throughout all 4 years of medical training with the intent that students become competent in using POCUS in clinical patient care. Clinical experience first encounter LCOM students are introduced to their first patient on the first day of orientation, where they learn the importance of patient communication skills. Additional clinical experiences occur during their first semester in the PCR course, which includes clinical history taking, spiritual care, and nurse shadowing. Clinical skills continue to develop in DIV, which begins in the second semester of the first year. Required and elective community-based rotations LCOM partners with outpatient clinics in Vermont, Connecticut, Florida, and upstate New York to deliver our clinical curriculum. Challenges in designing and implementing clinical experiences for medical students LCOM values diversity, equity, and inclusion and considers these factors when making decisions about clinical affiliations and curricular experiences. With increasing numbers of learners in the clinical environment, communication and collaboration among educators and clinical systems is necessary to ensure a high-quality clinical curriculum for our students. Curricular Governance The Medical Curriculum Committee is the institutional body that oversees the medical education program. This committee provides integrated institutional responsibility for overall design, management, integration, evaluation, and enhancement of a coherent and coordinated medical curriculum. The committee implements needed changes to the curriculum and is cognizant of national medical education priorities and requirements. See Figure 1—Committee structure.Figure 1: Committee structure.Education Staff The Office of Medical Student Education (OMSE) supports all aspects of the medical education curriculum, consisting of multiple teams involving 2 clinical campuses and additional clinical affiliates: The teams within the OMSE comprise faculty and staff, including administrative, admissions, medical student services, preclinical curriculum, clinical curriculum, active learning, Teaching Academy, and clinical simulation lab. The Office of Diversity and Inclusion, Technology Services, and Dana Medical Library provide integral support for successful program delivery. Clinical simulation facilities and staff are on both Vermont and Connecticut clinical campuses. OMSE supports high-quality educational programs and services for medical students and faculty development in educational methods and innovation. OMSE, which includes the senior associate dean for medical education, associate/assistant deans, and directors, is directly responsible for UME, continuing professional development, and academic integration across the University of Vermont Health Network. Faculty Development and Support in Education Professional development for faculty as educators is offered centrally through the Teaching Academy, which provides: Opportunities for professional development to all faculty in curricular design, program evaluation, learner assessment methods, instructional methodology, and educational scholarship, including educational research Programs open to all LCOM faculty including residents, fellows, and postdoctoral fellows Faculty development opportunities and webinars available to clinical affiliates and regional campuses by Internet connection, recordings, and remote viewing Faculty development activities, including medical education grand rounds and retreats, offered at multiple instructional sites (e.g., regional campus) Programs addressing educational skill development, mentoring, diversity and inclusion, IPE, leadership development, career development, academic program evaluation, and educational scholarship Programs including an annual intensive teaching course, annual medical education retreat, medical education grand rounds, and mentoring groups Access to national webinars and courses from organizations such as the AAMC, AMEE, International Association of Medical Science Educators, and Medical Education Research Certificate program Brief online videos on core teaching topics available at the Teaching Academy website Peer observation of teaching, a formative evaluation conducted by academy members Role of teaching in promotion and tenure Teaching and education activities are expected of all faculty. Promotion and reappointment decisions include consideration of the 5 AAMC educator activities. Membership in the Teaching Academy is considered in promotions decisions. The Education Scholar Pathway is for individuals whose predominant effort is dedicated to the overall education of health professionals and individuals in the health sciences. Teaching Academy The LCOM Teaching Academy mission is to become a community of educators that leads educational innovation and scholarship by promoting faculty members’ pursuit of education excellence and scholarship: Sustains and supports an interdisciplinary community of educators who value the scholarship of teaching and learning while facilitating educator development Improves efficiency and quality of medical education through collaboration and scholarship Promotes an academic environment that increases value and impact of educators locally, regionally, and nationally Provides recognition of excellence through peer-reviewed membership and awards for teaching and educational excellence Scope of the Teaching Academy: Membership is open to all LCOM faculty across all instructional sites. The 4 tiers of membership are distinguished educator, master teacher, member, and protégé. Protégé membership is for residents, fellows, and postdoctoral students. Membership requires applicants to submit a portfolio for peer review. Regional Medical Campuses LCOM has a regional campus focusing on the clinical curriculum located in Connecticut, described above. Student enrollment includes 70 students (35 students/year) from levels 2 and 3. Educational experience across sites The LCOM regional campus in Connecticut has the same programmatic objectives and assessments as the Vermont campus and the LIC. All clerkship courses, assessment activities, and quality improvement processes are managed centrally by OMSE and supported by technology services. Monthly clerkship meetings are held that include all course directors for required clinical courses; leadership from the Vermont, Connecticut, and LIC sites; and clinical support staff. Information is presented in the course quality assurance reports and reviewed and approved by the Medical Curriculum Committee. Acknowledgments: The authors wish to thank members of the Medical Education Leadership Team, Medical Communications, and Office of Medical Student Education who provided input for this project.