University of Arizona College of Medicine: Tucson and Phoenix

Abstract

Curriculum Management and Governance Structure ♦ The curriculum management and governance structure is designed to oversee the University of Arizona College of Medicine's (COM) four-year undergraduate medical education programs in both Tucson and Phoenix. ♦ The Phoenix campus has existed as a formal regional clinical campus since 1992, with approximately one third of the Tucson-based students transferring to Phoenix for their third and fourth years. In 2007, the Phoenix campus matriculated its initial first-year class of 24 students. ♦ The educational program consists of two equivalent but different year I and II curricular tracks at the Tucson and Phoenix campuses and a single year III and IV curriculum for both campuses. As such, curriculum governance and management is the responsibility of several principal entities, all of which are standing committees (see Figure 1).FIGURE 1:: Curriculum Governance and Management♦ The Educational Policy Committee (EPC) comprises faculty elected by the general faculty on each campus and students elected by their peers. The EPC is responsible for oversight of the educational program as a whole. Its meetings are teleconferenced between Phoenix and Tucson campuses. ♦ The oversight of each track is the responsibility of campus-based subunits of the EPC: the Tucson and Phoenix Educational Policy Committees (T-EPC and P-EPC), each comprising the EPC members representing each campus. ♦ These committees may establish local subcommittees and policies as required to fulfill their oversight functions. For example, the Tucson Curriculum Management Subcommittee (years I and II), which comprises the directors of year I and II blocks, curricular threads, and disciplines, reports to the T-EPC. ♦ The required clerkships and elective components of the curriculum in years III and IV are managed by the Clinical Curriculum Subcommittee (CCS), which reports to both campus subcommittees and to the EPC. This bicampus committee includes EPC members, faculty, and students. Office of Education Tucson campus ♦ The 25 full- and part-time education faculty and professional staff of the Office of Medical Student Education (OMSE) provide support for the educational programs along with organizational responsibility for the Commitment to Underserved People community service program, the Rural Health Professions Program rural preceptorship program, the Center for Professional and Clinical Education and Evaluation, and the MD/MPH Dual Degree Program. OMSE's services include the following: general instructional support (e.g., organization and scheduling, orientation for instructors, assistance with the development of lecture notes and other learning materials, logging all block/course information and learning materials into the ArizonaMed Online curriculum management and database system) for required blocks and courses in years I and II, the Societies Program (instruction in clinical skills, professionalism curriculum, mentoring), and for year III blocks (Transition to Clerkships and Intersessions). administration of programs for the teaching of clinical and professional skills, including the standardized patient programs and OSCEs, at the end of years I, II, and III. support of curricular governance and management committees (support for bicampus committees is shared with Phoenix-based staff). faculty development programs, resources, and consultation. design and administration of curriculum evaluation and teaching effectiveness systems, support for regular curriculum analyses and reviews, analysis and reporting of data. support faculty in writing exam items and interpretation of item analyses and in development of cases for case-based instruction and team-based learning sessions. collaborative educational research. administration of the education and clinical programs comprising the Commitment to Underserved People community service program. administration of the MD/MPH program. administration of the Rural Health Professions Program, including development of rural preceptorships (45 rural Arizona sites), and assistance with rural faculty development. ♦ The Student Affairs Offices of Student Development and Assessment provide learning skills services for medical students and assistance in the design and implementation of student performance assessment strategies. Phoenix campus ♦ The Vice Dean for Academic Affairs holds primary responsibility for supporting the medical education program in Phoenix. Although there is no formal office of medical education, a professional staff and faculty to support the educational programs have been identified commensurate with the development of the four-year Phoenix program. Faculty were named to direct the preclinical curriculum, scholarly project, the longitudinal clinical curriculum, and OSCE program. Additional faculty have been identified to provide oversight to Phoenix-based students in the MD/MPH program and supervise Commitment to Underserved People program activities. Eight professional staff provide general instructional support for all aspects of the educational program, including the year I and II blocks, clinical curriculum, electives, OSCE program, longitudinal clinical curriculum, Intersessions, and Transition to Clerkships. Another professional staff member serves as instructional technology coordinator. Staff also provide administrative support for curricular governance and management committees (support for bicampus committees is shared with Tucson-based staff). The Phoenix Office of Academic Affairs works closely with the Tucson OMSE on all curricular matters and the evaluation support staff of the Tucson office. The Phoenix Office of Student Affairs includes a medical learning skills professional staff member. Financial Management of Educational Programs ♦ The COM has faced sequential reductions in state funds. In response, the COM has reorganized the central administrative structure with an emphasis on efficiency. More importantly, key educational programs and student-related infrastructure have been identified with the goal of protecting these resources. ♦ Currently, the COM is re-evaluating strategies by which state funds are distributed for teaching to better emphasize performance and accountability in budget allocations. ♦ In Phoenix, the Office of Academic Affairs has hired the necessary support staff and identified faculty directors to ensure that educational program needs will be met, while emphasizing efficiency in the allocation of program funds. Valuing Teaching ♦ The COM established an endowed Academy of Medical Education Scholars in 2008. Members of the academy are distinguished COM faculty elected by its membership. ♦ New guidelines were designed by which educational scholarship is assessed for tenure track faculty. Definitions of educational scholarship are broadly stated, including such activities as program development, educational leadership in national organizations, educational research, and development of instructional tools and strategies. ♦ A new, nontenure-eligible track is being developed for consideration, which would recognize those faculty members whose primary duties involve the educational missions of the COM. Curriculum Renewal Process Tucson track (year I and II) curriculum renewal ♦ The most recent curriculum renewal process was initiated in academic year 2003-04, with year I of the ArizonaMed curriculum implemented in AY 2006-07 and year II implemented in AY 2007-08. ♦ Curriculum renewal was targeted at all aspects of the educational program, including the structure of the curriculum and integration of content; teaching and learning strategies; assessment of student performance; integration of social/economic/ethics/professionalism content; instruction in clinical skills; mentoring of students; interprofessional education components; and development of a faculty teaching effort and reward system. The key objectives of the renewal process and resulting curriculum components include the following: Design a curriculum structure that integrates the basic, clinical, behavioral, and social sciences, including the humanities, across all years of the curriculum. The ArizonaMed curriculum is structured in interdisciplinary blocks by organ systems and/or mechanisms of health and disease. “Threads” on aging, health and society, humanism, professionalism, gender-specific medicine, evidence-based decision making, and interprofessional education are woven throughout the curriculum. Provide longitudinal mentoring and teach clinical skills at bedside under the tutelage of clinical faculty. In the Societies Program, each student is assigned to a group of six led by a clinical faculty mentor, meeting weekly for the first two years and at regular intervals thereafter. There is an emphasis on active learning strategies to improve critical-thinking skills and develop life-long learning skills. A majority of curricular time is conducted in case-based instruction, team-based learning, and other interactive learning methods. Strategies are developed for assessing student performance and learning that measure the competencies throughout the educational program. Student performance is assessed on every competency (Medical Knowledge, Patient Care, Professionalism, Interpersonal Skills and Communications, Practice-Based Learning, Systems-Based Practice, and Population Health) a number of strategies, including peer evaluation, performance exams, and other written assignments in addition to objective examinations. Passing performance in every competency is required to advance through the curriculum. Interprofessional learning opportunities are provided. An interprofessional education program has been designed and is led by faculty from each of the Arizona Health Science Center colleges and the colleges of law and management. Students participate in approximately six interprofessional learning sessions in each of the first two years. A system was designed and implemented to reward faculty instructional effort, linking teaching effort to departmental financing. Phoenix track (years I and II) curriculum development ♦ A separate Phoenix curricular track was developed in 2006, meeting the overarching institutional objectives for the COM while emphasizing unique aspects of the partnership with Arizona State University as well as the Phoenix community at large. The key objectives and curriculum components include the following: Provide educational strategies focused on biomedical informatics. A longitudinal curriculum has been implemented. Prepare students to participate in research at many levels throughout their careers. All students are required to complete a four-year longitudinal scholarly project. Provide clinical skills education with clinician preceptors in ambulatory settings. Each student works with a clinical preceptor in the two-year ambulatory longitudinal clinical experience. Provide opportunities throughout the first two years for students to integrate block content with their clinical skills learning and with content in the social and behavioral sciences. Students participate in clinical capstone experiences following each of the organ-system, basic science blocks. Integrate content and educational experiences in themes. There are four themes integrated throughout the four-year curriculum: behavioral medicine; humanities and ethics; population medicine, prevention, public health, and policy; and biomedical informatics. Year III and IV curriculum renewal ♦ Planning for a collegewide (both Tucson and Phoenix campuses) curriculum for years III and IV began in AY 2007-08 with the Clinical Curriculum Planning Committee, which comprised faculty from both campuses who developed the general principles upon which the curriculum was designed; year III of the new curriculum was implemented on both campuses in AY 2009-10; and year IV will be implemented in AY 2010-11. Key objectives along with the resulting curriculum components include the following: Provide an experience for transition to clerkships. A two-week block, “Transition to Clerkships,” was implemented. Provide elective time before year IV during which students may explore their interests. A four-week elective period is now included in year III. Enhance integration among the clerkships. Clerkships are paired into “blocks” of two related clinical disciplines. Didactic content and some learning experiences are integrated in the blocks. Schedule opportunities for students to assimilate learning experiences in the clerkships and encounter/review content that has application across all clinical disciplines. One “Intersession” week is scheduled between each of the clerkship blocks for a total of four weeks. Intersession content includes those topics most applicable to clinical care and professional development. Provide clinical opportunities to prepare for residency. A four-week required selective subinternship has been established. Learning Outcomes/Competencies ♦ Educational objectives leading to the MD degree including core competencies and measurable objectives were developed and approved in 2004 and have been reviewed and reaffirmed periodically by the EPC. Patient care ♦ Graduates obtain appropriate histories and perform skillful, comprehensive, and accurate patient examinations. They develop appropriate differential diagnoses and patient care management plans. They recognize and understand the principles for managing life-threatening situations. They select, perform, and accurately interpret the results of laboratory tests and clinical procedures in making patient care decisions and use appropriate diagnostic and treatment technologies in providing patient care. Medical knowledge ♦ Graduates apply problem-solving and critical-thinking skills to problems in basic science and clinical medicine. They demonstrate knowledge about (1) established and evolving core of basic sciences, (2) application of sciences to patient care, and (3) investigatory and analytical thinking approaches. Practice-based learning and improvement ♦ Graduates are prepared to practice medicine within the context of society and its expectations. They use evidence-based approaches, demonstrating proficiency with information retrieval, and critical appraisal of the medical literature to interpret and evaluate experimental and patient care information. They understand the limits of their own personal knowledge, remediate inadequacies to remain current, and integrate increased self-knowledge into their daily activities. Interpersonal and communication skills ♦ Graduates must demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, patients' families, and professional associates. They promote health behaviors through counseling of individual patients and their families and through public education and action. Professionalism ♦ Graduates are committed to carrying out professional responsibilities, adhering to ethical principles, and demonstrating sensitivity to diverse patient populations. They are altruistic and compassionate in caring for patients and at all times act with integrity, honesty, and respect for patients' privacy and for the dignity of patients as persons. Graduates are advocates for improving access to care for everyone. They are committed to working collaboratively with the health care team and acknowledge and respect the roles of other health professionals. Graduates recognize their limitations and seek improvements in their knowledge and skills. Systems-based practice and population health ♦ Graduates demonstrate awareness of and responsiveness to the larger context and system of health care. They are able to effectively call on system resources to provide optimal care. Graduates are able to work with patients both as individuals and as members of communities and take this into account when performing risk assessments, diagnosing illnesses, making treatment plans, and considering the public health implications of their work. New Topics in the Curriculum Since 2000 ♦ Topics added since 2000 are listed below with the campus/curriculum track indicated if the topic is not included in both the Phoenix and Tucson tracks. ♦ Patient safety. Patient safety and error management content is included in the Transition to Clerkships course and during the Intersessions in year III. ♦ Team-based learning (Tucson). One team-based learning session per week is included in all blocks throughout years I and II. ♦ Simulations/training in new surgical techniques. In the Tucson track, students participate in simulations in the Arizona Simulation Technology and Education Center (ASTEC) in years I and II Interprofessional Education and Societies curricular activities; Transition to Clerkships block; year III required clerkships of Pediatrics, Medicine, and Surgery; and during the Intersessions. In the Phoenix track, the Simulation Center at Banner Good Samaritan (an affiliated hospital) is utilized for student training during the Transition to Clerkships block; clerkships in Pediatrics, Medicine, Obstetrics and Gynecology, and Surgery; and the Intersessions. ♦ Pain management. An organized pain management curriculum is included in the Intersessions block in both Tucson and Phoenix and in the Neurology clerkship in Phoenix. ♦ Interprofessional education. In Tucson, interprofessional education is integrated throughout years I and II, with four to six interprofessional workshops each year with students from the colleges of Nursing, Pharmacy, Public Health, Law, Management, and Journalism participating. In Phoenix, interprofessional education activities are provided in the Intersessions. ♦ Translational research. An organized curriculum in Translational Research has been implemented in the Intersessions in Tucson. In Phoenix, Translational Research topics are included in Intersessions and throughout the curriculum as part of the longitudinal scholarly research project. ♦ Biomedical informatics. Phoenix offers an organized Biomedical Informatics curriculum, with an emphasis placed on information management from the molecular level to population health and integrated throughout years I, II, and III. Biomedical informatics content is included in the Intersessions in Tucson. Changes in Pedagogy ♦ Tucson: Several changes in pedagogy were implemented in 2006 as part of the new curriculum, including longitudinal mentoring and bedside clinical skills education through the Societies Program; emphasis on active learning techniques and independent learning with one team-based learning session each week, two case-based instruction sessions each week, and virtual labs throughout years I and II; and reflective writing and journaling, portfolio review, simulations, and increased use of electronic independent learning modules throughout the curriculum. A survey of clerkship faculty has been implemented to measure preparation for the clerkship, independent learning skills, and clinical skills, comparing students in the new curriculum with those completing the former curriculum. New strategies to measure critical-thinking and clinical decision-making skills are being researched but have not yet been implemented. ♦ Phoenix: New pedagogy includes interactive lectures, case-based instruction, virtual labs, journaling, and simulation. New strategies for assessment of students' critical-thinking skills are being researched. Changes in Assessment ♦ Student performance in all competencies is assessed throughout the curriculum. Students must receive passing grades in every competency for advancement to the next curricular block. ♦ Assessments by student peers, along with faculty assessments, are used to measure the competencies of Interpersonal and Communication Skills and Professionalism. ♦ Year I and II OSCEs have been added to the OSCE administered at the end of year III. Tucson only ♦ Performance is assessed through the team-based learning sessions. ♦ Portfolio review is used in the Societies program to assess student progress. ♦ Beginning in 2010, all students are required to take an NBME; comprehensive exam at the end of years I and II. This exam does not contribute to grades but is required as a diagnostic and self-assessment tool on student learning progress and readiness for the Step 1 exam. Phoenix only ♦ Journals are used to assess student progress in the capstones, Transition to Clerkships, and the Pediatrics clerkship. ♦ Group projects are used to assess student learning in Biomedical Informatics. ♦ Benchmarks for performance have been established for the Scholarly Projects; for example, a student's prospectus is due by the end of the first academic year. Clinical Experiences ♦ Clinical clerkships, clinical electives, and clinical preceptorships are used across the curriculum in both Phoenix and Tucson. Sites include the following: inpatient experiences at community hospitals, public general hospitals, academic health centers, Veterans Affairs medical centers, and Indian Health Service hospitals in both rural and urban settings. inpatient units, including community hospitals, public general hospitals, major teaching institutions, and Veterans Affairs medical centers. ambulatory clinics, both specialty and primary care, in urban and rural areas, including underserved sites located in major teaching institutions; community-based physicians' offices, including group practices, individual practitioners' offices, and community health centers; and rural and urban Indian Health Service settings. hospices. prison health systems. long-term care facilities. rehabilitation facilities. free clinics, including those located in homeless shelters and domestic violence shelters. international settings. ♦ The primary challenges in delivering the clinical curriculum are identifying a sufficient number of clinical settings in which to conduct clinical education and designing meaningful educational experiences in the social, behavioral/psychological, economic, organizational, and interprofessional aspects of care as part of the students' clinical education. Regional Campus ♦ Officially known as The University of Arizona College of Medicine–Phoenix, the Phoenix program of the University of Arizona COM is a full four-year program, dedicated in October 2006. ♦ It is an expansion of the year III and IV COM program, which was implemented in Phoenix in 1992. The entering class has 24 students, while the current class size has risen to 48. ♦ The Phoenix track follows the interactive, integrated principles established for the ArizonaMed program and emphasizes biomedical informatics. ♦ Unique to the track is a requirement that students must prepare a scholarly project in one of four concentration areas: biomedical informatics; medical ethics and medical humanities; molecular medicine; or public health, population medicine, policy, and prevention. Highlights of the Program/School ♦ Student performance in all competencies is assessed throughout the curriculum. Students must receive passing grades in every competency for advancement to the next curricular block. ♦ The Commitment to Underserved People community service program began over 25 years ago. The program provides services to a variety of underserved populations and includes more than 20 separate educational and clinical programs. More than 80% of the student body participates in this program. ♦ The Tucson track is in the process of implementing a “developmental curriculum” in which content and learning strategies are matched to changing expectations for learning sophistication and increasing cognitive challenges as the curriculum develops. The developmental curriculum is expressed as standards for block and course design, learning method selection and design, and assessment strategies. ♦ In the Societies Program, part of the Tucson track curriculum, students begin patient-centered clinical education on the first day of medical school by meeting with patients at bedside with their mentors. These groups serve as the primary venue for clinical skills and professionalism training in the first two years and remain intact throughout each student's medical education. Over time, groups become more than educational units, supporting the development of strong mentoring relationships and enabling mentors to assess longitudinally students' development and provide career advice. ♦ The Tucson track requires that all students participate in an educational experience that serves a disadvantaged and/or resource-poor population. The requirement may be fulfilled in a variety of ways and different points in the curriculum but must encompass at least 30 hours of structured time. ♦ The Phoenix track requires a four-year longitudinal scholarly project. Students are given a series of didactic sessions to prepare them for scholarly endeavors (e.g., human subjects research ethics, IRB requirements, biostatistics, and so on), and advisors and mentors are assigned to the students to aid them in accomplishing their projects. ♦ The Phoenix track emphasizes content in biomedical informatics integrated throughout the curriculum. ♦ The Phoenix track includes one-week clinical capstones, which are scheduled following each organ-system block during which students participate in clinical experiences relevant to the block just completed.