University of Chicago Division of the Biological Sciences Pritzker School of Medicine

Abstract

Curriculum Management and Governance Structure ♦ The Pritzker School of Medicine's curriculum is overseen by the Education Executive Committee and is chaired by the Dean for Medical Education. Members of the Education Executive Committee include the Chair of the Pritzker Initiative Steering Committee (see below); the Medical Scientist Training Program (MSTP) Director; and representatives drawn from the medical students, faculty, educational affiliates, and the Graduate Medical Education Committee (see Figure 1).FIGURE 1:: Curriculum Management and Government Structure♦ The Education Executive Committee (EEC) is responsible for making and endorsing educational policy, oversight of curriculum review committees, integration with GME and other aspects of the Biological Sciences Division, and resource allocation. The EEC has responsibility for all aspects of the educational program at the Pritzker School of Medicine. ♦ The Pritzker Initiative Steering Committee (PISC) reports to the EEC and is chaired by the Associate Dean for Medical School Education. Members include the leadership of key course sequences, including Scientific Foundations of Medicine, Physician –Patient–Society–Systems (P2S2), and Scholarship and Discovery. Other members include the MSTP Director and representatives drawn from faculty, students, and administration. ♦ The PISC is responsible for ensuring appropriate content, integration of courses throughout the curriculum, oversight of all curricular elements including scholarship and discovery, nondenominational threads, longitudinal clinical experience, and time allotment. ♦ Two committees report to the Pritzker Initiative Steering Committee. The Preclerkship Curriculum Review Committee (PCRC) oversees the first two years of the curriculum, whereas the Clerkship Curriculum Review Committee (CCRC) oversees the third and fourth years. ♦ The PCRC membership consists of the faculty directors of all required courses in the first two years of the curriculum, and the CCRC membership consists of the faculty directors of all required clinical clerkships in the clinical biennium (years 3 and 4). Both committees include four elected medical student representatives (including one MSTP student) from each of the four medical school classes and the Director of the Clinical Performance Center (CPC). The committees are staffed by the Director of Medical School Education. The PCRC and CCRC both meet every other month for 2 hours at a time. ♦ Policy changes recommended by the PCRC and CCRC must be approved by the Pritzker Initiative Steering Committee and the Education Executive Committee. Office of Education ♦ The Dean for Medical Education oversees all medical education for the University of Chicago Pritzker School of Medicine (PSOM) and Graduate Medical Education activities at the University of Chicago Medical Center (UCMC). ♦ All groups within the PSOM—Admissions and Financial Aid, Medical Student Education, Student Life, Communications/Residency Advising, and Multicultural Affairs—support the multiple elements that comprise a student's medical education. ♦ Faculty Deans and staff directly reporting to the Dean for Medical Education include nine faculty deans or directors and 27 full-time staff members. ♦ The Medical School Education Office is directly responsible for supporting medical student education activities and is led by the Associate Dean for Medical School Education. ♦ This office oversees all aspects of the academic mission of the school, including curriculum implementation and evaluation, student academic performance, and student academic progress. ♦ The office includes two additional faculty members who oversee the Scholarship and Discovery Curriculum and the Community Health and Service-Learning Curriculum, as well as a faculty dean who oversees Technology and Innovation in Medical Education. Faculty deans are directly supported by nine full-time staff members, including a Director of Medical School Education and Senior Education Specialist. Financial Management of Educational Programs ♦ The University of Chicago is dedicated to a tripartite mission of education, research, and patient care. ♦ The Pritzker School of Medicine, responsible for undergraduate medical education, is allotted part of the institution's overall budget to fulfill that aspect of the educational mission. ♦ Abiding by the belief that providing both our students and our curricular programming sufficient resources will maximize the individual learning experience, the PSOM decreased its class size to 88 students for the 2009 matriculants. ♦ This change has allowed the PSOM to devote not only more monetary resources to each student, but also to commit even greater faculty time in order to foster greater involvement with each student's education. ♦ Approximately 80% of our students receive some form of support, including need and merit-based aid. ♦ Because the amount of dollars that are allocated for student scholarship will remain the same but student enrollment will decrease, we are able to offer each student additional financial support, thus significantly reducing students' debt upon completion of medical school. ♦ In the 2008-09 academic year, PSOM reduced its operating budget by 10% by streamlining administrative support and processes. No cuts were made for those programs and services supporting medical students. Valuing Teaching ♦ The Academy of Distinguished Medical Educators was founded in 2006 by the former Dean of the Biological Sciences Division (BSD) and the Dean for Medical Education at the Pritzker School of Medicine. ♦ The mission of the Academy is to recognize and reward teaching excellence, to build community among medical educators, to support scholarship in medical education, and to enhance the status of medical education at the University of Chicago. ♦ The Academy is led by the Associate Dean for Medical School Education. ♦ The Academy sponsors an annual Medical Education Day, provides competitive grants for educational innovation and research, and supports faculty development programs for faculty. ♦ Appointment, reappointment, promotion, and tenure in all BSD faculty tracks require a significant and excellent program of education. Documentation of teaching quality and quantity is necessary in all appointment, reappointment, and tenure proposals. Curriculum Renewal Process ♦ The Pritzker School of Medicine underwent an 18-month-long LCME institutional self-study in 2003-04. ♦ Among the recommendations from that process was a recommendation to review the overall curriculum. ♦ This review, undertaken in 2004-05, recommended some key principles for future curriculum development: an emphasis on active learning integration among disciplines when possible and appropriate a requirement for a scholarly project for all medical students ♦ In October 2005, the Pritzker School of Medicine commenced The Pritzker Initiative: A Curriculum for the 21st Century to review, evaluate, and redesign the curriculum for the medical school. ♦ In 2005, the Dean for Medical Education created a task force of key faculty to help determine the six basic intellectual domains upon which the new curriculum would be founded, which include molecules and cells normal body (structure/function) body and disease physician–patient–society–systems foundations of clinical medicine scholarship and discovery ♦ The task force was led by three senior faculty members drawn from the basic and clinical sciences and with a longstanding commitment and engagement in medical education. ♦ In 2006, the Dean for Medical Education created the Pritzker Initiative Steering Committee to operationalize the recommendation of the task force and to begin planning for implementation. The committee met monthly over three years. ♦ The key components of the new curriculum include the following: Medical school begins in early August (rather than the end of September). The beginning of the school year is anchored by an introduction to anatomy, via The Human Body course, and to scholarship and discovery. The early-August start date allows for comprehensive study of Human Body before the start of other preclinical coursework. The restructured Human Body incorporates participation from the clinical departments of Radiology, Surgery, and Anesthesia and Critical Care. The curricular time “vacated” by Anatomy in the autumn and winter quarters allows time for small-group and independent learning in the other courses. A required Scholarship and Discovery thread highlights the principles of medical research and bioinformatics and prepares students to complete a mentored scholarly project by the time of graduation. During their second year, students must declare a focus on one of five scholarly tracks: Scientific Discovery, Medical Education, Quality and Safety, Community Health, and Global Health. Each student has a faculty mentor at all stages and will participate in companion coursework designed for each track. Students may have the opportunity to spend six to eight weeks at the end of the second year to focus on their scholarly projects. The required course on Health Care Disparities in America commences during the summer and is a unique experiential program to help further students' understanding of disparities that exist within the health care field. Students attend lectures taught by leaders from the area and University and spend time visiting local free clinics, community centers, emergency rooms, and hospitals to gain a first-hand perspective of health care inequalities. Students leave the class informed of the magnitude of health disparities, better prepared to effectively communicate across cultures, and with a commitment to reduce these disparities. Years one and two: Scientific Foundation of Medicine blocks: Integrated preclinical courses that progress sequentially from the study of cellular function to organ systems to disease. The blocks include Cells and Molecules,Physiology and Histology,Response to Injury, and Neurobiology and cover the following topics: biochemistry and metabolism, cellular organization and function, developmental biology and organogenesis, genetics, organ biology, immunology, neurosciences, cellular pathology, microbiology, and pharmacology. Four-year longitudinal course Physician–Patient–Society–Systems prepares students for the complexities of practicing medicine in the 21st century. This sequence includes Clinical Skills and Physical Diagnosis: Doctor–Patient Relationship; Social Context of Medicine, a longitudinal clinical experience, and a thread in geriatrics and palliative care medicine. Restructured clinical years: Neurology is a new required four-week core third-year clerkship and Emergency Medicine is a required four-week fourth-year clerkship. Transitions courses: Students take required transitions courses following their second year and fourth year to provide them with the skills and knowledge they need to transition from preclinical realm to the clinical realm and from fourth-year students to their internship training. Students will participate in a required two-week Foundations in Clinical Medicine course prior to the entry into the third-year clinical rotations and a Capstone experience at the end of the fourth year. In addition, most students take an elective Subinternship Preparation course prior to the beginning of the fourth year. ♦ Although some key elements of curricular change were implemented in the 2008-09 academic year, the class matriculating in 2009 was the first to go through the fully implemented curriculum in year one, with progressive implementation of the remaining curriculum through 2012. Pritzker School of Medicine Learning Objectives ♦ The goal of the University of Chicago Pritzker School of Medicine is to graduate accomplished physicians who aspire to excellence as outstanding physician–scientists, medical educators, and clinicians. ♦ The educational objectives for all students graduating from the Pritzker School of Medicine are listed below. Students will: exhibit exemplary professionalism in all personal and professional actions and interactions. exhibit the highest moral and ethical standards in the care of patients and in their interactions with others. be prepared to assume future leadership roles as outstanding investigators, educators, and/or clinicians. develop sustained competence in medicine through commitment to lifelong learning. develop the skills necessary to critically evaluate the medical literature and integrate new developments into medical practice in an appropriate manner. acquire a thorough understanding of the basic sciences and their application to the practice of medicine and to medical research. demonstrate excellent interpersonal communication skills with patients, colleagues, and staff. exhibit a high level of clinical proficiency in history taking, physical examination, differential diagnosis, and the effective use of medicine's evolving diagnostic capabilities and therapeutic modalities. apply to clinical care an understanding of the impact of psychological, social, and economic factors on human health and disease. develop effective teaching skills in order to educate colleagues and patients. possess the skills and competencies necessary to address the needs of a diverse patient population. New Topics in the Curriculum Since 2000 ♦ Patient safety and quality improvement: Patient safety and quality improvement are core topics in the Scholarship and Discovery thread in the first year and in the Physician–Patient–Society–Systems thread in the second year (through the Social Contexts of Medicine course). ♦ Simulation: Simulation exercises and standardized patient experiences occur throughout the four-year curriculum. Standardized patient experiences occur in the Clinical Performance Center on the University of Chicago campus. Students participate in a standardized series of simulated experiences in a state-of-the-art simulation center at the educational affiliate, NorthShore University Health System, during the required clerkship in Emergency Medicine. ♦ The PSOM utilizes simulated and standardized patients in all aspects of the Clinical Skills course sequence for teaching and assessing communication and physical exam skills, as well as for OSCE's during clinical clerkships. ♦ The Clinical Performance Center also provides a safe and protected environment for experiences that combine both patient encounters and simulation equipment for teaching and assessment. The Clinical Performance Center resources include the following: Ten exam rooms for teaching sessions and student–patient encounters, all equipped with recording cameras and desktop computers for assessing encounters. HARVEY cardiac patient simulator, with 27 possible disease state manifestations. HeartMans infrared headphones allow for teaching sessions with HARVEY for up to 20 participants. B Line AV system, an online video capture and objective assessment tool. A reporting function allows faculty members to filter and extract data on projects and events, which can then be translated to research opportunities. ♦ Simulation is also an integral part of the clerkship in Emergency Medicine and the Capstone Course on transitioning to internship at the end of the fourth year. Additional new topics in the Curriculum since 2000 also include: ♦ Scholarship and discovery. This thread runs through all four years of the curriculum (described earlier). ♦ Physician–Patient–Society–Systems (P2S2). The P2S2 thread runs through all four years of the curriculum (described earlier). ♦ Foundations in clinical medicine. This two-week course is offered just prior to clinical clerkships (described earlier). ♦ Capstone course. This new required course at the end of the fourth year brings the fourth-year students back together before residency. The course provides opportunities for reflection and advanced clinical skills to prepare for internship (e.g., procedural skills, teaching skills, advanced interviewing and physical diagnosis skills, physician wellness, and work–life balance). ♦ Health care disparities course. This course is offered at the beginning of the first year of medical school (described earlier). Changes in Pedagogy ♦ As part of the Pritzker Initiative curriculum reform process, all preclinical courses incorporated more small-group learning experiences. ♦ There was an attempt to integrate course material more effectively than the previous departmentally based course structure. For example, a new course entitled “Cells, Molecules, and Genes” integrates material from biochemistry, cell biology, and human genetics and uses patient cases as the scaffolding upon which the basic science concepts are learned in facilitated small groups. ♦ Another example of the evolution of pedagogy is the horizontal and vertical integration of the TIME (Technology In Medical Education) project, one aspect of which makes the entire Pritzker curriculum available through online media and searchable databases to learners at all levels, allowing access to preclinical material in the clinical years and vice versa. This accessibility fosters and supports students' independent learning. Changes in Assessment Since 2000, there have been two enhanced trends in assessment: ♦ There has been a dramatic increase in the use of technology to assess students: Online tests and quizzes provide students with reasons for incorrect/correct choices, and students are able to retake quizzes until they achieve competency. OSCEs go online: The use of online systems to record student interactions with standardized patients allows faculty to view and annotate interactions for subsequent review with and by students. ♦ The second trend involves the enhanced assessment of competencies: expanded use of OSCEs to neurology and psychiatry clerkships. reintroduction of an oral exam in medicine clerkship to stress differential diagnosis competency. introduction of a comprehensive Clinical Skills exam at the end of third year. evaluation of professional behavior as part of clerkships. Clinical Experiences ♦ Sites for clinical education include the following: University of Chicago Medical Center NorthShore University Health System Mercy Hospital and Health System Community health centers ♦ Challenges related to clinical education emerge from the changing health care environment both within the University of Chicago and in its surrounding neighborhood. ♦ Maintaining the appropriate balance between onsite and offsite experiences and between exposure to primary and specialty care in clinical education is an ongoing challenge for clinical education of medical students. ♦ As the University of Chicago's case mix has changed, the medical school has utilized educational affiliations to support the appropriate balance of general and specialty care. Nevertheless, the majority of clinical training continues to be offered through the University of Chicago Medical Center. Highlights of the Program/School ♦ The University of Chicago Pritzker School of Medicine is physically situated on the campus of the University, which allows for robust interdisciplinary exchange between the research scientists and clinical teachers. ♦ It is this legacy of scholarship that has inspired the new scholarship and discovery component of the Pritzker curriculum. ♦ Currently more than 60% of students have published research work in peer-reviewed publications. ♦ Students are primarily taught by full-time faculty, and as a result, Pritzker graduates aspire to academic medicine careers at more than twice the rate of all U.S. medical school graduates. ♦ Pritzker's robust mentoring and advising structure provides intensive interactions with the faculty both through the scholarship and discovery component of the curriculum and through the advising societies. ♦ Students are assigned to one of four advising societies, which provide students with layered peer mentoring and career advising support throughout all four years. ♦ Students have the opportunity to take electives in their first, second, and fourth years. Because of the location of the medical school, students have unparalleled opportunities to access the unique interdisciplinary resources of a world-class university. ♦ Located in the diverse Chicago neighborhood of Hyde Park, Pritzker's curriculum and student programs focus on reducing health care disparities. ♦ The school requires all first-year students to participate in a required course on Health Care Disparities and offers four summer pipeline programs for high school and college students who are underrepresented minorities in medicine to learn the skills they need to succeed in future health care careers. ACKNOWLEDGMENTS: The authors wish to thank Dana Levinson and Kelly Smith for their expertise in preparing the manuscript.