University of Cincinnati College of Medicine

Abstract

Curriculum Management and Governance Structure ♦ The educational program is coordinated through an Office of Medical Education led by the Senior Associate Dean for Academic Affairs. ♦ The Senior Associate Dean serves as chair of the Education Policy Committee (EPC). The EPC was created in the early 1990s in response to LCME accreditation standards that require “integrated institutional responsibility for the design and management of a coherent and coordinated curriculum” (see Figure 1).FIGURE 1:: Curriculum Governance♦ Two standing committees report to the EPC, a combined Year-I/II Curriculum Committee and a Year-III/IV committee. Membership on each of the standing committees includes course/clerkship directors, faculty at-large, and medical students. ♦ The EPC reports to the College of Medicine Council, the governing body for the College of Medicine. This Council must approve major curricular initiatives. Office of Education ♦ An Office of Medical Education is well established in the College of Medicine. Major activities of the Office of Medical Education include leading the curriculum analysis, revision, and implementation process directly supporting major interdisciplinary courses such as Clinical Reasoning I/II and Clinical Skills I/II directing the course evaluation process and providing summary results to course directors and curriculum committees developing and implementing the student assessment process coordination of the activities of and providing staff support for the curriculum committees coordinating the activities of the College of Medicine Promotion Boards developing new curricular initiatives ♦ A Department of Medical Education was formed in 2009. This Department will be the academic home for select key teaching faculty. The Department will also be the center for an increased emphasis on teaching skills development. Budget to Support Educational Programs ♦ A defined budget is available to support the activities of the Office of Medical Education. ♦ Each year, the office prepares a budget request for submission to the dean, as do all departments in the College. ♦ The Office of Medical Education budget is subject to the same review and scrutiny as are all other budget submissions. ♦ In 2009, the College of Medicine created a Department of Medical Education. The budget for the Department of Medical Education is distinct and separate from that of the Office of Medical Education. ♦ Funds for teaching activities within the departments are distributed directly to those departments by the dean. ♦ A model has been created that partially distributes funds based on departmental teaching activities. ♦ The formula utilized is based on contact hours in each of the first two years of the medical school curriculum and length of a rotation in weeks multiplied by the number of students on a rotation for the clinical years. Valuing Teaching ♦ Faculty whose primary responsibility is the medical student education program are identified and recognized through a variety of means. ♦ Teaching awards are presented every year at the college level. The nomination process for these awards is student driven, with faculty recipients being chosen by those who are closest to their teaching. ♦ At the departmental level, a similar awards process recognizes teaching. Although the details vary from department to department, most have some sort of award that uses student evaluations of teaching as part of the decision-making process. ♦ Every two years, the College of Medicine presents the “Dean's Award for Excellence in Teaching” to faculty nominated by their peers. ♦ A monthly skill development seminar series is offered for medical school faculty engaged in classroom, bedside, or community provider teaching; instructional design and curriculum development; scholarly activity; and leadership, administration, and organizational development. ♦ The College of Medicine is creating a Teacher's Grove to recognize and memorialize a highly select cadre of faculty members who have contributed significantly through their teaching in medical student and graduate medical education. Curriculum Renewal Process ♦ The College of Medicine embarked upon a major curriculum renewal effort in 1997. Although there was significant resistance to major structural changes, the result of the efforts included an increased integration among courses in the first two years, the increased use of small groups and case based learning, and the adoption of a developmental stage learning outcome model. ♦ In 2009, UC committed to a comprehensive analysis and revision of the medical school curriculum across all four years. ♦ The Curriculum Analysis and Revision Taskforce (CART) and supporting work groups include members of undergraduate and graduate medical education faculty, students, department chairs, administration, and COM organization leaders. ♦ The mission of the taskforce is to facilitate the development of an integrative curriculum that prepares physicians for practice in the 21st century. The taskforce has been charged by the Educational Policy Committee with the following objectives: integrating basic, clinical, and social sciences throughout the four-year curriculum; transforming the medical school curriculum to work as a single unit to allow revisitation of topics while applying an ever-changing base of knowledge; incorporating societal concerns that arise in the areas of health disparities, prevention, outcomes, and safety; designing clinical experiences that will provide students the opportunity to work with patients early in the curriculum and in a variety of venues; designating more time in the curriculum for students to explore areas of interest, service learning opportunities, and scholarly research; designing opportunities for students to become skilled at lifelong learning; assessing needs of faculty related to teaching skills; creating a centralized curriculum management system. ♦ Initial implementation of the revised medical school curriculum is anticipated to begin Fall 2011. Learning Outcomes/Competencies ♦ The College of Medicine currently utilizes a three stage developmental model to determine anticipated student learning outcomes. ♦ Year-level competencies have been cross-referenced against the 27 ACGME subcompetencies listed under the six overarching ACGME competencies (Patient Care, Medical Knowledge, Practice based Learning, Systems based Practice, Interpersonal Communication, and Professionalism). ♦ At the end of each year, all course and clerkship directors review and make needed changes to the Year-level, course/clerkship goals/competencies as well as the ACGME competency table to ensure continued relevance for the upcoming academic year. ♦ During the third and fourth years, students are required to either observe or demonstrate skill attainment of 34 clinical procedures identified by the Year-III/IV committee. New Topics in the Curriculum Since 2000 ♦ Third-year students participate in an annual Disaster Preparedness workshop to provide education related to both natural and terrorist disasters. ♦ A four-week global health elective is offered with two weeks of didactics in the United States and two weeks spent working in the clinic and participation in public health projects in remote communities of Brazil, Ecuador, Honduras, or Tanzania. ♦ A four-week elective is offered in Population Health and Evidence Based Medicine. ♦ Third- and fourth-year students engage in team training for rapid medical response using SimMan scenarios. Changes in Pedagogy ♦ Since 2000, there has been a concerted effort to shift the curriculum from a lecture based approach to a more interactive and case based approach. ♦ Success of these changes has been measured by student performance, student and faculty feedback, and NBME examination scores. ♦ Small-group interactive sessions have increased. ♦ Scheduled contact hours have been reduced to a maximum of 22 hours per week, with no more than 50% scheduled as large group lecture activity. ♦ The basic science courses have worked to improve organ based content integration while maintaining a discipline based format. ♦ Courses have increased clinician involvement, and clinical cases are utilized as part of the teaching methodology. ♦ The UC SimCenter opened in 2001 and provides learning and assessment services through the use of high-fidelity simulators and task trainers in the Clinical Skills Learning Laboratory and a vibrant Standardized Patient (SP) program. ♦ Placed computer terminals at each dissecting table. This enables the students to access an eDissector with directions for the dissection sequences. An electronic dissector gives us the capability of custom designing the laboratory dissections to meet our needs here at the College of Medicine. ♦ Introduced team based anatomy-learning sessions at the conclusion of each content block to reinforce the clinically relevant anatomy. This was done to accomplish the goal that the student should be able to make reasonable predictions of the clinical manifestations of injury or disease to anatomic structures and relate anatomic structures to clinical diagnostic procedures and treatment approaches. ♦ Implemented computer based lecture examinations, with digital slides included on laboratory examinations in Histology and Cell Biology. ♦ Virtually 100% of first-year students and 64% of second-year students accessed peer tutoring over the past three academic years. Tutoring is provided predominately in small groups by second-year students who are paid for their instruction. ♦ A group of MD/PhD students provide instruction for a Student-Led Board Review Course for USMLE Step 1 that began in 2006. Modeled after a similar course at the Mayo Clinic School of Medicine, the course is offered free of charge in the spring quarter of the second year of medical school. The school's pass rate for USMLE Step 1 for the past three years is 98.7%. ♦ Opportunities for community service are numerous, and the medical students at UCCOM provide many hours to a wide variety of sites in the Greater Cincinnati area. Even without a requirement for service learning in the curriculum, survey data indicates that 75% of the student body volunteers in service organizations while in medical school. Changes in Assessment ♦ UC COM has moved to computerized test administration for basic science courses. All students are able to be tested at one time in our expanded computer laboratory space. ♦ All clinical clerkships require students to practice and have assessed a variety of clinical and procedural skills in the UC SimCenter. ♦ Clinical clerkships (e.g., Medicine, Psychiatry) have replaced all or parts of their traditional clinical assessments with SP assessments in the UC SimCenter. ♦ Fourth-year medical students are required to pass the Clinical Competency Examination (CCX). ♦ First- and second-year medical students undergo training and assessment of history taking and physical examination skills in the UC SimCenter. ♦ First- and second-year students are evaluated on the ability to manage challenging patient problems such as domestic violence, ethical dilemmas, substance abuse, and geriatric patients in the UC SimCenter. Clinical Experiences ♦ First-year students work extensively in the Standardized Patient Learning Laboratory of the UC SimCenter to develop and assess History and Physical Examination Skills. ♦ First-year students refine their history taking and presentation skills by working with hospital based patients. ♦ First-year students participate in the Clinical Opportunities rotation of the Clinical Skills I course. This rotation offers students the opportunity to work with physicians in a community based office setting several times during the year. ♦ Second-year students continue to develop, refine, and assess their history taking, advanced interviewing skills, physical examination, and presentation skills during the Clinical Skills II course through work with Standardized Patients in the UC SimCenter and hospital based patients. ♦ Third-year clerkships combine ambulatory and inpatient experiences in a variety of settings including University Hospital Veterans Administration, Cincinnati Children's Hospital Medical Center, community hospitals, hospital based outpatient clinics, and community practice sites. ♦ Fourth-year students are required to participate in eight weeks of Internal Medicine Acting Internships (AI). ♦ Fourth-year students participate in a four-week Neurosciences rotation. ♦ Fourth-year students have 24 weeks of elective time available to enhance their clinical training as they prepare for graduate medical education. Four weeks are designated for an Internal Medicine elective; 8 weeks are designated for Intensive Clinical Experience (ICE) electives in any number of specialties; and 12 weeks of elective time can be scheduled at the students' discretion based on their interests and career plans. ♦ A number of unique specialty clinical experiences are available to fourth-year students at the Shriner's Hospital Burn Institute and the Drake Center, a full service rehabilitation center. Highlights of the Program/School ♦ Officially opened in September 2008, the Center for Academic and Research Excellence (CARE)/Crawley Building in the University of Cincinnati (UC) Academic Health Center features a nine-story glass atrium connecting it to the Medical Sciences Building, providing almost 240,000 square feet of additional space on the medical campus for research and teaching. ♦ The new building houses the new health sciences library and some of the most technically advanced laboratory research and teaching space in the nation. ♦ The College of Medicine requires that every fourth-year medical student complete two months of Acting Internship (AI) in Internal Medicine. ♦ The UC SimCenter, with its state-of-the-art digital imaging equipment and its superb standardized patient program, focuses on the development and assessment of the essential skills of the medical interview and physical examination and diagnosis. ♦ The Clinical Skills Laboratory houses state-of-the-art simulation devices and equipment, such as SimMan® and task trainers to support training in medical skills and procedures. ♦ UC COM is committed to designing and providing an integrative curriculum that prepares physicians for practice in the 21st century. This dedication is demonstrated by the creation of a Department of Medical Education, the current comprehensive analysis and revision of the four-year curriculum, and the dedication of resources to the medical education mission.