University of Massachusetts Medical School

Abstract

Curriculum Management and Governance Structure ♦ The Educational Policy Committee (EPC) and its subcommittees share responsibility for oversight and management of the program leading to the MD degree (see Figure 1).FIGURE 1:: Organizational Structure for Governance of Educational Program♦ EPC voting membership is constituted by departmentally appointed representatives and positions allocated to representatives from major clinical teaching affiliates and community-based partners. ♦ As the representative governance body for the curriculum, the EPC reports to the Dean through the Senior Associate Dean for Educational Affairs and is responsible for oversight, quality assurance, policy approval, and management of the overall curriculum. ♦ The EPC's three curriculum subcommittees (Year 1, Year 2, and Clinical Years) are constituted by course and clerkship leaders, students, and ad hoc nonvoting administrative members. ♦ Under the oversight of the Associate Dean for Undergraduate Medical Education, the EPC's subcommittees are responsible for oversight, management, and quality assurance of individual courses and clerkships. Office of Education ♦ In 2007, under the direction of the Dean, the academic enterprise of the medical school was restructured as a mission-driven model, with the creation of leadership positions reporting directly to the Dean in the areas of educational affairs, faculty affairs, clinical affairs, and research (see Figure 2).FIGURE 2:: Offices Serving the Education Mission♦ The Office of Educational Affairs (OEA), led by the Senior Associate Dean for Educational Affairs, is responsible for oversight, coordination, supervision, and reporting for the continuum of medical education, spanning the offices of admissions, student affairs, undergraduate medical education, graduate medical education, continuing education, and allied health and interprofessional education. ♦ The OEA serves as the operational core for the school's educational mission, providing key resources to assure quality and promote state-of-the-art innovation in teaching and learning. ♦ Under the OEA umbrella, seven divisions and programs serve comprehensive needs of faculty and students. The work of the OEA is supported by full- and part-time positions that include 5 staff, 17 professionals, and 6 faculty. ♦ A new position of Associate Dean for UME was established to oversee the Office of Undergraduate Medical Education (OUME) and to provide dedicated oversight for the school of medicine's curriculum, including comprehensive curriculum redesign, curriculum development and management, programmatic evaluation, student assessment, and faculty development. This position reports to the Senior Associate Dean for Educational Affairs. ♦ Drawing on OEA resources, programs sponsored by OUME include community-based education; Doctoring and Clinical Skills course; interclerkships; longitudinal clinical experiences; enrichment electives; targeted faculty development; and programs in student research, international medical education, and service learning. ♦ The OUME is supported by 6 full-time staff and 5 professional and 11 faculty positions on either a full- or part-time basis. ♦ The OUME supports the Educational Policy Committee and its curriculum subcommittees; on-line curriculum calendar and database; and curriculum development funding. Financial Management of Educational Programs ♦ In addressing fiscal constraints challenging academic medicine nationwide, our educational mission is guided by institutionwide processes and strategies aimed at enhancing operational efficiencies and augmenting revenues. ♦ The “continuum of medical education” model for oversight under the OEA promotes consistency, economies of scale, and streamlined administration for fiscal management, including: consolidated budget reporting for personnel and operations funded through the Dean's office; and joint planning for educational space and technology investments. ♦ The OEA and component offices participate in institutionwide initiatives in resource maximization. ♦ OEA resources support educational needs of the two other graduate schools housed on the UMMS campus (nursing and biomedical sciences), streamlining resource oversight and promoting economies of scale. ♦ Supporting a mission-based model, departmental funding for teaching effort is undergoing review. ♦ Under the Dean's oversight, a task force has been charged with developing metrics for educational effort of faculty and department support for educational programs, including undergraduate and graduate medical education. These metrics will inform allocation of institutional funds to departments, assuring optimal alignment of educational effort with institutional support. ♦ Supplementing strategies for enhanced efficiencies, opportunities for augmented revenues include the following: Philanthropy targeted at expanding and upgrading educational space; State funding for capital infrastructure to support class expansion; Modest increase in student curriculum fees supporting educational technology and infrastructure enhancements; Revenue lines through OEA resources: standardized patient program, research and evaluation consultation, and use of simulation center; External funds supporting educational innovation and scholarship: Since 2000, we have secured 14 educational grants and contracts with private foundations, government sponsors (NIH, HRSA), oversight organizations (AAMC, NBME, and AMA), and our parent university. Valuing Teaching ♦ The valuing and development of teaching among our faculty are vested in the medical school's Office of Faculty Affairs (OFA). ♦ Under the oversight of the Vice Provost for Faculty Affairs, the OFA offers programs and initiatives to advance faculty skills, knowledge, and scholarship in teaching. ♦ The OFA comprehensively serves the broad needs of faculty in their teaching roles through customized, one-on-one mentorship and guidance and formal professional development programs. ♦ The OFA is guided by an advisory committee whose membership spans all faculty ranks, the medical education continuum, and diverse expertise including information technology, library services, and medical education research and scholarship. ♦ Programs include the following: Scholarship of Teaching and Learning Program: Teaching to Publication; Innovations in Teaching and Learning with Technology; Simulation in Teaching Faculty Development Program; Faculty Promotion and Teaching Integrated Workshop Series. ♦ The faculty appointment, promotion, and tenure processes recognize and reward the value and importance of teaching. ♦ The UMMS Academic Personnel Policy provides specified criteria for educational activity for each rank across three pathways (clinical, traditional, and research), for tenure and nontenure track faculty. ♦ Specific measures for assessing faculty contributions to educational programs or mentoring are delineated for each level of appointment and promotion, across all pathways and tracks. ♦ A teaching portfolio template has been developed for guiding and standardizing documentation of educational activities for all levels of appointment and promotion, and faculty may schedule one-on-one coaching sessions to further develop their portfolios. ♦ In 2008, the medical school approved guidelines for developing faculty compensation plans, consistent with and supportive of appointment and promotions criteria. Developed under joint leadership of the Dean and physician group practice, these guidelines assure that faculty compensation plans across departments fairly reward and incentivize contributions to education, as well as clinical care, research, and service. ♦ Clinical and basic sciences departments must implement compensation plans according to these guidelines, with criteria for teaching achievement and excellence, consistent with appointment and promotions standards. Curriculum Renewal Process ♦ UMMS is in the process of comprehensive curriculum renewal formally launched in Spring 2008, following a four-year period of data gathering and analysis with key objectives and components as follows: 2003: Approval of six UMMS competencies, guiding curriculum review and redesign. 2004–05: Comprehensive data gathering and review: internal course evaluations; AAMC GQ data; performance on internal and external assessments (USMLE, NBME); alumni, resident, and faculty surveys; LCME standards and accreditation outcomes; and recommendations from the literature and national organizations. 2005–06: Curriculum needs assessment: identifying the need for structural redesign and priorities for change. 2006–08: Curriculum “Blue-Printing”: approval of new framework for redesigned curriculum featuring: Comprehensive basic and clinical science integration with shared course leadership representing clinical and basic sciences and multiple specialties; Earlier start to clerkship experiences with earlier elective time in Year 3; Required capstone project promoting scholarship and life-long learning; Learning communities fostering continuity of teaching and mentoring relationships with faculty, peer mentoring, and teaching, and community engagement; Transitional curricula at key “junctions” in the curriculum; Enhanced student responsibility for learning through directed preparatory exercises; Longitudinal themes integrated across years. 2008–present: Detailed design for new “Learner-centered Integrated Curriculum” (LInC): establishing a representative body of “curriculum trustees” to lead the project, with oversight and resources from OUME and schoolwide engagement through: multiple retreats; town hall meetings; list-serv updates to over 450 faculty and students; presentations at standing curriculum, faculty, departmental, and institutional leadership groups; and comprehensive LInC intranet and internet websites. (http://www.umassmed.edu/curriculum.aspx) August 2010 and beyond: LInC Rollout commencing with the new Foundations of Medicine curriculum for entering class of 2010, followed by staged implementation to be completed in 2013-14. Learning Outcomes/Competencies ♦ Six competencies for the educational program leading to the MD degree were developed through an institutionwide initiative engaging faculty, students, residents, alumni, community-based and volunteer faculty, and institutional leadership. ♦ Approved by the UMass Educational Policy Committee in June 2003, these competencies are Physician as Professional, Scientist, Communicator, Clinical Problem Solver, Patient and Community Advocate, and Person (see http://www.umassmed.edu/uploadedfiles/competencies.pdf). New Topics in the Curriculum Since 2000 ♦ Integration of contemporary topics is driven by central curriculum oversight through analysis of recommendations from national medical education societies, faculty innovation, and internal and external stimulus grants. ♦ Representative examples of new or significantly enhanced topics include the following: Geriatrics: Longitudinally integrated geriatrics curriculum across all four years, now undergoing expansion through support from the Donald W. Reynolds Foundation, featuring: geriatrics-based simulation, formative and summative OSCEs, case-based integration in the preclerkship and clinical years (http://www.umassmed.edu/AGE); Patient Safety and Medical Errors: Required full-day interclerkship in Year 3, addressing root causes analysis, disclosure of medical errors, ethics and professionalism, medication safety, and reflection on related clinical experiences; Conflicts of Interest and Sound Prescribing: Web-based modules offering tools for prescriber decision-making, evidence from published literature, and case-based discussion in clinical clerkships; Quality Improvement Curriculum (QuIC): Coordinated curriculum across all four years, including the history of health care quality improvement; health care systems; team collaboration; and analytic quality tools; Simulation: List of “top 40” common procedural skills, identified for simulation-based task training and integrated into case-based modules, beginning in the preclerkship orientation and continuing throughout third-year clerkships. Examples: endotracheal intubation, phlebotomy, central and peripheral venous access, and lumbar puncture. Other notable topics include the following: Pain Management and Addiction: Interclerkship with case-based exercise on prescription drug abuse; Integrated Complementary and Alternative Medicine: Modules in clinical clerkships; Standardized Framework for Health Communications: Data gathering, oral presentation, and clinical hand-offs integrated across all four years; Professionalism: Case discussions and reflective exercises in first three years of curriculum; Sexual Health: Education including sexual orientation and gender identity in the obstetrics and gynecology clerkship and multicultural interclerkship. Changes in Pedagogy ♦ Changes in pedagogy have featured a shift from traditional didactic teaching toward blended and self-directed learning and implementation of appropriate technology to support active learning. ♦ Pedagogical changes since 2000 include Interactive, multimedia instructional technology advances Online videos and podcasts of lectures allowing “out of classroom” access on demand (indexed and searchable); PDF-formatted course materials enabled for personalized study guides; Online virtual patient cases, providing physical diagnosis demonstrations, oral communications skills exercises, and encounters with “real” patients; Virtual microscopy with web-based access to high- resolution digital images, promoting group learning and independent study; Audience response system offering content-focused polling and “real-time” formative assessment; Integrated web-based platform for digital video recording and archiving, allowing remote access for formative, summative, and remediative assessment, peer-to-peer review and self-assessment, and interactive distance learning in clerkships; Required technology purchases for students: Student-owned audience response systems devices; personal digital assistant (PDA) for clinical clerkships with drug data bases applications; and beginning in 2010, a standard issue laptop requirement (Mac or PC models). Space and infrastructure enhancements State-of-the-art Anatomical Sciences Laboratory with drop-down computers at dissection tables, online “dissector” and image data bases, and high-resolution AV digital projection systems; Full service Simulation Center with screen-based simulation, task trainers, and high fidelity manikins; Integrated Teaching and Learning Center, scheduled for fall 2010, providing state-of-the-art technology to support small or large group interactive sessions; high-resolution imaging; multimedia programs; and computer-based testing. Interprofessional and integrated multidisciplinary experiences Enhanced interdisciplinary and interprofessional curricula, including interclerkships in Year 3 addressing eight “hot topics;” Integrated Case Exercises for case-based clinical problem-solving; and two-week interprofessional community health clerkship for medical and graduate nursing students. Student-driven elective opportunities Over 20 “optional enrichment electives” developed through student-faculty partnerships and addressing diverse contemporary topics including: medical interviewing in Spanish, care of the seriously ill, students as teachers, wilderness medicine, and complementary and alternative medicine. Simulation-based experiences Diverse sessions in the Simulation Center spanning preclinical and clinical years, with teaching by senior students, residents, allied health professionals, and medical school and nursing faculty. Pathways offering optional “areas of concentration” A longitudinal “pathway” program providing supplementary curricular experiences for students with interest in three defined areas: rural health, serving underserved and multicultural populations, and clinical/translational research. ♦ Robust assessment of pedagogical change is a standard component of curriculum innovation. Methods include: Comprehensive monitoring of student feedback through focus groups, curriculum committees, end-course and summative end-of-the curriculum evaluations; Pre/postintervention changes in student knowledge, skill, or competence; Longitudinal tracking of GQ survey outcomes; Response on one-year-out alumni surveys with trended analysis; Student performance assessment on internal and external exams; Tracking of peer reviewed presentations and publications as a measure of quality in educational innovation and pedagogy; Recognition of pedagogical innovation through teaching awards, both internal and external, and competitive grants. Changes in Assessment ♦ End of course, clerkship, and yearly evaluations are revised annually by key faculty in consultation with the Division of Research and Evaluation. ♦ Evaluations routinely request student feedback on course content, structure, pedagogy, technology, and student assessment. ♦ Significant course innovation in any area is linked to specific new questions incorporated into these evaluations to capture students' experience and feedback. ♦ Highlights in student assessment implemented since 2000 include: Developed, validated, and implemented a high stakes end-of-third-year OSCE-based assessment, including hybrid cases utilizing standardized patients, high fidelity simulation, and task trainers; Piloted computer-based standardized testing using school-owned laptop equipment for nationally validated question bank; Utilized learning-management system and audience response system for internal course-developed high stakes student assessment; Broadened use of summative OSCEs to include all six required third-year clerkship experiences, as well as implementing a formative OSCE and student self-review of OSCE video for self-assessment and goal-setting; Implemented use of the Comprehensive Basic Science Exam for formative assessment, supported by the school, to aid student preparation for boards; In coordination with comprehensive curriculum redesign, competency benchmarks are being developed, linked with coordinated formative and summative assessment tools. Assessment methods to include: multiple-choice and short answer exams, rubric-graded exercises and problem sets, participation in small group classwork, related simulation and standardized patient cases for thorough student appraisal. Clinical Experiences ♦ The medical school's principle site for clinical teaching is our clinical partner, UMass Memorial Health Care, which features UMass Memorial Medical Center and its three campuses, as well as nine community-based member hospitals and health centers across the region. ♦ Additional clinical training is provided by diverse educational affiliates: three major inpatient teaching hospitals and eight regional community hospitals. ♦ A comprehensive network of ambulatory-based training sites support outpatient teaching, including six federally qualified community health centers, two large multispecialty groups, and over 200 private practices statewide. ♦ Challenges in clinical education of our medical students include Limitations in faculty availability for teaching due to clinical productivity pressures; Standardization of educational experiences across diverse sites through recruitment and faculty development to maintain a high-quality pool of inpatient and ambulatory preceptors; Incentives to assure retention and stability of clinical training sites; Support for developing distance learning and web-based technologies, including faculty effort, technology tools, and instructional technology expertise; Student access to and use of EMR systems across diverse sites; Maintaining an optimal learning environment for students across diverse sites and assuring effective monitoring of professional conduct by faculty, residents, and clinical staff. ♦ Enrollment expansion, with a 20% increase in class size, presented new demands to existing challenges and yielded new opportunities and unexpected outcomes in clinical education for our students, with highlights as follows: Current and new clinical teaching sites welcomed additional student placements, due to several factors: perceived value of affiliation with the medical school; potential downstream recruitment of students as house-staff and practicing physicians (particularly in primary care); accountability of nonprofit organizations to fulfill their mission of service to the broader community; access to medical school assets such as CME, the school library's licensed products and on-line holdings, and partnership in the medical school's growing clinical research enterprise. ♦ Through the OUME's Division of Community-Based Education, we have invigorated faculty recruitment and retention, focusing on volunteer, community-based preceptors, through the following: facilitating appointments and promotions through a comprehensive community-faculty data base; recognizing teaching excellence by volunteer faculty through community-based educator awards; appointing an “Associate Dean for Medical Education” at each major affiliate as the designated representative to the medical school; an annual reception event hosted by the Dean and Chancellor recognizing senior leaders and key educators from affiliate sites. ♦ Interprofessional clinical education for medical and nursing students has been expanded with innovations including team-based clinical case simulations and task training in common clinical procedures. Highlights of the School ♦ The following highlights reflect the medical school's founding mission, the mission-based model for our academic enterprise, and institutional priorities: ♦ Sustained commitment to primary care education: As the state's only public medical school, our principle founding mission was to serve the health care needs of the commonwealth, with a focus on primary care and the care of underserved populations statewide. ♦ Through medical student selection, faculty development and recruitment, quality and innovation in primary care teaching, and institutional support for primary care education, we consistently achieve goals for student recruitment in primary care fields and have established a track record of excellence and national distinction in primary care education and leadership. ♦ The continuum model of medical education: The recent administrative redesign of our academic enterprise, grounded in a mission-driven model, has bolstered the visibility and engagement of education across the institution. ♦ Consolidating the medical education continuum under one umbrella of oversight and management has enabled education to “speak with one voice” and advocate for substantive institutional investments to support diverse learners and programs and assure ongoing quality of teaching and learning. ♦ Education as a cornerstone of our institutional strategic plan: The educational mission of our academic health sciences center features prominently in the 2008 institutional strategic plan, with two of the six major aims focused on education: “Building the workforce of the future” and “Creating the ideal learning environment.” ♦ These aims have stimulated unprecedented advances in our educational programs with initiatives including comprehensive curriculum redesign for the school of medicine; expansion of class size in all three schools on our campus; growth of educational affiliations; and capital investments in the educational infrastructure, including construction of a new education and research facility with dedicated space for learning communities, and a Center for Experiential Learning and Simulation. ♦ Inclusive, integrated, comprehensive curriculum redesign: Our process of engaging hundreds of faculty spanning basic and clinical sciences, evaluation and technology partners, and graduates and students over a period of years allows us to innovate locally and incorporate new national standards in the design of our Learner-centered Integrated Curriculum. ♦ Our model for cross-departmental design and shared leadership of courses brings together new partners to model integrative and interprofessional practice and support student learning and achievement into the next decade and beyond.