University of New Mexico School of Medicine.

Abstract

Curriculum Management and Governance Structure ♦ The curriculum changed in 1993 and now requires centralized governance of education. ♦ Currently, there are two governing bodies for education. The Education Council, a committee of the faculty (formerly known as the Curriculum Committee) makes education policy recommendations to the faculty. The Integrating Group implements and monitors the curriculum. The Integrating Group reports to the dean via the associate dean for undergraduate medical education. ♦ Prior to the changes in the new curriculum (1993), two steering committees (one for years one and two; another for years three and four) were responsible both for implementation and for evaluation and promotion of students. ♦ The evaluation and promotion functions, formerly carried out by the steering committees, are currently handled by the committees on student promotion and evaluation. Office of Education ♦ The Office of Undergraduate Medical Education was established in 1971. ♦ The office was enhanced significantly during the 1980s and 1990s as a direct result of funding from the W. K. Kellogg Foundation to support the innovative Primary Care Curriculum and The Robert Wood Johnson Foundation's Program for Medical Education. The latter facilitated the union of the two prior parallel tracks of 15 years' duration. Budget to Support Educational Programs ♦ This budget was established originally with the Office of Undergraduate Medical Education (1974) and has been increasing steadily through grant support for innovation in curriculum and education. ♦ Over time, hard money has replaced grant support for undergraduate medical education. ♦ Currently, funding is from the state and the dean's office. Valuing Teaching ♦ Faculty with primary responsibility for education components and programs are: elected by block committees appointed by chairs self-identified ♦ In addition, these faculty serve on committees that organize and implement the curriculum. They are recognized and receive credit for their leadership roles in education. CURRICULUM RENEWAL PROCESS Learning Outcomes ♦ Almost all components of the medical education experience specify learning outcomes. ♦ Five competencies (communication; clinical skills; critical integration of knowledge; professional attitudes, values, and ethics; and self-assessment) are specified and assessed as part of a series of comprehensive Student Progress Assessments (SPAs) that occur three times over the course of four years. ♦ There are specific outcomes for student research, clinical skills, rural primary care experiences, individual organ system blocks, and clerkships. They are developed by faculty committees and groups that report to the Integrating Group. ♦ At the present time, we do not have a unified statement of graduate outcome objectives. Changes in Pedagogy ♦ Parallel education tracks existed during years one and two of the curriculum from 1979 to 1995. The two tracks were joined, combining the best of each, extending their innovative features across all four years. ♦ Student-centered, small-group, problem-oriented, community-based learning is now part of all students' experiences. Formerly such learning was focused more on the students in the Primary Care Curriculum (20 of 73 students). ♦ All learning experiences are focused around the use of clinical cases from the first day of medical school. ♦ Integration of learning throughout the four years includes consideration of normal and abnormal; biology, behavior, and population; primary and tertiary care; and urban and rural community experiences. ♦ Small-group, problem-based learning using cases has been extended beyond the early years of medical education into all of the core clinical clerkships. ♦ Standardized patients, used during training in clinical skills, selected courses, and clerkships, are a key feature of the Student Progress Assessments. ♦ Prior to graduation every student is required to complete a research project. Application of Computer Technology ♦ Students are required to have computers at entry to medical school. ♦ Computer technology is used to provide case exhibits in problem-based tutorials, for intranet communication among students, faculty, and staff, and in student-assessment (formative and summative). ♦ Syllabi and handouts are available electronically. Changes in Assessment ♦ A performance assessment of students is administered three times during the four years of medical school. ♦ This assessment, known as the Student Progress Assessment (SPA), assesses five competencies: (1) clinical skills, (2) communication, (3) critical integration of knowledge (CrIK), (4) professional attitudes, values, and ethics (PAVE), and (5) self-assessment. ♦ The assessments are administered during the second semester of the first year (SPA 1), during the fall semester of the second year (SPA 2), and as an exit clinical examination in the final year of medical school (SPA 3). ♦ SPA 3 is a sequential assessment. The first administration is a screening assessment in which the students have the opportunity to demonstrate their skills and abilities in each of the competencies. If necessary, a second attempt is provided six months later. ♦ Standardized patients are used in an objective structured clinical examination (OSCE) format to assess clinical and communication skills. ♦ Other methods include multiple-choice examinations, modified essay questions, self-assessment, and essays about professional attitudes, values, and ethics. ♦ Computers have been used in the SPA in the past; however, at the present time the use of computers occurs primarily during the various block/course assessments. ♦ In SPA 1, the students are observed by faculty and given feedback on their communication skills. ♦ Increasingly, SPA methods are also used throughout the curriculum. Individual blocks use modified essay questions in addition to multiple-choice questions. ♦ Several blocks use computers to administer modified essay questions. Students submit their answers electronically, and receive immediate feedback from the course director. ♦ Students are observed doing a complete history and physical examination as part of the assessment in the Clinical Skills course. ♦ Two of the core clinical clerkships administer OSCEs as components of their assessments. One OSCE is administered formatively early in the clerkship and the other at the end. All core clerkships are committed to having OSCEs beginning in March 2001. ♦ Assessment takes place in the student-centered, problem-based, small-group tutorials. It is based on students' self- and peer-assessments and faculty assessments. This accounts for 30% of each student's grade in Phase 1 of the curriculum. Clinical Experiences ♦ Students start clinical training and experience with patients from day one. They learn to perform a screening history and physical examination and develop interviewing skills during the first semester of medical school. ♦ Students begin learning in community- and university-based clinical settings one afternoon each week. This starts in the second semester and continues through the end of the third year. ♦ At the end of the first year of medical school, all students spend four to 12 weeks in a primary care community-based setting seeing patients under supervision and refining their self-directed learning skills. Students may elect to return to medical school to begin work on their required research projects. Approximately two thirds of the students elect to spend the full 12 weeks in the primary care setting. ♦ Approximately half of the core clerkship experience is ambulatory. ♦ Every student is required to take a four-week preceptor-ship outside the academic health science center during the final year of medical school. Curriculum Review Process Fifteen years of parallel-track innovations have taught us the value of longitudinal and comprehensive curriculum review and analysis. ♦ Integration of basic and clinical sciences has been accomplished by extending tutorial learning through the core clerkships and by moving USMLE Step 1 to the end of the third year. ♦ Student-centered, problem-based learning, lectures, laboratories, and seminars are combined in an interdisciplinary curriculum that takes place in urban and rural ambulatory and inpatient settings. ♦ Faculty development in teaching, education, and assessment is integral to all programs as part of the continuum of education and practice. ♦ Comprehensive short-, medium-, and long-term data gathering and analysis are an institutional feature of our innovations. ♦ The data are reported orally and in writing regularly at the Integrating Group and Education Council meetings and at meetings of departmental chairman, deans, and directors. ♦ Planning resources are provided by the dean's office and used to support the Office of Program Evaluation, Education, and Research, whose task it is to carry out the evaluation of the curriculum. ♦ Decision-linked research informs implementation and guides analysis of unanticipated outcomes. ♦ Annual education retreats based on information acquired from the curriculum review process, Student Progress Assessment data, and faculty perspectives are used to modify the curriculum. Future Goals ♦ In the next five years, plans are to introduce more uniform and codified performance assessment throughout the continuum of undergraduate and graduate medical education. ♦ There is a plan to increase the relevance of the missions of the medical school to the health of the citizens of New Mexico. New and innovative approaches to recruiting and retaining educationally disadvantaged New Mexicans in the health professions are being created. ♦ Establishing quality assurance and leadership in medical education through faculty development and peer review remains a central mission of the institution.