University of Vermont College of Medicine

Abstract

Curriculum Management and Governance Structure ♦ The Instructional Improvement Committee (IIC), which is the standing curriculum committee of the college, is responsible for the overall curricular goals and objectives and supports quality improvement across the curriculum (Figure 1).FIGURE 1:: Curriculum Management and Governance Structure♦ The IIC monitors course evaluations and planning and works with the Level Committees (described later) and individual course directors to implement changes. The IIC reviews curricular objectives and competencies as needed; writes, reviews, and approves policies; reviews utilization of resources; and is responsible for longitudinal integration. ♦ A Foundations Committee is charged with design, implementation, and evaluation of the Foundations Level of the curriculum. This committee provides peer review of courses, writes policy for the Foundations Level, and provides ongoing quality improvement through discussion of successes and challenges in curriculum delivery. ♦ A Clerkship Committee is charged with design, implementation, and evaluation of the Clerkship Level of the curriculum and the required components of the Advanced Integration level. Activities of this committee mirror those of the Foundations Committee. ♦ A Medical Education Leadership Team provides strategic planning, ensures implementation of changes, and is responsible for operational management of the curriculum. Office of Education ♦ The Office of Medical Student Education (MSE) supports all aspects of the curriculum including course delivery support, management of the Standardized Patient and Medical Simulation Programs, curriculum evaluation, curricular change, innovation within courses, and faculty development in education. ♦ The MSE comprises seven professionals/educators and eight administrative support staff. Course Directors for Foundations, Clerkship and Advanced Integration required courses are supported through the MSE. Clerkship Coordinators and elective educational components are supported through departmental resources. ♦ The Dana Medical Library and offices of Instructional Technologies and Information Systems also provide integral support for curriculum development and delivery. Financial Management of Educational Programs ♦ The budget for the educational program is developed by the Senior Associate Dean for Medical Education and includes allocation from the Dean of the College of Medicine and grants for specific projects. ♦ The college has developed a system of mission-based budgeting that supports faculty effort within departments for contribution to medical education. Valuing Teaching ♦ Teaching evaluations for all teaching activities are required for review for reappointment and promotion decisions. ♦ Course Directors review faculty evaluations and identify faculty for whom targeted teaching skills training would be beneficial. The training is provided by the Director of Educational Instruction and Scholarship in the Office of Medical Student Education. ♦ Faculty development activities (workshops, retreats, seminars) are ongoing and supported by MSE. Additional funds are available for innovation and travel to learn new education skills. Scholarly presentations of research at educational meetings are supported by MSE. ♦ Teaching faculty are recognized through a number of awards given by students in each class. The MSE contributes additional funding to departments whose faculty are recognized in this way. Curriculum Renewal Process ♦ In 1996, the UVM College of Medicine began to redesign its medical curriculum, culminating in the opening of the new Vermont Integrated Curriculum (VIC) in 2003. ♦ The college made a commitment to introduce educational innovation at all levels of the curriculum and to evaluate new programs as they are introduced. ♦ The curriculum redesign was guided by a commitment to (1) integration of teaching and learning across the disciplines, (2) assessment of professional competency, (3) patient and family centeredness, and (4) optimal use of information technology to enhance learning and information retrieval. ♦ Interdisciplinary groups of faculty, students, and community members worked in task forces to identify curriculum objectives and competencies and to design the overall curriculum and new systems for faculty development and promotion, information systems, and assessment systems. ♦ An annual faculty development activity, The Mud Season Educational Breakout, brought together larger numbers of the college and community to contribute to the design of new systems while learning new skills. ♦ An overall curriculum design group distributed VIC learning objectives into blocks of time allocated to courses. ♦ Interdisciplinary course design groups then developed courses that incorporated the assigned objectives and developed multiple types of learning activities. ♦ At the Foundations level, courses were built on a model of a 60-hour work week. Study time was allocated to specific types of learning activities, and any combination of activities could be used that fell within the 60-hour week. ♦ With the exception of a longitudinal leadership and professionalism course that meets once a week, only one course occurs at a time. ♦ In collaboration with our academic medical center, Fletcher Allen Health Care, the college built new education facilities. These facilities included a new ambulatory care center in which clinical teaching space is allocated, a clinical assessment center, and a new education building comprising large and small lecture halls and small-group rooms to support a new focus on collaborative learning. ♦ Since its implementation, the VIC has continued to undergo iterative improvement. Continuing efforts to improve longitudinal integration of educational themes (e.g., evidence-based medicine, palliative care, clinical skills) are ongoing. Learning Outcomes/Competencies ♦ A database of learning outcomes underlies the knowledge, skills, and attitudes that define our graduates. The basic goals are consistent with the outcomes described by the AAMC Medical School Objectives Project. ♦ These outcome-based learning objectives were developed through an extensive faculty consensus process within 10 interdisciplinary education themes and formed the basis for the development of the Vermont Integrated Curriculum, which graduated its first class in 2007. ♦ The Vermont Integrated Curriculum will produce physicians who uphold responsibilities to patients and their families, the public and communities, their profession and themselves. These three areas of responsibility are interdependent; however, each is defined by the following characteristics of the UVM graduate of the future. Responsibility to patients and their families 1. Graduates have a strong foundation in basic medical sciences and clinical medicine. In the foreseeable future, much of this foundation will be an understanding of the human genome and how the genetic makeup of an individual patient may drive treatment of disease or illness. 2. Graduates access and critically evaluate medical and scientific literature and assimilate new information into clinical practice. 3. Graduates understand behavioral and social sciences. They create good interpersonal relationships between themselves and their patients. 4. Graduates interpret clinical information in formulating effective management plans for diagnosing and treating illness and disease. 5. Graduates understand the impact of socioeconomic issues on patients. Responsibility to the public and communities 6. Graduates have a strong foundation in public health, epidemiology, and decision analysis. 7. Graduates understand various health care practice plans. 8. Graduates incorporate effective prevention strategies into practice. 9. Graduates are cost effective in their practice of medicine. Responsibility to their profession and themselves 10. Graduates demonstrate leadership potential. 11. Graduates demonstrate high personal and professional standards of honesty, integrity, and compassion. 12. Graduates critically evaluate their personal performance and that of their peers and recognize the need to remediate. New Topics in the Curriculum Since 2000 ♦ In addition to a complete restructuring of the previous curriculum, the VIC added significant content in a number of areas. ♦ Longitudinal curricula were added to address nutrition; public health; global health; spiritual care; palliative care; geriatrics; gay, lesbian, bisexual, and transgender health topics; evidence-based medicine; genetics; integrative medicine; health care financing; patient safety; and advanced communication skills. These topics appear in both Foundations and Clerkship levels and include didactic and experiential learning activities. ♦ A new focus on communication skills appears in multiple formats across the curriculum from patient interviewing to teaching and presentation. ♦ The Foundations level medical interviewing training includes higher level skill development than had previously occurred in the preclinical curriculum. ♦ Foundations students have experiential training in obtaining histories from patients with abnormal mental status and in eliciting a detailed sexual history. ♦ In clerkships, students learn to work with interpreters, discuss informed consent, cover patient safety issues, discuss advanced directives, and deliver bad news. ♦ They learn to communicate with other members of the medical team by working with advanced practice nurses on the patient safety curriculum. ♦ Students learn communication skills in the Foundations level through multiple small-group formats and in didactic presentations they make on the interface of basic science and patient care that integrated their preceptor experience with their course work. In the second year of the MSLG course, students complete community-based public health research projects that they present in poster format to the College and community. Many of these posters are then presented at national meetings. ♦ In a component of the global health curriculum in the Clerkship level, students research and present topics to their peers. In each of these venues, students are provided training in communication skills and are assessed both on content and presentation skills. ♦ Students in the Advanced Integration level must complete a scholarly research project or complete a 1-month teaching rotation in a Foundations course. These activities are part of a course directed by an education professional. ♦ Those who choose the scholarly project learn to write a short proposal and a longer report on the outcomes; they also present the research in poster or oral format at an annual research event and receive training and feedback on communication of the project. ♦ Those who choose the teaching option participate in learning activities related to best practices for laboratory, small-group, and lecture-based teaching. They synthesize material in the course each week and provide a review for students. They are given feedback on their teaching performance by both students and the education professional. Changes in Pedagogy ♦ The VIC uses a variety of educational methods with the lecture, laboratory, and patient-based teaching of the previous curriculum enhanced through addition of small-group learning, experiential community-based research, standardized patient-based skills training, online instruction, and development of teaching/presentation skills. ♦ Standardized patients teach physical examination and medical interviewing skills in the Foundations level courses. ♦ Computer technology is integrated into the educational program from the first day of medical school. An integrated teaching and learning environment is supported by the College of Medicine Educational Tools (COMET); all course materials for all levels are available in an online repository, and some curriculum is delivered either totally or partially online. ♦ Virtual microscopy supports histology and pathologic anatomy learning. ♦ All new curricular programs incorporate clinical cases. Complementary themes of genetics, ethics, epidemiology, and public health weave through the 4-year curriculum through these cases. ♦ Education in Family Centered Care brings students together with families of children with disabilities and is introduced with clinical cases to discuss family systems. ♦ Small-group learning experiences support problem solving and collaborative learning. ♦ The first-year Medical Student Leadership Group (MSLG) course introduces students in small collaborative learning groups to concepts of professional and personal development, team building and conflict resolution, and independent learning. ♦ In the second year, the student groups use their collaborative skills to conduct community-based public health research projects. ♦ In the Bridge curriculum, students work through cases in small groups working with a mentor at the beginning of the clerkship year. The last Bridge week students work independently to complete three cases, which they hand in as a group project. ♦ A month-long problem-based learning course serves as a capstone of the Foundations level and transitions students to the hypothesis-based reasoning approach integral to clinical practice. ♦ In the clinical arena students are introduced to and complete their work using the electronic health records of their respective clinical sites. ♦ Success of new pedagogical styles is measured through ongoing curriculum evaluation. Changes in Assessment ♦ Standardized patient-based clinical skills examinations are part of student assessment in most courses in the Foundations Level of the curriculum and in all clerkships. ♦ Students must successfully complete a standardized patient-based clinical skills examination at the end of the Foundations level to advance to the Clerkship level. ♦ At the end of Clerkship, students must successfully complete a multistation standardized patient-based clinical skills examination. Students are assessed with a clinical skills exercise upon completion of their required “acting internship” rotation in Medicine. ♦ With the exception of laboratory practicals, knowledge-based summative assessments at all levels of the curriculum are deployed as secure online examinations. ♦ Faculty development workshops provide training for faculty to develop examination questions that match the best practices developed by the National Board of Medical Examiners. ♦ Students in courses with substantial small-group activities are evaluated by written assessments by faculty leaders. In the longitudinal first-year MSLG course, this written faculty assessment includes assessment of professionalism and development of self-reflection skills. ♦ Formative assessments occur weekly in the Foundations level in the form of online quizzes. ♦ Standardized patient clinical skills training contributes to formative assessment of clinical skills in both the Foundations and Clerkship levels. ♦ Midcourse feedback is provided to students in the MSLG course as formative assessment of professionalism development. Clinical Experiences ♦ Students undergo clinical training at our primary clinical teaching site, Fletcher Allen Health Care of Vermont. ♦ Some clerkship training and other clinical rotations also take place at other affiliates including Maine Medical Center (Portland, Maine), and clinical practices throughout the states of Vermont and Maine. ♦ Starting in 2010-11, students will also have the opportunity to participate in clinical rotations at Danbury Hospital (Danbury, Connecticut), St. Mary's Hospital (West Palm Beach, Florida), and Eastern Maine Medical Center (Bangor, Maine). ♦ Students have the opportunity to complete selectives at other locations around the country and abroad. ♦ Students in the first and second year of school have an introductory preceptorship (“Doctoring in Vermont”) with physicians in the community within a 45-minute radius of the medical school. ♦ During the first-year MSLG course, students shadow a spiritual care team at the Fletcher Allen Health Care. ♦ Sending students to distant locations has both rewards and challenges. The challenges include ensuring that students are well integrated in that site yet connected to their peer group. This has been accomplished by the use of technology. ♦ Faculty development is also a challenge that requires frequent communication and involvement in the student curriculum. ♦ Maintaining the affiliation agreements and site recruitment requires a substantial effort and cost. Highlights of the Program/School ♦ The VIC is a systems-based integrated curriculum that integrates basic science and clinical education across all four years and includes programs in leadership, professional development, research, and teaching skills. ♦ Assessment provides continual feedback on students' progress and certifies competency to move forward in the curriculum. ♦ The VIC is divided into three levels of increasing complexity and breadth of study, progressing from the study of the basic foundations of medicine (both clinical and basic science), to applications in Clinical Clerkship, to senior scholarship and supervised patient management in Advanced Integration. ♦ Students begin clinical experiences in the first year of the curriculum by precepting with a community physician; students begin the Clerkship Level during March of their second year. ♦ Standardized patient exercises are used for teaching, formative, and summative assessment throughout the Foundations level and are integrated within the same courses as the basic science content. ♦ Standardized-patient and simulation-based assessment of students continues through the Clerkship and Advanced Integration levels. ♦ Leadership and professionalism are valued, taught, and assessed. The medical community requires knowledge of and skills for collaboration, cultural awareness, decision making, lifelong learning, and self-assessment. ♦ The Medical Student Leadership Groups are designed to introduce and support the development of the capacities, attitudes, and behaviors critical to medical professionalism. ♦ The skills acquired in their leadership groups are put into practice in the Convergence course and in the Bridge Clerkship, which foster the development of strong group skills required to accomplish the tasks and cases. ♦ In the Advanced Integration level, the Teaching Requirement/Scholarly Project course provides students with basic skills in teaching and evaluation in a “coached” environment to revisit foundation sciences by teaching or scholarly activity. ♦ Students fulfill the practicum experience in one of two ways: the Teaching Requirement or a Scholarly Project. ♦ The Teaching Requirement entails 1-month continuous participation as a teaching assistant in the VIC Foundations courses. ♦ The Scholarly Project, a research project in the basic or clinical sciences, encourages the development of students as physician–scholars. The scholarly project polishes inquiry, analytical, and communication skills.