University of Virginia School of Medicine

Abstract

The University of Virginia School of Medicine is inspired by a truly great university founded on the values of innovation, accountability, integrity, and collaboration. The undergraduate medical education program is guided by the School's core educational purpose and values: Core purpose: To train physicians to help people achieve healthy, productive lives and to advance knowledge in the medical sciences. Core values: To attract, motivate, and guide outstanding people by nurturing the dreams of those embarking on a career in medicine; engage the creative abilities of people to generate new knowledge and improve the quality of life; and foster excellence in medical education by blending compassion, technical ability, and thirst for knowledge. Curriculum Management and Governance Structure ♦ The Curriculum Committee is a standing committee responsible for defining the goals and objectives of the undergraduate medical education curriculum; overseeing the design and management of the curriculum; establishing a process for reviewing, evaluating, and revising the curriculum on a recurring time line to ensure that the curriculum is coherent, coordinated, fully integrated, current, and effective; making recommendations to the Dean about the system of incentives for teaching effort, salary support for teaching faculty, instructional space, and other support requirements needed to make the curriculum operational. ♦ The Curriculum Committee has the authority, with the approval of the Dean, to set educational objectives, establish educational requirements, allocate curriculum time, specify teaching methods, approve course leadership, and evaluate educational outcomes (Figure 1).FIGURE 1:: Curriculum Governance♦ The Curriculum Committee has the authority to set performance standards for instructors, initiate faculty development efforts, and evaluate instructor performance. ♦ The Integrated Clinical Sciences Committee (ICSC) and the Clerkships and Advanced Clinical Training Committee (CACTC) are responsible to the Curriculum Committee and VP/Dean for (1) effecting the goals, objectives, and teaching responsibilities for the foundations courses, organ-system units, clerkships, and electives program and (2) maintaining a schedule of learning activities and coordinating examinations and evaluations (Figure 1). Office of Medical Education Support ♦ The Office of Medical Education Support (OMES) provides instructional, educational technology, evaluation, and administrative support for the undergraduate medical education program. ♦ The Educational Technology Group has seven full-time equivalents (FTEs), Instructional and Clerkship Support has 6.5 FTEs, and UME Administration has 4.5 FTEs. The OMES is responsible for Administering and coordinating foundations courses and organ-system units; Providing course support, scheduling, and maintaining instructional space; Publishing a combined course schedule; Scoring and analyzing tests and evaluating courses and instructors; Supporting and developing a learning-management system and other computer applications; Providing administrative support of clinical and ambulatory courses and clerkships; Maintaining student and faculty evaluations, course and small-group schedules, and grades in the Online Access to Student Information and Scheduling (OASIS) database; Supporting faculty development; and Consulting with course directors and faculty about instructional design, evaluation, and educational technologies. The OMES also supports the Student Advocacy Committee, which is devoted to ensuring a professional environment for students, and the Mini-Med School, an educational program for the community. The Clinical Performance Education Center (CPEC) collaborates with the OMES to administer and support all clinical performance development experiences across the preclerkship, clerkship, and postclerkship phases of the curriculum. Financial Management of Educational Programs ♦ The School consolidated administrative structures and eliminated redundancies to reduce overhead costs within the Office of Medical Education. ♦ The strengthening of fiscal controls resulted in operational surpluses that allowed for the recruitment of new faculty members and expansion of educational facilities. Valuing Teaching ♦ Founded in 2003, the Academy of Distinguished Educators recognizes and rewards outstanding teachers, works to make excellence in teaching a domain of academic advancement, and develops effective faculty educators. ♦ The Academy has more than 140 members representing both basic science and clinical departments. ♦ The Dean's Office provides $100,000 annually to the ADE to fund research grants in undergraduate medical education. ♦ The School introduced a “Pay for Teaching” model whereby the Dean's Office provides funds to clinical departments based on the amount of faculty time the department devotes to direct medical student education. This model promotes fiscal transparency and ensures educational funding goes to the teaching faculty. ♦ The School has a robust faculty development program that provides ongoing professional development, promotes educational training and skill development, and encourages educational innovations. The program recognizes that the integration of pedagogies, educational technologies, and learning-space design can enhance learning. ♦ The criteria for excellence in education that are required for appointment, promotion, and award of tenure are articulated clearly. ♦ All faculty are encouraged to compile a Teaching Portfolio that documents teaching activities and accomplishments and details the faculty member's educational contributions (e.g., teaching activities, teaching awards, curricular innovations, educational scholarship, and so on). ♦ The Dean's Office funds five faculty teaching awards annually, each consisting of a $2,500 stipend. The Dean's Office and the University fund 10 teaching awards for residents annually, one for $1,000 and the others at $250. ♦ The student body gives outstanding teaching awards to a basic-science instructor, a clinical instructor, and a clinical department each year and provides additional awards to teachers in the first two years. Curriculum Renewal Process ♦ The School is committed to continuous curricular improvement. ♦ Curriculum renewal has been an ongoing process based on the research, recommendations, and discussions of various working groups and task forces over the past decade. Much of this was highlighted in the September 2000 supplement to Academic Medicine. ♦ Substantial curricular renewal efforts have occurred in the past three years. ♦ The Dean established an Education Task Force (ETF) in October 2007 to assess the technological, personnel, and support needs of the new Claude Moore Medical Education Building and to make recommendations for the best use of space and technology. ♦ The ETF also considered the means by which new and existing facilities and educational research could be used to transform medical education at UVA and create a model clinical education program. ♦ A number of administrative, technical, and curricular proposals came from the final ETF report delivered in May 2008. ♦ Regarding the curriculum, the ETF specifically recommended that the School: integrate and coordinate basic-science and clinical experiences horizontally and vertically throughout the four years; allocate time for imaginative and creative expression in basic sciences, clinical medicine, and in service to the community while including elective opportunities to explore the alternative pathways of general medicine, specialty medicine, and research; ensure a balance of lecture, problem-based learning, patient experiences, and blocks of productive open time to optimize the learning environment and encourage a problem-solving approach to learning; and create time in the early years for regular, frequent patient contact and integrate and coordinate patient experiences with the clinical sciences. ♦ In the summer of 2008, the School decided to move away from a traditional, discipline-based curriculum to one that would be more integrated and system based. ♦ The Curriculum Committee developed five goals to guide the development process of the “Next Generation” Curriculum: Goal 1: Assure that all graduates demonstrate mastery of the 12 UVA School of Medicine Competencies Required of the Contemporary Physician. Goal 2: Integrate content around the organ systems. Goal 3: Integrate clinical and basic-science content across the four years and within systems. Goal 4: Use more active learning methodologies and provide a learner-centered curriculum. Goal 5: Provide frequent and developmental opportunities for learning clinical skills throughout the curriculum. ♦ More than 100 basic-science and clinical faculty members, decision scientists, educational technology specialists, faculty development experts, instructional designers, and students have been working over the past two years to plan, develop, and implement a curriculum integrated around organ systems. ♦ Faculty and staff retreats were held in May and August 2009 and March 2010. ♦ Appreciative Inquiry—an organizational development process that leverages organizational strengths and successes to create new organizational policies, procedures, structures, and programs—was used to generate a series of educational-design principles and action items that faculty and staff felt were important in the development and support of the “Next Generation” Curriculum. ♦ These principles defined the ideal medical education program, guided and ensured consistency during curricular implementation, and served as standards by which faculty could determine whether and how well each system unit incorporated the most important curricular elements and educational values into each educational experience. ♦ In addition to the retreats, scores of monthly meetings were held to discuss, prepare, and determine foundations and organ-system content and sequencing, learning objectives, learning activities, assessments, evaluation plans, and faculty development sessions. ♦ As a result of this process, the “Next Generation” Curriculum is organized for maximum integration of clinical education, preparation for clinical practice in a complex practice environment, and effective learning that models the lifelong learning expected of physicians (Chart 1).CHART 1: “Next Generation” curriculum Learning Outcomes/Competencies ♦ The Curriculum Committee adopted a set of objectives for undergraduate medical education in 1998 based on the findings of the Task Force on Medical School Objectives. ♦ The Curriculum Committee amended the objectives in 2008 and revised them in 2009 to align with the AAMC and ACGME objectives and competencies. The competency goals are listed in the following text. ♦ The first three competency goals describe abilities that students may already possess to some extent before beginning their medical education. The undergraduate medical education experience should provide them with opportunities to further develop and apply these competencies within the context of clinical care learning. These goals include 1. The development and practice of a set of personal and professional attributes that enable the independent performance of the responsibilities of a physician and the ability to adapt to the evolving practice of medicine. These include humanism, compassion, and empathy commitment to collegiality and interdisciplinary collaboration engagement in continuing and lifelong self-education awareness of a personal response to one's personal and professional limits engagement in community and social service commitment to high ethical standards for personal and professional conduct knowledge of legal standards and commitment to legal conduct awareness of economic issues in clinical practice cultural competency in clinical practice and professional relationships 2. The ability to understand the scientific basis of medicine and apply it to current clinical practice analysis and further expansion of medical knowledge and understanding 3. The ability to engage and communicate with a patient, develop a student-patient relationship, and communicate with others in the professional setting using interpersonal skills to build relationships for the purpose of information gathering, guidance, education, support, collaboration, and the provision of individualized patient care. ♦ Competency goals 4–8 represent specific individual clinical skills activities that are performed in any medical encounter. These goals include 4. the ability to take a clinical history, both focused and comprehensive. 5. the ability to perform a mental and physical examination. 6. the ability to select, justify, and interpret selected clinical tests and imaging. 7. the ability to understand and perform a variety of basic clinical procedures. 8. the ability to record, present, research, analyze, and manage clinical information. ♦ Competency goals 9–11 reflect the three major tasks of individual patient care that involve the integration of competency goals 1–8: identifying and prioritizing clinical problems; understanding, selecting, and implementing clinical interventions; and predicting the course of illness and anticipating future patient health care outcomes. ♦ These competency goals reflect the three major reasons for which patients seek clinical care and are 9. the ability to diagnose and explain clinical problems in terms of pathogenesis, to develop a basic differential diagnosis, and to learn and demonstrate clinical reasoning and problem identification. 10. the ability to understand and select clinical interventions in the natural history of disease, including basic preventive, curative, and palliative strategies. 11. the ability to understand and to formulate a prognosis about the future events of an individual's health and illness based upon an understanding of the patient, the natural history of disease, and known intervention alternatives. ♦ The preceding competency goals are the core elements of clinical medicine. The final competency goal reflects the fact that in providing patient care, the physician must also consider the practical context within which medical care is delivered from the perspective of both the individual patient and the environment in which they live. This goal is 12. The ability to provide clinical care within the practical context of a patient's age, gender, personal preferences, family, health literacy, culture, religious perspective, and economic circumstances. This competency goal also includes consideration of relevant ethical, moral and legal perspectives, including patient advocacy and public health concerns, and the resources and limitations of the health care system. New Curricular Topics/Experiences: 2000-09 (see http://www.med-ed.virginia.edu/ for descriptions and details) ♦ Short Courses Cells to Society Diagnosis and Treatment: The Healthcare System ♦ Electives/Selectives Medical Education Elective Advanced Clinical Electives Selectives Discussing making “learning how to teach” part of the curriculum beginning in 2010 ♦ Clerkships Perioperative and Acute Care Medicine Clerkship Geriatric Medicine Clerkship Clinical Skills Passports (updated in 2008 to include “Student managed a patient effectively within the context of the patient's cultural beliefs, practices, and needs.”) ♦ Simulation-Based Training Ultrasound Guided Central Line Placement Crisis Resource Management Team Training Surviving Sepsis Life Savings Techniques Workshops Advanced Airway Workshop (including Bronchoscopy) Disaster Medicine Wilderness Medicine Elective (Management of Crush Injuries, Snake bites, Hypothermia) Interdisciplinary Approach to the Recognition, Management, and Treatment of Acute Coronary Syndromes Introduction and Approach to Common Birthing Scenarios and Techniques ♦ Service Learning Social Issues in Medicine ♦ Clinical Skills and Clinical Reasoning Practice of Medicine I and II New Curricular Topics/Experiences: 2010 (see http://www.med-ed.virginia.edu/ for descriptions and details) ♦ Clinical Skills and Clinical Reasoning Clinical Performance Development ♦ Foundations Courses Molecular and Cellular Medicine Microbes: The Essentials ♦ Organ-System Units Musculoskeletal and Integument Mind, Brain, and Behavior Gastrointestinal Cardiovascular Pulmonary Renal Endocrine-Reproductive Hematology Changes in Pedagogy ♦ Increased numbers of small-group discussions, laboratories, web-based materials, podcasts of course presentations, case discussions, clinical demonstrations, standardized patient activities, self-directed learning, simulation, and team-based learning. ♦ Active learning (e.g., think-pair-share, student-led review sessions, debates, games, video analysis, role play, case studies, collaborative learning groups). ♦ Analysis of course and USMLE examinations and student surveys indicates that these changes have been accompanied by higher examination scores and more positive student attitudes. Changes in Assessment ♦ Increased number of OSCEs and standardized-patient experiences. ♦ Introduction of an end-of-basic-science NBME custom examination (one year only). Clinical Experiences ♦ Sites for Clinical Education University of Virginia Medical Center, Charlottesville, Virginia Carilion Clinic, Roanoke, Virginia INOVA Health System, various hospitals in Northern Virginia Salem Veteran Affairs Medical Center, Salem, Virginia Western State Hospital, Staunton, Virginia Physician offices throughout Virginia ♦ Clinical Education Challenges Competing with new and expanding medical schools for educational encounters and for community-, office-, and hospital-based experiences Maximizing the use of nearby outpatient settings Ensuring balance between direct patient care and education given the consequences of duty hour reform for faculty and medical students Highlights of the Program/School ♦ Faculty commitment to education. The School combines expectations of academic excellence with a warm and nurturing environment for faculty and students. Students have consistently praised the School's responsiveness to their concerns and have rated the faculty as one of the school's major strengths on the AAMC Graduation Questionnaire. In ongoing course and clerkship evaluations and in focus groups, students have consistently commented on faculty members' expertise and availability for support, advice, and opportunities. ♦ Claude Moore Medical Education Building (MEB). Completed in May 2010, the new five-story medical education building is a technologically integrated educational facility with state-of-the-art learning spaces. The technology- enabled active learning activities available in the MEB foster collaboration, build patient-care skills, and teach the appropriate use of information technology in the clinic. Highlights of the building include The Clinical Performance Education Center (CPEC) houses the Medical Simulation Center and the Clinical Skills Center (Clinical Skills Training and Assessment Program). CPEC provides students myriad opportunities to practice and demonstrate competency in cognitive and psychomotor skills in simulated clinical settings. The Learning Studio, a technology-enabled active learning (TEAL) classroom, is large enough to accommodate the entire class and still provide an interactive, hands-on learning environment in which students work collaboratively in small groups. Students work at round tables seating nine, so that they can work individually, in small groups, by tables, or as a whole class. The Learning Studio allows for many kinds of learning activities and the use of integrated media to foster the development of analytical and problem-solving skills. ♦ Integrated Clinical Sciences. The “Next Generation” Curriculum moves beyond the traditional split of basic and clinical sciences and instead integrates them through system-based experiences to prepare physicians for patient-centered care, evidence-based medicine, and lifelong learning. The curriculum comprises a careful balance of active and experiential activities, clinical cases, problem-based learning, small-group and team-based experiences, hands-on laboratories, self-directed learning, lectures, and hospital- and community-based clinical experiences. Patient contact begins on the first day of the first year and increases throughout the four years. ♦ Clinical Performance Development. The CPD element provides frequent and developmental opportunities for learning clinical skills throughout the curriculum. During the Integrated Clinical Sciences (the preclerkship curriculum), CPD is integrated with basic sciences, where it focuses on the acquisition and the regular practice of basic clinical skills. Higher-level skills are acquired throughout the clerkship period and into the advanced clinical skill development period (postclerkship). Throughout the curriculum the focus is on continued improvement and practice of skills. ♦ Social Issues in Medicine. The required Social Issues in Medicine course involves medical students in a broad range of social service, educational, medical, and nonmedical programs throughout the community. The community agencies range from the AIDS Services Group to the Virginia School for the Deaf and Blind to the YMCA. Two medical students who had completed their SIM service in a homeless shelter recently founded Charlottesville Health Access, which assists the homeless and others in navigating the local health care system. Many medical students also volunteer individually at the Charlottesville Free Clinic. ♦ Collaboration across the University. The School collaborates in projects and teaching with other University units. In particular, faculty partner with the Curry School of Education, School of Engineering, Darden Graduate School of Business, and the School of Law. The School has dual-degree programs: MD-MPH, MD-MBA, and MD-MSCR (MS in Clinical Research). Medical school faculty use the University's Teaching Resource Center (TRC), and the School's faculty development program has developed joint programs with the TRC. The School of Medicine has a robust and innovative medical education program; is highly ranked nationally; has a sound financial position both short term and long term despite the present economic climate; and has a dedicated, diverse, and collegial student body, faculty, and staff. Thomas Jefferson boldly claimed that the University of Virginia would be “based on the illimitable freedom of the human mind.” In that spirit, the School is committed to (1) curricular innovations and continuous curricular improvement; (2) competency-based education and assessment; (3) meeting new and revised accreditation standards for diversity, cultural competency, curricular integration, active learning and independent study, and clinical and translational research; (4) preparing students for the planned changes in licensure examinations; and (5) reorganizing clinical training for more emphasis on nonhospital settings to better prepare graduates for the practice environment.