University of Wisconsin School of Medicine and Public Health.

Abstract

Medical Education Program Highlights Since the last Snapshot in 2010, the University of Wisconsin School of Medicine and Public Health (UWSMPH) has implemented its most innovative curriculum change since the early 20th century. The ForWard curriculum, with its focus on competency-based education, self-directed learning, teamwork skills, and individual coaching, is delivered under new centralized institutional systems for governance and oversight, which facilitate continuous curricular improvements. This transformation has charted a new course for ensuring UWSMPH graduates are prepared to optimize the health of patients and populations for the twenty-first century and beyond. 3-phase, 4-year, competency-based curricular model that horizontally, vertically, and developmentally integrates basic and clinical sciences with 10 longitudinal content threads Early clinical immersion in interprofessional teams starting in the first semester followed by ongoing interprofessional health learning Longitudinal coaching with each student to enhance mastery, based on program objectives Immersive parallel tracks in rural and urban health as well as MPH and PhD dual-degree programs available Statewide campus with 4 regional campus hubs in addition to central campus sites Curriculum Curriculum description The ForWard curriculum, launched in 2016, fully integrates basic science, public health, and clinical science throughout medical students’ education. ForWard is a 3-phase curriculum composed of integrated, multidisciplinary, thematic blocks within which all content threads are woven longitudinally: Phase 1 (3 semesters; 6 blocks): Core basic science content integrated with public health and clinical experiences Phase 2 (2 semesters; 4 blocks): Immersive clinical training with integrated public health and basic science content Phase 3 (3 semesters): Advanced specialty-specific experiences in clinical medicine, basic science, and public health See Supplemental Digital Appendix 1—Curriculum Description—at https://links.lww.com/ACADMED/A905. Curriculum changes since 2010 The ForWard curriculum is the product of a multiyear curriculum transformation process that included input from hundreds of UWSMPH faculty, staff, and students. The school’s graduation competencies (program objectives) were updated and revised with broad input. These competencies were used as the starting point for a formal backward design process to develop a horizontally and vertically integrated 3-phase curriculum. Each ForWard block was designed by a multidisciplinary faculty team. Before and during the design process, course and clerkship directors (integrated block leaders) met monthly for formal faculty development in educational best practices and to develop consensus on shared teaching and assessment toolboxes. This centrally coordinated process allows students to experience learning that is well-connected across all 4 years, with consistency in learning management systems, design, teaching modalities, and assessment methods across blocks. These educational leaders now compose the Curriculum Content Subcommittee, a standing subcommittee of the school’s Educational Policy and Curriculum Committee, to ensure long-term curriculum coordination. Assessment The UWSMPH medical education program objectives are based on ACGME domains of competence. In the ForWard curriculum, phase-specific milestones and developmental benchmark scales were developed to ensure clear expectations for all students, at every level of their education, with respect to each of the 20 program objectives. To ensure specific and reliable outcome measures, students are evaluated via assessment rubrics based directly on the milestones and benchmark scales. Additional assessment tools (e.g., multiple-choice assessments, focused assignments) are linked to school competencies via course-level and learning activity-level objectives. See Supplemental Digital Appendix 2—Graduation Competencies and Assessment Methods—at https://links.lww.com/ACADMED/A905. Parallel curriculum or tracks UWSMPH has 2 parallel tracks, the Wisconsin Academy for Rural Medicine (WARM) and the Training in Urban Medicine and Public Health (TRIUMPH) programs. WARM prepares students for rural medicine practice and to improve health in rural Wisconsin communities. TRIUMPH prepares students to become community-engaged physician leaders who will address health disparities in disadvantaged urban communities. After Phase 1 completion in Madison, students in these tracks relocate to a regional academic campus in either rural Wisconsin (WARM) or Milwaukee (TRIUMPH) to complete Phases 2 and 3. In addition, UWSMPH has formal MD–PhD and MD–MPH dual-degree programs. Pedagogy A teaching toolbox was developed for use by all blocks across the ForWard curriculum based on educational best practices. In Phase 1, ≤ 30% of instructional time is lecture based. Online learning modules, large-group (36 students in 6 groups/room) case-based learning, and small-group (8 students/room) self-directed, problem-based learning each constitute ~15% of instructional time. Laboratories, clinical skills with standardized patients, and clinical experiences (mostly ambulatory) each make up approximately 5%–10% of Phase 1 instructional time. In Phase 2, 80% of instructional time is spent in immersive clinical experiences, equally divided between inpatient and ambulatory settings. The remainder consists of structured discussions divided primarily between large-group and small-group case-based learning sessions that require preparatory readings/online activities and variably include simulation, standardized patients, and peer teaching. In Phase 3, distribution of clinical versus didactic time varies, depending on the block (rotation). The inpatient acting internship and ambulatory acting internship are each 90% clinical activity and 10% lecture- and case-based learning activities. Public health and basic science selectives may include synchronous and/or asynchronous teaching modalities, projects, presentations, discussions, clinical activities, and lab sessions. The internship preparatory course allows students to synthesize material with standardized patients, simulation, clinical skills, and group discussions. The core curriculum, pedagogical approaches, and assessments for students in WARM and TRIUMPH are the same as that of the traditional MD program. Clinical experiences Students are paired with a physician preceptor at the beginning of Phase 1 with whom they complete a longitudinal clinical experience (15 sessions over 18 months) focused on practicing early clinical skills and contributing to an interprofessional team clinic-based quality improvement project. Phase 2 consists of four 12-week integrated clinical blocks. In the acute care block (inpatient medicine, neurology, psychiatry, and emergency medicine), students have a consistent preceptor across all 12 weeks for case-based learning and bedside teaching. The chronic and preventive care block (ambulatory internal medicine, family medicine, neurology, and psychiatry/behavioral health) also provides consistent ambulatory clinical teachers across the block. In the surgical and procedural care block (general surgery, surgical subspecialties, anesthesia, and other procedural subspecialties), students follow at least 1 patient longitudinally through anesthesia care, surgery, and postoperative care. The care across the life cycle block integrates pediatrics, obstetrics–gynecology, and geriatrics in various care settings, including a longitudinal clinic in pediatrics and in obstetrics–gynecology. Phase 3 required experiences include a 4-week ambulatory acting internship in one of many statewide outpatient clinics, a 4-week inpatient acting internship, public health selectives (4 credits), basic science selective (4 credits), and an internship preparatory course (3 credits). Basic science and public health selectives offer a range of unique ways to engage in deep learning in areas related to students’ field of future interest. Required clinical experiences in Phases 2 and 3 occur at affiliated institutions throughout Wisconsin, including the local tertiary care, academic medical center’s inpatient and ambulatory sites, as well as rural and urban community-based hospitals and ambulatory practices. These statewide campus opportunities help minimize any capacity issues created by having second-, third-, and fourth-year students concurrently doing clinical rotations. Curricular Governance The Educational Policy and Curriculum Committee is the primary curricular governing body and oversees 3 standing subcommittees that continuously monitor specific areas of the medical education program: Medical Student Subcommittee, Curriculum Content Subcommittee, and Assessment Subcommittee. Though not part of formal governance, the Health Equity Activation Team, composed of faculty and students, serves in a key advisory role to optimize diversity and inclusion throughout the curriculum. Curricular governance is centralized, including all assessment and academic support, but departments and sites are responsible for recruiting and supporting teachers to assist in delivery of content, bedside teaching, and clinical assessment. The quantity of teaching provided by faculty and the number of learner-weeks are tracked centrally and used to allocate funding to departments and sites, respectively, to support teaching. Education Staff The Medical Education Office (MEO) is housed in the Office of Academic Affairs, which provides oversight to all health professions degree programs and graduate medical education as well as academic campuses. The associate dean for medical student education and services is responsible for the MD curriculum and related student programs through their leadership team, which includes the assistant dean for admissions, associate dean for student services, and associate dean for medical education. Key faculty leaders within the MEO reporting to the associate dean of medical education include the 3 phase directors and the director of the longitudinal teacher/coach program. Each phase director oversees a team of faculty who direct required courses and clerkships in their respective phases. All faculty teaching roles, including faculty participants in the longitudinal teacher/coach program, are financially supported through the MEO. The MEO also includes professional and support staff. The director of longitudinal curriculum and instruction oversees faculty leads (thread directors) in key content areas to ensure longitudinal integration. The director of assessment and analytics oversees the clinical teaching and assessment center, the standardized patient program, and staff to oversee testing. Additional staff support the implementation of all required courses under the leadership of their respective faculty leads. The MEO is an administrative office; teaching faculty have academic appointments within basic science or clinical departments. See Figure 1—Institutional leadership structure.Figure 1: Institutional leadership structure.Faculty Development and Support in Education Numerous faculty development opportunities are available through various UW–Madison campus offices and UWSMPH. For example, Medical Education Day, held annually at UWSMPH, engages over 200 faculty, staff, fellows, and graduate students to explore innovations in medical education. The associate dean for faculty affairs and development, in partnership with the Office of Continuing Professional Development in the Office of Academic Affairs, oversees professional development opportunities for faculty on all the UWSMPH campuses, across all missions and departments, and across all faculty tracks. Together with the Schools of Pharmacy and Nursing, they established the interprofessional Clinical Teaching and Learning Community for faculty and academic staff, affiliated with both the UW–Madison Teaching Academy and the Interprofessional Continuing Education Partnership. The UW–Madison Teaching Academy is composed of faculty, instructional staff, and graduate students across the main university campus who have been recognized by peers for sustained teaching excellence. This academy works to promote, recognize, and support excellence in teaching and learning. The Interprofessional Continuing Education Partnership includes faculty and staff from the UW health professions schools and provides joint accreditation for faculty and staff development activities across health professions. Teaching may be used as an area of excellence or significant accomplishment for academic promotion at UWSMPH. Candidates must demonstrate a record of achievement in education of the highest caliber. Examples of scholarly achievement include publication/presentation of educational scholarship, development/dissemination of a new curriculum, or creation of innovative teaching or assessment methods. Regional Medical Campuses UWSMPH has 4 regional campuses, including 3 designated academic campuses that support UME, GME, and significant research activities. The regional campuses offer Phase 2 and Phase 3 curriculum to all UME learners. WARM and TRIUMPH students are assigned to 1 of the regional campuses for Phases 2 and 3, and all other students are assigned at least 1 block at a regional campus. Maintenance of consistent educational experiences across sites is achieved via a novel CQI process termed “Going for Green,” centered around a standardized checklist covering all important required clerkship elements (e.g., learning objectives, required clinical encounters/skills, curriculum delivery, development of faculty and residents as teachers/assessors). Every site completes this checklist annually for each required clerkship block, providing details about how sites ensure completion of tasks. Completed checklists are reviewed centrally, discussed, and adjustments are made as needed to ensure any potential or identified inconsistencies are prevented or remedied. See Table 1—Regional Campuses.Table 1: Regional CampusesRobust communication and strong relationships are nurtured between central curriculum leadership and regional leadership, faculty, and clerkship coordinators through in-person meetings (including multi-annual site visits and distance conferencing) as well as by regular email and phone communication. Updates or changes are communicated via email, in conference calls, and during in-person meetings as needed. Regional faculty have access to clerkship curriculum, assessment methods, and requirements via the UWSMPH website and learning management system.