Medical Education Program Highlights In 2016, the University of California, San Francisco (UCSF) School of Medicine launched the Bridges Curriculum, developed to ensure that graduates are prepared to tackle the most complex problems of 21st-century patients and communities. The curriculum has an enduring focus on providing evidence-based, compassionate care while leveraging emerging skills in systems science and new methods of discovery. The Bridges Curriculum seeks to instill the 4 UCSF physician habits of mind: inquiry, continuous improvement, adaptive leadership, and social justice. To teach these habits of mind, the curriculum has an inquiry thread focusing on deep exploration into a scholarly area. Each step advances the learner, first to a sophisticated consumer of biomedical science, then to a producer of new knowledge. Continuous improvement skills are instilled through the clinical microsystem clerkship (CMC), a longitudinal clinical skills curriculum integrating skills in direct patient care, health systems improvement, and interprofessional collaboration. The CMC engages students in systems improvement work directly affecting the quality and safety of care. During the core clerkship phase, we offer a series of clinical immersion experiences (CIExes) electives, which provide opportunities for deeper exploration of a specialty or subspecialty. Trained and dedicated faculty “coaches” support students’ progression. The coaching program is designed to provide academic guidance for students and support professional/personal development throughout the curriculum. Curriculum Curriculum description The Bridges Curriculum is a 4-year, 3-phase curriculum: Foundations 1 (F1) is the preclerkship phase, including foundational sciences coursework and early, robust instruction and practice of health systems sciences (CMC). Foundations 2 (F2) starts in December, year 2, with six 8-week blocks for 8 core clerkships and 8 weeks of CIExes. Career launch starts in March of year 3, including a longitudinal ambulatory subinternship, dedicated time for completing scholarly projects, and advanced clinical training preparing students for their chosen career paths. Other curricular characteristics: Early, robust instruction and practice of health systems science (CMC) Incorporation of a dedicated coaching program, integrated with the CMC during the preclerkship phase, embedded in a longitudinal curriculum in assessment, reflection, coaching, and health (ARCH) across all 3 phases Deliberate instruction with dedicated time in concepts and application of inquiry in scientific domains Intentional incorporation of elements of social justice into all curricular aspects, including a planned required rotation demonstrating these principles in the community-engaged context Collaborative integration of foundational science content into clerkships Curriculum changes since 2010 The rollout of the Bridges Curriculum will be complete in May 2020, a significant evolution of our curricular content and pedagogy. Structural changes within the 4-year timeline include: A shortened preclerkship phase (ends December, year 2) Earlier start of clerkship phase (January, year 2) Longitudinal structure of the family and community medicine clerkship Shift in placement of USMLE Step 1 examination to after core clerkships (January, year 3) Earlier start of postclerkship phase (March, year 4) Over the coming year, we will also adjust delivery of foundational science content. Class size changes since 2010 In AY 2019–2020, UCSF became the sponsoring institution for the San Joaquin Valley Program in Medical Education (SJV PRIME), serving central California communities. The class size increased by 6 students for the first academic year’s entering class and will subsequently rise to 12. These students have been incorporated into class structures with minimal change required in structure or function, primarily because their clerkship and postclerkship phases take place at UCSF Fresno, where they had been placed previously for clerkships while managed by a different institution. Assessment Medical education program objectives are based on ACGME domains of competence, with the addition of interprofessional collaboration as a separate domain. See Supplemental Digital Appendix 1—Program Objectives and Assessment Methods——at https://links.lww.com/ACADMED/A959. Assessment changes since 2010 UCSF has implemented programmatic assessment in the F1 phase of the curriculum and is in the process of implementing programmatic assessment in core clerkships, F2. Implementation of programmatic assessment aims to support students’ learning across the curriculum and ensure achievement of expected competence. The assessment system emphasizes students’ development of reflection, learning, and planning skills in close coordination with their coaches throughout the 4-year curriculum. Students and coaches have ready access to performance data in an individual electronic student dashboard containing visual displays of student progress compared with expected benchmarks and class averages. The dashboard includes score reports from summative assessments and students’ reflections and learning goals. In the core clerkships, the school eliminated tiered (honors) grades in January 2019. This decision was made after a multiyear effort to explore and address concerns about accuracy, fairness, and equity of clerkship grades and the impact of grading on students’ learning and well-being. Clerkships are now graded Pass/Fail, with a new requirement for 2 weekly work-based assessments for formative feedback, completed collaboratively by a faculty/resident supervisor working with the student. Parallel curriculum or tracks UCSF has 5 parallel tracks: Joint Medical Program is a 5-year integrated MS–MD program for 16 students who begin their education at UC Berkeley and transfer to the UCSF campus for clerkships and senior year. Program in Medical Education for the Urban Underserved is a 5-year track accepting 12 students annually. Students take a year off to pursue a master’s degree in a field enhancing their leadership ability in the care of vulnerable populations. SJV PRIME is a 4-year track recruiting 12 students from the Central Valley of California committed to addressing health care disparities in this underserved area. Students participate in their preclerkship years at UCSF in San Francisco, then relocate to Fresno to complete clinical studies. The Medical Scientist Training Program is the UCSF MD–PhD program, accepting 12 students yearly into a T32 and institutionally supported combined program. The Oral Maxillofacial Surgery (OMFS) program accepts 4 students with DDS degrees into an integrated MD–OMFS residency program. Pedagogy The core curriculum and 5 parallel tracks use these pedagogical approaches: Case-based learning Clinical experience: ambulatory Clinical experience: inpatient Discussion: large group (> 12) Discussion: small group (≤ 12) Laboratory Lecture Peer teaching Preceptorship Problem-based learning Changes in pedagogy since 2010 Our work since 2010 has been in identifying the balance between instructional strategies and content to best help learners with cognitive integration, particularly in the content-dense, preclerkship phase. Clinical experiences Clinical sites represent the spectrum of communities for which we provide care, including urban and rural, primary and tertiary/quaternary, ambulatory, and inpatient sites. Required longitudinal experiences The Bridges Curriculum has numerous longitudinal experiences: Longitudinal small groups to support learning for each key element in the preclerkship phase Longitudinal delivery of the family and community medicine core clerkship 3 longitudinal integrated clerkships Longitudinal, ambulatory experience during the postclerkship phase (specialty practice ambulatory subinternship) A longitudinal curriculum (ARCH) delivered at key touchpoints across all 3 phases Clinical experience first encounter Students first enter the clinical environment in the third week of the preclerkship phase, during the CMC. This experience starts with a focus on health systems and systems improvement, gradually introducing patient care skills. Required and elective community-based rotations All core clerkship rotations have community-based sites; many clinical electives are also offered at community-based sites. The San Francisco Veterans Affairs Health System is a key affiliate, and over 75% of students rotate there at some point during medical school. Challenges in designing and implementing clinical experiences for medical students The primary limitation on students’ clinical experiences comes from increased demands placed on limited clinical sites by learners from other domestic and international institutions, and across the health care training spectrum. Curricular Governance The faculty committee with primary curricular responsibility is the Committee on Curriculum and Educational Policy (CCEP), a standing committee of, and deriving its authority from, the Council of the Faculty. The CCEP accomplishes its work through a group of subcommittees: an executive committee, subcommittees focused on operations during the 3 phases, Mapping and Integration Committee, and Student Governance Committee. Each committee has LCME standards of primary responsibility and meets monthly. The executive committee is responsible for operational management of and reporting on CQI through reviewing operations reports and program evaluation data. Decentralized curricular governance None of our governance is managed at the department level. Clerkship directors and staff are funded through a centrally managed budget for curriculum leadership. Education Staff The Medical Education Unit oversees the continuum of medical education, under the vice dean for education and associate dean for medical education (ADME). The ADME oversees all staff, including the medical student programs. The structure includes a central office under the chief of staff, which oversees accreditation, financing, staff engagement, affiliations, communications, and overall strategic support. The ADME oversees educational technology, data and analytics services, and simulation and anatomy centers. Medical student programs are organized under the associate deans for admissions, students, curriculum, and assessment. Student services provides daily support for students and career advising. The Assessment, Curriculum, and Evaluation Unit oversees curriculum support and clinical phase coordination. It also supports required scholarly activities (inquiry curriculum), student coaching program, and CQI of the curriculum under the director of program evaluation. Medical education leadership The dean provides overall leadership for the School of Medicine. Reporting to the dean is the executive vice dean and vice dean for education, responsible for the medical education continuum. There are 6 associate deans reporting to the vice dean for education: Associate dean for medical education: Responsible for staff, program development and support, communications, physical space, technology, finance Associate dean for admissions: Responsible for admissions process, student scholarships, financial aid Associate dean for students: Responsible for the medical student experience and assisting students and faculty with issues with student activities, supports, career planning, professional development Associate dean for curriculum: Responsible for the medical student curriculum, including foundational sciences, clinical and systems sciences, the inquiry curriculum, and curriculum governance and CQI Associate dean for competency assessment and professional standards: Responsible for student assessment, including competencies and milestones, and the MSPE; also oversees the coaching program, which provides nonevaluative longitudinal student support Department of Medical Education Medical education staff support the medical education continuum: outreach and postbaccalaureate preparation for medical school, admissions, medical student curriculum, GME, continuous professional development, educational technology, and simulation and anatomy-based instruction. Central staff also support multiple student support services. The Office of Medical Education includes the Center for Faculty Educators (CFE), which houses our Academy of Medical Education (AME), faculty develop programs, and educational research. The center includes faculty directors of the academy and of faculty development and educational research. Faculty Development and Support in Education Professional development for faculty as educators The CFE hosts the AME and an award-winning faculty development program, recipient of an ASPIRE to Excellence Award. Faculty can view online orientation resources for the Bridges Curriculum and coaches receive tailored faculty development. We are initiating workplace-based faculty development through the Learning and Caring Ecosystem program. Faculty can participate in “Teach for UCSF” certificates in general, clinical, simulation, interprofessional, quality improvement and patient safety, and equity and inclusion teaching as well as educational leadership. Education-focused faculty can apply to the longitudinal Teaching Scholars Program and advance to master’s and doctoral degrees in health professions education through external partners. Role of teaching in promotion and tenure Faculty must demonstrate quality teaching. Peer observation of teaching can be submitted as data for promotion and tenure application. Clinical educators must show engagement in creative activity and/or dissemination of educational scholarship and/or substantial educational leadership and can be promoted through the University of California “clinical X” series. Educators can embed a teaching portfolio into their CV. Academy for Medical Educators Since 2000, the AME has supported the educators who carryout and advance UCSF’s education mission through community, diversity, advocacy, service, and innovation. The AME currently has 163 members from medicine, dentistry, nursing, and pharmacy, selected by a rigorous application process. Programs include education grants, endowed chairs (24), teaching awards, quarterly meetings/workshops, an education showcase, teacher observation program, and UCSF-wide initiatives to address diversity/equity/inclusion, wellness, learning climate, and education finance. Regional Medical Campuses Directors of both campuses are ex officio members of the CCEP, which oversees educational programming. See Table 1—Regional Medical Campuses.Table 1: Regional Medical CampusesEducational experiences across sites Directors of each program meet quarterly with main campus associate education deans to review curriculum, assessment, student experience, and progress. Each regional campus submits an annual report to the CCEP demonstrating equivalency in student satisfaction, outcomes, and competency. Memorandums of understanding between main and regional campuses are reevaluated and renewed every 5 years.