Medical Education Program Highlights Geisinger Commonwealth School of Medicine (GCSOM) was founded as The Commonwealth Medical College (TCMC) in 2009. Established by the community, without a parent university or sponsoring hospital system, the school collaborated with volunteer community faculty and local health care institutions to deliver the curriculum. From the beginning, the school has embraced a mission to serve the community and to replenish its physician workforce. It has been innovative in significant ways: The first medical school to use the longitudinal integrated clerkship (LIC) for the entire class Using active learning and the flipped classroom extensively, with lectures representing less than 23% of classroom time in the preclinical years Integrating community experiences, community health, and community service fully into the curriculum On January 1, 2017, the school integrated with Geisinger, a highly functioning, integrated health care delivery system, which immediately provided robust and stable clinical learning venues; access to over 1,600 clinician–educators to serve as faculty; and exposure to cutting-edge research and clinical innovation in informatics, data science, precision health, genomics, implementation science, and outcomes research. Geisinger’s existing graduate medical educational programs include over 450 learners in 48 accredited residency programs, providing enhanced learning for GCSOM students in an environment of cutting-edge innovations in education, research, and patient care. The Family-Centered Experience (FCE) is an integral part of GCSOM’s patient-centered approach to medical education. This program matches a pair of first-year medical students with a volunteer family from the community to teach them about the impact of illness on family life. Students follow their volunteer family for 2 years and participate in scheduled debriefing sessions with peer students and faculty regarding their experiences, observations, and lessons learned in an effort to foster student compassion and understanding. All first-year medical students complete longitudinal community health intervention projects (L-CHIPs) in collaboration with community partners to learn about community health research. The L-CHIP experience, anchored in the Physician and Society course, includes presentations on community-based participatory research, scientific method, research design, clinical and epidemiological research methods, research ethics, and biostatistics. Students work in small groups, to perform a literature review, interact with community partners, help develop and/or investigate a researchable question and proposal for community health intervention, and present a poster at a spring symposium. All third-year medical students are required to complete quality improvement community collaboratives to introduce the core competency of systems-based practice. Under the mentorship of QI staff in GCSOM teaching hospitals, students apply the principles of performance improvement, identify and analyze a health care delivery problem, and help develop and carry out a quality intervention in small groups. Through these projects, students learn to engage stakeholders to make changes in their routines that improve health care delivery and patient safety. A professional identity formation curriculum was developed to address explicitly the professionalism competency. It maps longitudinal identity growth with an ultimate goal of becoming a reflective practitioner by providing a system of academic coaching for students. This includes a referral process to the GCSOM Center of Learning Excellence focused on early identification of academic and professionalism issues. The process documents each student’s professional identity formation growth throughout medical school through the use of an ePortfolio. Curriculum Curriculum description See Supplemental Digital Appendix 1—Curriculum Schematic—at https://links.lww.com/ACADMED/A929. Curriculum changes since 2010 Initially, the third year was a 12-month LIC with brief “bursts” of inpatient experiences. Based on feedback from students and preceptors, the third year was redesigned in 2017 into a hybrid LIC/block curriculum that consists of 6 months of inpatient experience and 6 months of outpatient LIC experience. This redesign eliminated interruptions in the continuity experience and provided a more robust inpatient experience, which facilitates full student engagement on clinical teams for a total of 23 weeks as compared with the previous 10 burst weeks. In 2019, the Longitudinal Continuity Experience (LCE), with 1 half day per month in year 2, was launched as part of the Art and Practice of Medicine course. The LCE pairs students to outpatient clinic sites where they are expected to practice their clinical skills and learn to navigate the day-to-day operations of an outpatient practice, under the guidance of a GCSOM faculty physician preceptor. In 2017, a new 4-year interprofessional education (IPE) core curricular element was established. The IPE component introduces foundational concepts of IPE in the first 2 years through IPE exercises with nursing and pharmacy students, using a Team STEPPS model. Third-year IPE sessions include multiple health care learners and simulated patient scenarios. In the fourth year, all students complete a required 2-week IPE rotation on a highly functioning interprofessional team to learn about roles, responsibilities, and factors that enhance or hinder team function. All IPE sessions are aligned with Interprofessional Education Collaborative core competencies. In 2017, TCMC became GCSOM. This resulted in the realignment of the clinical campus structure around 3 Geisinger sites: North (Scranton), South (Wilkes-Barre), and Central (Danville). A fourth campus site had been established earlier in Sayre, Pennsylvania, in affiliation with the Guthrie Health System. In 2019, a fifth campus was established within AtlantiCare in Atlantic City, New Jersey. All sites follow a similar clinical training curriculum. Assessment The ACGME core competencies inform GCSOM’s MD program objectives. Each of the 6 competencies has subcompetencies that are measured using formative and summative feedback, objective structured clinical examinations (OSCEs), team-based learning, exams, essays, peer evaluations, and performance on national exams. See Supplemental Digital Appendix 2—Medical Education Program Objectives—at https://links.lww.com/ACADMED/A929. Pedagogy See Figure 1—Pedagogical approaches.Figure 1: Pedagogical approaches.Clinical experiences The sites used for the required rotations are primarily Geisinger or Guthrie network locations; however, students also rotate with GCSOM faculty at the Wilkes-Barre VA Medical Centers and at community-based sites for some clinical experiences. All GCSOM third-year learners complete a yearlong clerkship comprising a 6-month longitudinal integrated experience and discipline-specific block rotations in 6 core specialties. Half of the class begins the third year with longitudinal experience and half begins with block rotations, switching at midyear. GCSOM students spend a considerable amount of time at community sites during their clinical training, beginning with their first-year L-CHIP project and FCE, and continuing with their second-year LCE longitudinal outpatient experience. During the third-year LIC, students in the outpatient curriculum spend at least 1 half day weekly with an assigned physician in an ambulatory setting in each of the 6 core specialties, followed by intervals of 1–4 weeks in block inpatient rotations. Additional community experience is found in the 100 hours of required community service completed by each GCSOM student. GCSOM faced significant challenges in maintaining the original clinical campus structure as the health care environment in northeast Pennsylvania underwent structural change. Since the integration with Geisinger, we have established stable campuses and are in the process of renewing our medical education program and governance to match better the integrated health system. This integration has helped GCSOM establish early clinical exposure, enhancements in our required third- and fourth-year required rotations, and expansion of our elective rotation catalog. We are beginning a period of curriculum renewal in which we will further optimize our clinical education program by leveraging the strengths of the Geisinger and Guthrie health care systems. Curriculum Governance See Figure 2—Curricular governance committees.Figure 2: Curricular governance committees.Education Staff The Office of Academic Affairs, led by the vice dean for medical education, comprises 16 staff who support planning, implementation, evaluation, and oversight of the curriculum. The chair of the Department of Medical Education (DME) reports to the vice dean. The DME, with 43 faculty, is responsible for curriculum development and delivery in years 1 and 2. In addition, the department has 6 assistant chairs in core clinical disciplines (family medicine, internal medicine, obstetrics–gynecology, pediatrics, psychiatry, surgery) who are responsible for curriculum development, assessment, and comparability in the required clinical curriculum. Five regional associate campus deans lead the clinical campuses. Each campus associate dean is responsible for delivery of required clinical curriculum in years 3 and 4. Every campus has an assistant dean for student affairs and core clerkship directors, a regional education specialist (master’s-level educator responsible for monitoring student progress and implementing the curriculum), and support staff. See Figure 3—Medical education leadership.Figure 3: Medical education leadership.Each campus has a robust GME program that is administered by separate staff. Likewise, education for other learners outside of UME is administered through separate individuals. The UME mission at each campus has its own staff, as described above. In 2018, GCSOM combined its 2 medical school departments (basic and clinical science) into the single DME that represents all clinical and basic science disciplines at the medical school. Faculty Development and Support in Education The school has a robust faculty development program that is administered by the associate dean for faculty development. This includes a quarterly workshop in education topics at each campus, a yearlong medical education certificate program, and additional faculty development programs. Other campus-specific development activities include NBME-style question-writing workshops, narrative composition workshops, facilitator development, professional identity workshops, implicit bias training, and well-being/resiliency workshops. All faculty at GCSOM are evaluated based on teaching excellence (quantity and quality) and use of a scholarly approach in education and their level of scholarship (engagement). All faculty submit educational portfolios that include evidence of excellence and documentation of engagement (abstracts, workshops, presentations, seminars, posters, etc.) based on the AAMC’s Group on Educational Affairs criteria, including teaching, learner assessment, curriculum development, mentoring/advising, and educational leadership/administration. Regional Medical Campuses See Table 1—Regional Medical Campuses.Table 1: Regional Medical CampusesEducational experiences across sites Consistency of educational experiences across sites is monitored at quarterly intervals. Regional campus leadership and the assistant chairs for the 6 core disciplines are sent aggregated data that include shelf exam performance, preceptor assessments of student performance, OSCE scores, and clinical encounters and skills. This allows student progress and campus comparability to be evaluated and discussed in real time. The regional deans are also responsible for meeting with the hospital and clinical leadership within their campuses to ensure that the learning environment is appropriate for students. This is also monitored using a learning environment survey that is delivered annually to first- and third-year students. An online event-triggered learning environment form can also be submitted by students at any time during their education. Initiatives in Progress The Abigail Geisinger Scholars Program awards up to 10 students per class up to 4 years of tuition and fees in the form of a loan, which is forgiven upon completion of a service commitment as a Geisinger physician. The award recipient is obligated to practice as a Geisinger-employed physician upon completion of residency training. One year of service is required for each year of support, with a 2-year minimum commitment. Thus, participants who complete their obligation will have no tuition debt. This initiative was launched in the spring of 2019. The Geisinger Primary Care Scholars Program, launching in the spring of 2020, supports up to 40 students per class with full tuition and fees and a $2,000-per-month stipend in the form of a forgivable loan. Upon completion of residency training, the student will become a Geisinger-employed primary care physician (family medicine, medicine, medicine–pediatrics), providing 1 year of service for each year of support. The objective of this program is to create new regional primary care physicians who have no educational debt from pursuit of their MD degree. A 2020 curriculum renewal effort is currently gathering the talent of all stakeholders across our 2 health systems to create a curriculum that will produce practitioners who are ideally suited to practice medicine in a changing health care environment. Thus, the renewed curriculum will include themes that reflect strengths evident in our health care systems based on the following principles and foundational elements: Integration of basic and clinical sciences throughout the curriculum Establishment of signature, evidence-based pedagogies Creation of meaningful roles for students in the clinical environment with progressively increased levels of responsibility throughout training Explicit inclusion of professional development formation Service to the community Leveraging system and regional strengths to ensure curricular excellence Ensuring that graduates are prepared to become excellent residents