Curriculum Management and Governance Structure (See Figure 1)
♢ The Educational Policy Council (EPC) is composed of administrators and faculty who advise on all College of Medicine educational issues, including undergraduate, graduate, CME, and faculty development.
♢ The Undergraduate Curriculum Committee (UCC) is a faculty committee that addresses undergraduate medical education issues, including course changes, scheduling issues, student and course evaluation processes, LCME accrediation issues, and pertinent student affairs issues.
♢ The UCC is ultimately responsible for monitoring the effectiveness of the curriculum and approving substantive changes.
♢ The Curriculum Coordinating Committee (CCC) has the specific charge of managing the logistics of the curricular renewal for the College of Medicine undergraduate curriculum. It is charged with the responsibility for fostering meaningful integration of content and educational processes within and between the four years of the curriculum.
♢ Curriculum-year coordinators (a basic scientist and a clinical scientist for each year) are responsible for curricular decisions in each year of the curriculum (e.g., year two).
♢ Two doctoring-curriculum coordinators are responsible for the Doctoring Curriculum that spans all four years.
♢ The Curriculum Coordinating Committee is composed of the curriculum-year coordinators, the doctoring-curriculum coordinators, the associate dean for student affairs, the associate dean for primary care, the assistant dean for curriculum and evaluation, two medical students, and two resident physician graduates of MUSC.
Themes for Curriculum Renewal
♢ Increased integration of basic and clinical sciences throughout all four years, with emphasis on the basic science underlying clinical medicine
♢ Emphasis on self-directed learning and development of critical-thinking skills
♢ Use of multiple methods of learning and evaluation throughout all four years
♢ Use of comprehensive assessments to provide feedback to students about their performances and indicate areas for remediation
♢ Early exposure of students to patient care through primary care clinical experiences
♢ Emphasis on the preparation of a generalist physician
♢ Development of an evaluation system to increase faculty and student accountability
♢ Development of students as medical professionals with effective interpersonal skills and knowledge of issues related to the delivery of health care
♢ Early and frequent contact between students and basic and clinical science faculty
♢ Emphasis on the use of information technology to access information and provide effective patient care
Curriculum before Renewal
Traditional 2 + 2 basic science and clinical medicine
Timeline for Process of Curriculum Renewal
♢ A preclinical, problem-based learning “parallel curriculum” was established in 1994 for 18 students to pilot a curricular innovation.
♢ The College of Medicine 1995-96 strategic plan included objectives for the undergraduate medical education program and identified competencies for medical school graduates.
♢ In the fall of 1997 and the early winter of 1998, “virtual” site visits were conducted with the University of New Mexico, Northwestern University, and the University of Pittsburgh to gather information about their curricula and processes they had used to introduce change.
♢ A retreat was held in spring of 1998 with the Educational Policy Council members and invited guests to discuss curricular change.
♢ Estimated date for full implementation of the new curriculum is the fall of 2000.
Design for Renewal Process
♢ Appointment of an associate dean for primary care and development of the Office of Primary Care, with a curriculum and evaluation coordinator to facilitate the change process
♢ Acquisition of information through “virtual” site visits from other medical schools that have changed their curricula
♢ Working groups charged to develop curricula and evaluation plans for the following curricular areas: physician-patient communication, human values and ethics, evidence-based medicine and continuous quality improvement, and health promotion disease prevention
♢ Retreat held with key stakeholders
♢ Curriculum-year coordinators named and the Curriculum Coordinating Committee established to manage the details of curriculum renewal
Planning and Implementation Resources Needed
♢ An Office of Primary Care with administrative support personnel to facilitate the curricular change process
♢ Funds to pay for “virtual” site visits and education consultants to visit MUSC
♢ Faculty time and sufficient faculty to teach small groups of medical students
♢ Funds and personnel to conduct faculty development programs
♢ Food for lunch meetings and retreats
♢ A defined educational budget
Strategies of Process
♢ Leadership by the dean
♢ Office of Primary Care established to facilitate change process
♢ Student involvement
♢ Establishment of task forces
♢ Appointment of respected, innovative educators as curriculum-year coordinators
♢ Realignment of education dollars
♢ Development of Center for Medical Education
♢ Success of the “parallel curriculum” as an educational innovation and the demand for the addition of six more students to each year of the curriculum
♢ Establishment of the Center for Clinical Evaluation and Teaching (CCET)—the CCET provides space for conducting clinical performance assessments
♢ Implementation of a primary care, community-based experience for first-year students to provide them with early patient-care experience
♢ Implementation of a rural, interdisciplinary third-year clerkship that emphasizes students' application of the principles of community-oriented primary care and continuous quality improvement in the provision of health care in rural, underserved communities in South Carolina
♢ Implementation of a comprehensive examination week that includes three study days, a day for the written comprehensive examination, and a day for the laboratory practical and clinical skills examination
♢ Introduction of a problem-based-learning component in the first-year curriculum
♢ Implementation of a clinical practice examination required of all students to pass before graduation, administered at the beginning of the fourth year
Challenges of the Process
♢ Faculty resistance to the need for curriculum change—“If it isn't broken, don't fix it.”
♢ Fear of loss of autonomy in a more centralized curriculum structure among faculty and chairpersons
♢ Pressures on clinical faculty for clinical productivity
Plans for Evaluation of Change
♢ Evaluations by students of all courses, including use of liaison groups for formative feedback
♢ Evaluations by faculty of courses and assessments of faculty satisfaction with the curriculum
♢ Assessments of student satisfaction with the curriculum and quality of life during medical school
♢ Assessment of student performances on a clinical practice examination at the beginning of the fourth year
♢ Examination of USMLE performance
♢ Examination of NBME subject examination scores in third-year clerkships
♢ Examination of AAMC Graduation Questionnaire data
♢ Assessment of graduates' performances during residency by issuing questionnaires to residency directors
♢ Examination of graduates' specialty choices and the geographic distribution of practice locations
♢ Development of a system for measuring faculty performances, including the use of student, peer, and experienced senior faculty evaluations