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Academic Medicine:
The Reports: United States: Minnesota

University of Minnesota Medical School — Minneapolis

HI, GREGORY M. VERCELLO MD; MACKENZIE, THOMAS B. MD; HARRIS, ILENE B. PHD

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University of Minnesota—Minneapolis

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Curriculum Management and Governance Structure

♢ The governance and management of the educational program were revised in 1998 following a school-wide strategic planning process that created an Education Council (EC) to advise the dean on matters of educational policy.

♢ The EC was designed to ensure dialogue among faculty constituencies responsible for the education program— department heads, course directors, and faculty leaders.

♢ Administrative personnel from Curriculum Affairs, Student Affairs, Admissions, and the Office of Educational Development and Research are ex officio non-voting members.

♢ The senior associate dean for education also sits on the EC. The chair, appointed by the dean, receives salary support for this activity.

♢ Overall responsibility for management of the educational program lies with the senior associate dean for education (a new position), who reports directly to the dean of the medical school.

♢ Operation of the education program is the responsibility of the curriculum director, who is chair of the Curriculum Committee (CC), composed of all required course directors. The CC is responsible for the implementation of curriculum.

♢ The directors of year one (basic sciences and Introduction to Clinical Medicine), year two (pathophysiology), and years three and four (core and elective clerkships) report to the curriculum director. Course directors report to their respective year directors.

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Office of Education

♢ The Office of Educational Development and Research (EDR) was created in 1998 with the appointment of a director and the recruitment of a coordinator.

♢ Prior to 1998, activity related to faculty development, course assessment, student evaluation, curriculum development, and educational research had been managed by a faculty member in the Curriculum Affairs Office.

♢ The EDR provides faculty with collaboration and support on curriculum and faculty development, evaluation of programs and student performance, and education/research.

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Budget to Support Educational Programs

♢ The Office of Education, directed by the senior associate dean for education, has a budget that supports administration of student affairs, curriculum affairs, admissions, and educational programs without departmental affiliation. The budget is negotiated yearly with the dean.

♢ Funding for departmental activities and faculty effort related to medical student education is not part of a discrete budget; however, efforts are under way to identify the costs of these efforts and to fund them from state appropriations. It is likely that such support would remain part of a department's overall yearly budget negotiated with the dean.

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Valuing Teaching

♢ Through the Minnesota Medical Foundation, the medical school coordinates the annual selection by students from each class of a faculty member to receive the Distinguished Teaching Award.

♢ The foundation solicits faculty nominations yearly and selects one faculty member to receive the Outstanding Medical School Teacher Award.

♢ Two years ago the university began selecting eight faculty members from the graduate and professional schools each year to receive the Graduate—Professional Teaching Award. The award carries with it a $3,000-per-year life-time stipend during tenure at the university. The medical school submits five nominees per year, and to date three medical school nominees have received this award.

♢ The medical school has recently established the Academy of Medical Educators to recognize excellence in teaching.

♢ Recipients of the aforementioned awards and one faculty member per year selected by the academy itself will be members and recognized with a photograph and plaque in an public area adjacent to medical student instructional space.

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CURRICULUM RENEWAL PROCESS

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Learning Outcomes

♢ In February 1998 the senior associate dean for education convened a broadly representative group of 35 faculty members to assess progress in primary care education in the medical school curriculum and make recommendations for changes.

♢ The faculty group built on committee reports commissioned in 1993 and 1996 aimed at establishing the basic competencies expected of all graduates.

♢ Faculty approved a set of learning outcomes for graduates of the school. [The learning outcomes are available from the authors.]

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Changes in Pedagogy

♢ In 1985 a small-group format was introduced into the second-year pathophysiology curriculum. The ratio is roughly two hours of lecture for every one hour of small-group. Most of these group sessions are built on clinical cases, and in many instances they use a problem-based method.

♢ Plans are under way to create standardized clinical case narratives for use by year-one lecturers when illustrating the application of basic science principles.

♢ In the last two years standardized patients have been recruited and trained to simulate specific clinical encounters.

♢ Standardized patients, reimbursed on a daily basis, are used to train second-year students in the male genital and the female pelvic/breast examinations. Each student encounters four such patients during a six-week period.

♢ A required objective structured clinical examination (OSCE) using standardized patients, to be given at the end of the eight-week ambulatory primary care rotation in the third year, is under development.

♢ Third- and fourth-year students serve as standardized patients in a second-year OSCE designed to give students feedback about their performances.

♢ Standardized and paid patients have been recruited to be examined by groups of up to four second-year students during a course on physical examination in the second year. They have been trained to give feedback to these students.

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Application of Computer Technology

♢ It is recommended, but not required, that students have computers.

♢ Funds for purchasing a computer are included in the student financial aid package.

♢ A medical student computer lab with full-time technical support has been created. New lab and small-group space under construction will have ports for using laptop computers in didactic activities.

♢ Computer technology is used to present visual material in lecture and laboratory activities.

♢ Selected courses use Web pages in place of a traditional syllabus.

♢ A Web-based system to obtain student evaluation of clerkship experiences is under development.

♢ Hand-held computers are being used to keep logs of patients seen in our eight-week primary care rotation.

♢ Computers are being used to gather student feedback on required clerkships.

♢ A student-run site reviews the various clerkship venues.

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Changes in Assessment

♢ Standardized patients are used in evaluations of physical examination skills and in the Introduction to Clinical Medicine course in the second year.

♢ Direct observation of students when examining actors and paid patients is part of the Clinical Medicine II rotation in the second year.

♢ An OSCE examination using third- and fourth-year students as patients and examiners is included in the second-year ICM course.

♢ An OSCE at the end of the year-three primary care clerkship is being developed. Successful completion of the OSCE will be a course requirement. Standardized patients will be used exclusively.

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Clinical Experiences

♢ Clinical Medicine IV is a third-year required eight-week primary care course that is taught entirely in office and clinic settings.

♢ Other required clerkships typically are taught in hospital settings.

♢ Students who elect the Rural Physician Associate Program spend nine months during their third year in a rural primary care setting.

♢ Students in years one and two visit hospital wards, clinics, or physician offices as part of their course in physical diagnosis.

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Curriculum Review Process

♢ A major review of the primary competencies expected of all graduates was completed in 1999.

♢ The review was conducted by a committee of faculty selected by the senior associate dean for education. The committee included representatives from the schools of nursing, public health, pharmacy, and dentistry.

♢ The committee identified eight areas in need of additional attention in the curriculum. These were communication and interviewing skills, cultural competence, ethics, evidence-based medicine, health care delivery systems, informatics, interdisciplinary teamwork, and preventive medicine. Content relevant to these competencies was to be integrated into the existing curriculum using problem- and case-based methods without adding substantial curriculum time.

♢ The Education Council adopted the report of the committee and its recommendations.

♢ For each of the deficiency areas, the Curriculum Committee (membership consists of the directors of all required courses) constituted a steering committee charged with coordination of curricular design, faculty development, and evaluation of progress in the designated areas.

♢ Currently, a steering committee coordinates the efforts of these eight committees. Two additional areas have been added: end-of-life care and investigative medicine.

♢ The Education Council has been charged by the dean with developing a method to review the entire curriculum, to conclude with a faculty retreat in 2001. Plans to initiate this review are ongoing.

♢ The Curriculum Committee has proposed the following plan for a review of all years of the curriculum. Approximate times for completion are indicated in parentheses.

* Step 1: The Curriculum Committee Executive Committee will gather the following reports and information, review them and categorize all the recommendations made:

- Year one review In progress

- Year two review Complete

- Years three and four self-study In progress

- Primary Care Education Committee report Complete

- Cultural Competence Committee report Complete

- Strategic Plan Education Work Group report Complete

- Report from year two course director's retreat, 1997 Complete

- Graduation Questionnaire summaries Complete

- Year one end-of-year survey summaries Complete

- Year two end-of-year survey summaries Complete

- LCME reports from recent site visits Complete

* The group will also gather curriculum information from other top medical schools, especially ones that have experienced recent curriculum revisions. Recent graduates will be surveyed about the curriculum and suggestions for change. (Mid-summer 2000)

* Step 2: After Step 1 has been completed, the Curriculum Committee itself will serve as the review committee for the entire curriculum. They will meet, discuss, and prioritize the recommendations and will prepare proposals for implementation. This will be done with input from both the UMD Medical School faculty and medical students. (Fall 2000)

* Step 3: The Curriculum Committee will prepare a report and forward it to the Education Council, which will discuss the report and organize an all-faculty retreat. The purpose of the retreat will be to give faculty the opportunity to discuss the recommendations and plans for implementation. (Winter 2001)

* Step 4: After final approval of recommendations by the Education Council, the Curriculum Committee will be responsible for implementation. (Fall term 2001, or earlier)

* Course directors are charged with reviewing the content and methods of instruction on a yearly basis.

* Review of the subjects covered, the times allotted, and the methods used to integrate the curriculum are the purview of the Curriculum Committee and the Education Council. When these groups identify a need for significant change, an ad-hoc committee of faculty is convened to review the educational program. This process usually takes place over a two-year cycle and has historically occurred at intervals of ten to 15 years.

© 2000 Association of American Medical Colleges

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