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Academic Medicine:
The Reports: United States: Oklahoma

University of Oklahoma College of Medicine

ANDREWS, M. DEWAYNE MD

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University of Oklahoma

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Curriculum Management and Governance Structure

All students (150 per class) take their first two years of medical school at the college's main campus in Oklahoma City. In the third year, approximately 30 students annually elect to take the last two years at the clinical branch campus in Tulsa. The educational program for both campuses is under one governance and management structure.

♢ Prior to 1997, the college had a single medical education committee that was large, cumbersome, and somewhat stale in its approach to assessment, evaluation, management, and innovation in the curriculum. Since 1997, significant changes in curricular integration, planning, and evaluation have occurred. Now the undergraduate educational program oversight and management is vested in three committees:

* The Basic Science Curriculum Committee (BSCC) has responsibility for the first and second years, which includes significant early and continuing experience with patient contact and clinical skills development.

* The BSCC membership includes all course directors for the first two years, elected student representatives from the first and second years, and ex officio members from the dean's office; the committee is chaired by the senior associate dean for academic affairs.

* The Clinical Sciences Curriculum Committee (CSCC) has responsibility for the third and fourth years.

* The CSCC membership includes all core clinical clerkship directors (Oklahoma City and Tulsa); the faculty directors for the required fourth-year ambulatory medicine clerkship; the faculty director for the required rural preceptorship; three members appointed by the faculty board representing a surgical subspecialty, a non-surgical subspecialty, and a hospital-based specialty; one member of the volunteer faculty; elected student representatives; and ex officio members from the dean's office. The committee is chaired by the senior associate dean for academic affairs.

* The Curriculum Coordinating Committee is a small group of individuals selected from the BSCC and the CSCC who meet occasionally to monitor the progress of the BSCC and CSCC; to ensure appropriate integration; and to serve as a “think tank” group for longterm direction and strategy.

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Office of Education

♢ Historically, support for the educational program, faculty, and administration of the curriculum was provided through individual departments and the dean's office.

♢ In 1996, the executive dean created the position of senior associate dean for academic affairs, which led to the consolidation of a number of support functions.

♢ Two new roles have been created: associate dean for medical education and associate dean for educational assessment and informatics.

♢ In 1999, the College created the new Office of Educational Development and Research.

♢ The director of the Office reports to the senior associate dean for academic affairs.

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Budget to Support Educational Programs

♢ The college receives discrete state funds targeted for support of education.

♢ The funds are derived from tax dollars and are appropriated annually by the legislature.

♢ The college receives tuition dollars.

♢ Clinical departments and the college fund some aspects of the educational programs through clinical practice revenue.

♢ A new project has been initiated to develop cost accounting for the educational programs as part of a move to mission-based budgeting.

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Valuing Teaching

♢ Faculty recognition includes

* teaching evaluations and accolades

* annual Aesculapian nominations and awards given by students for outstanding teaching

* the annual Stanton L. Young Master Teacher Award, which carries a $10,000 cash prize

* special awards and professorships granted by the board of regents of the university to recognize sustained, outstanding teaching and/or service to education

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CURRICULUM RENEWAL PROCESS

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Learning Outcomes

♢ In late 1996 and early 1997 there were educational strategic planning retreats involving many faculty, students, and the administration of the college.

♢ New educational program objectives were established with corresponding outcome measures/indicators.

♢ The faculty board approved the objectives in March 1997 and they have been used to guide the educational planning and implementation efforts since that time.

♢ In the fall of 1998, another educational planning retreat was held in which many faculty education leaders and student representatives participated.

♢ The educational program objectives were reviewed, their utility discussed, and some amendments made. [An elegant chart of the educational objectives and their corresponding outcome measures/indicators is available from the authors upon request.]

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Changes in Pedagogy

♢ Small-group discussion (module teaching) has always been of primary importance in basic science years.

♢ The basic science education building was designed to accommodate the modules.

♢ There is increased use of interdisciplinary teaching using clinicians and basic scientists together.

♢ A case-based approach to small-group studies is used in the basic science years.

♢ There are increased numbers of problem-based applications; these occur in the second year.

♢ Student-centered learning is a critical part of a course called Professional Ethics and Professionalism, with students selecting the course content, meeting in small groups with faculty and community facilitators, and making presentations to classmates.

♢ Since 1990 standardized patients have been used in the Principles of Clinical Medicine course in the first and second years.

♢ The standardized patient program is being expanded to include cultural diversity exposure; a family is being “trained” to allow student observation of the family dynamics in the Native American culture.

♢ All standardized patients are trained to provide appropriate assessment and feedback.

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Application of Computer Technology

♢ Since 1997 students have been required to own modern computers upon entry to medical school.

♢ Upon matriculation, every student is given a campus computer account for access to e-mail, central server space, and dial-up Internet connectivity.

♢ A centralized Web site (〈hippocrates@ouhsc.edu〉) provides students with on-line educational resources, including lecture slides, multimedia tutorials, quiz banks, video clips, and animations.

♢ Students may access their class schedules on-line and download them for use on personal hand-held computers.

♢ Current clinical materials include clinical calculators, obstetrics, case presentations, and information regarding various procedures.

♢ Links are provided to the library's on-line journals and reference tools and to external Web sites such as those of ERAS, FREIDA, the NRMP, and the USMLE.

♢ Instructors employ computers during both laboratory sessions and lecture presentations.

♢ Faculty use discussion boards to deliver class announcements and post answer keys after examinations.

♢ Course directors offer anonymous on-line course evaluations to gather information about their courses.

♢ A state-of-the-art fiberoptic network provides students access to curricular resources.

♢ Each major lecture hall is equipped with a lecturer work-station and an LCD projector.

♢ Plans are under way to improve students' access to computers in campus hospitals and clinics.

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Changes in Assessment

♢ The primary means of assessment in the basic science courses are multiple-choice examinations and practical examinations to identify specific structures in the anatomy course.

♢ At present, computer-based examinations are not used. With the implementation of computer-based examinations for Steps 1 and 2 of the USMLE, serious consideration is being given to using the computer format for other examinations.

♢ In the clinical years, students are assessed utilizing

* faculty attendings' and residents' written evaluations on clinical clerkships, using a standardized form

* NBME subject examinations

* seminar/symposium presentation assessments

* internally developed examinations, written and oral

♢ The CSCC is exploring the feasibility and implementation strategies necessary for an OSCE to be administered near the end of the third year.

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Clinical Experiences

♢ Students begin clinical experiences early in the first year with standardized patient interviews and regularly scheduled experiences in community physicians' offices.

♢ Students begin work with “senior mentors,” who are elders in the community who have agreed to work with the students over time to assist them in understanding the special needs of the geriatric population.

♢ In the second year, students are assigned to clinical preceptors, both in hospital units and in community physicians' offices, where they examine real patients, write up their experiences, and review them with their preceptors.

♢ The third year consists primarily of core clinical clerkships that provide a variety of learning venues, including inpatient hospital units (University, Childrens, VA, and some private community); outpatient hospital-based clinics, outpatient clinics in freestanding ambulatory care centers, and physicians' offices.

♢ The fourth year includes a required ambulatory medicine clerkship and a required rural preceptorship (both office and hospital experiences).

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Curriculum Review Process

♢ Faculty have been involved in a review of the curriculum for the past several years.

♢ Two faculty retreats generated recommendations and included a process of course review involving faculty, students, and course directors, with appropriate feedback to all.

♢ In addition to two curriculum committees, a curriculum coordinating committee meets biannually to discuss the direction, structure, and approach to new curricular design. Such discussions have resulted in the development of longitudinal curricular topics. To date these include

* complementary and alternative medicine (taught in a seminar series in the third year)

* palliative care (surveys of students, presentations in existing courses, and incorporation into clinical clerkships)

* domestic violence

* professional ethics

* evidence-based medicine (longitudinal experiences with assignments in biostatistics and epidemiology, physiology, human behavior, and ethics)

* family-centered care activities (incorporated in the curriculum and in student organizations)

* a new Patient, Physician, and Society program that includes medicine and literature and medicine and law experiences (under development)

♢ Ongoing review of the educational program is the responsibility of the associate dean for educational assessment and informatics.

♢ A standardized course-evaluation process for the basic science curriculum has been in place for a number of years. Students are requested to complete a computer-based evaluation form for each course. Students also have the opportunity to provide written comments about the course on the evaluation form. These data are collated by the associate dean and sent to the course director.

♢ The course directors and the associate dean meet with a representative group of students to discuss each course in detail. The course director then prepares a report and submits it to the Basic Sciences Curriculum Committee. The committee reviews these data and makes recommendations to the course director.

♢ At present, the course directors of the required clerkships submit to the Clinical Sciences Curriculum Committee a report that describes their course in detail in a standardized format. The major goal of this process is to ensure comparability of the educational experiences between clerkships on the Oklahoma City and Tulsa campuses.

♢ An evaluation process similar to that employed in the basic science curriculum is being designed for student evaluation of the third-year required clerkships. This was expected to be implemented in July 2000.

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Future Goals

♢ The major issues that will be addressed in the next five years include:

* implementation of a comprehensive course-evaluation process for the required clinical clerkships

* continuation of efforts to reduce the number of lecture hours in the basic science courses and increase integration of material and the number of small-group activities

* increased utilization of problem-based-learning experiences

* continuing evolution of computer-assisted instruction

* enhancement of faculty teaching skills

© 2000 Association of American Medical Colleges

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