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Academic Medicine:
The Reports: United States: West Virginia

West Virginia University School of Medicine

SHUMWAY, JAMES M. PHD

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West Virginia University

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Curriculum Management and Governance Structure

♢ Since 1990, the management of the curriculum has become more centralized. This more centralized management resulted in a major revamping of the curriculum for the first two years.

♢ Departments and faculty who want to make changes in the curriculum consult the associate dean for medical education.

♢ The Curriculum Committee and the associate dean for medical education now manage the educational program.

♢ The Curriculum Committee reviews recommendations for changes in the curriculum.

♢ The Curriculum Committee, working with the associate dean for medical education, recommends curricular changes to the dean.

♢ If a recommended curricular change is major, such as a “new” curriculum, then the faculty is consulted. The faculty meet to discuss and vote on major curricular changes.

♢ The dean, through the associate dean for medical education, also may seek advice and guidance on curricular changes from the executive faculty (chairs) of the School of Medicine.

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Office of Medical Education

♢ Recommendations from the Curriculum Review Task Force, the Education Strategic Planning Committee, and the Curriculum Committee resulted in the establishment of the Office of Medical Education in 1998.

♢ The Office of Medical Education (OME) is an academic support unit located administratively in the dean's office of the school of medicine.

♢ The mission of the OME is to foster excellence in medical education, to contribute to the knowledge base that informs decisions in medical education, and to support the educational mission of the school of medicine.

♢ The Office of Medical Education contributes to realizing the overall vision of the school of medicine—“Changing to care better for those we serve: students, patients, and community.”

♢ The OME staff works with faculty to provide leadership in curricular development, instructional development, program evaluation, student assessment, and research in medical education.

♢ In collaboration with the school of medicine faculty, the OME enhances the educational programs in the school of medicine by

* improving current teaching, learning, and evaluation in medical education

* improving the measurement and recognition of faculty members' educational contributions

* assessing outcome measures of educational progress for students and faculty

* promoting and conducting scholarship and research in medical education

* disseminating information about medical education

* assuring continuing accreditation and excellence in the educational program for the MD degree

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Budget to Support Educational Programs

♢ There is not a discrete budget identified to support the educational program at the present time. However, the situation will change in budget year 2000-2001.

♢ The WVU School of Medicine has implemented the mission-based management program, which will create reporting tools to measure financial performance and productivity on a mission-specific basis at three levels: school, department, and individual faculty member.

♢ Equipped with improved measuring and accounting systems, the WVU School of Medicine will be better able to fund programs on a mission basis. As a result, the education mission will have its own identified and discrete funds that will be based on need and productivity in the delivery of educational programs.

♢ Funds will be drawn from state, practice plan, hospital, grant, foundation, and other sources to fund the education mission as the School goes to an all-funds budget, another outcome of participation in the mission-based management program.

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Valuing Teaching

♢ ♢ Department chairs and course/clerkship coordinators identify faculty who make significant teaching contributions. The associate dean for medical education recommends to the dean that they be recognized for their efforts.

♢ ♢ Recognition includes letters for their files, compensation for outstanding teaching contributions, and departmental and school teaching awards.

♢ ♢ Clinical faculty whose primary responsibilities are for course direction are compensated for their time by the dean's office to offset clinical dollars that may be lost because of the time and contribution they put into the teaching program.

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CURRICULUM RENEWAL PROCESS

♢ The themes and goals of the curricular renewal effort resulted from a vision to become more student-centered in teaching strategies and to focus on student learning. That effort resulted in a basic science curriculum characterized by the following changes:

* The lengths of the first and second years of medical school were increased with no change in contact hours.

* The basic sciences were integrated and modularized into blocks.

* Patient-related experiences and associated small-group discussions were provided in the second week and beyond.

* Active learning opportunities, including weekly PBL sessions, were increased.

* Lease/purchase of laptop computers was required of all incoming first-year medical students.

♢ The actual process to get to these changes started early in the last decade and can best be described by the following chronology of events:

* 1991: the Curriculum Advisory Council described the state of educational affairs at that time.

* 1993: The school was reviewed by the LCME, which expressed concerns about

—the role of the Curriculum Committee in addressing the curriculum as a whole

—the need for integration of the basic and clinical sciences

—the need to create more opportunities for active learning

—the appropriate reduction in the large number of scheduled hours in the first two years

* 1994: The first-year basic science faculty started using PBL.

* 1995: The Curriculum Review Task Force made recommendations that would serve as the foundation for the future changes.

* 1996: The Education Strategic Planning Committee recommended goals and objectives for the education mission of the School. A day-long faculty curriculum retreat was held.

* 1997: The Curriculum Committee recommended significant changes in the education of medical students during their first two years. The provost approved the change in the School of Medicine academic calendar. The recommended changes were endorsed by the executive faculty of the School of Medicine. A faculty forum was held. Faculty approved the curricular changes by unanimous vote.

* 1998: The WVU Faculty Senate approved the new curriculum and courses. First year of curricular changes implemented in the fall.

* 1999: Second year of curricular changes implemented in the fall.

♢ Among the unanticipated outcomes of the process was a camaraderie that developed among the faculty from different departments as they cooperated and worked as a team to develop the integrated basic science courses. Faculty became more interested in learning how to teach well.

♢ The challenges of the changes in the curriculum were the scheduling of the new first- and second-year modular blocks, which did not conform to traditional college semester schedules; meeting expectations and needs for faculty development; and providing timely and hands-on support for faculty using new information technologies in the classroom.

♢ One of the recommendations of the Curriculum Committee for adopting the new curriculum was that it be evaluated after it has been fully implemented.

♢ The school of medicine is designing a system to identify the expected learning outcomes, developing various measurement strategies to assess changes, and developing a “user-friendly” database to capture data for short- and long-term curricular improvement.

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Learning Outcomes

♢ The faculty has not identified specific learning outcomes students must demonstrate prior to graduation at the present time.

♢ The dean has asked that an education strategic plan advisory board be formed and charged with developing the process to determine specific student learning outcomes.

♢ In 1996 the Education Strategic Planning committee recommended the following goals and objectives for the education mission of the school. These goals and objectives are the ones being followed today:

* Graduate professionals who demonstrate integrity and compassion and who acknowledge an obligation to society. It is necessary but not sufficient to graduate physicians and scientists who are only intellectually prepared and technically proficient. It is also an important part of the medical school process that our learners be instilled with a sense of responsibility to individual patients and to society as a whole. It is easy to lose sight of this goal within rigorous curricula, which demand the mastery of large amounts of rapidly changing information. With the exception of a single second-year course, these issues are largely dealt with informally, without explicit educational objectives.

—Objective 1.1: Weave an appreciation of ethical issues throughout the curriculum.

—Objective 1.2: Provide an environment where students and residents can develop their potential to become community leaders.

* Promote the acquisition and use of lifelong learning skills on the part of students, residents, and graduate students. Our students need to become actively involved in the learning process. As educators, we need to be flexible in allowing them to pursue individual learning interests and creating an atmosphere where they can achieve to their highest potential. To guide their patients toward effective, affordable health care, our graduates will need to be able to apply innovations and to limit the use of interventions without proven benefit. That is, their practice of medicine will need to be based on current evidence. We also need to provide our graduates with opportunities to improve their skills through high-quality, continuing medical education.

—Objective 2.1: Develop competent, self-directed learners.

—Objective 2.2: Develop knowledge, attitudes, and skills to practice evidence-based medicine.

—Objective 2.3: Improve continuing medical education opportunities for health care providers throughout the state.

* Stimulate interest of medical students and residents in practicing primary care medicine, especially in rural areas of West Virginia. There is widespread agreement that we need to increase the number of primary care physicians in proportion to specialists. The key components of the provision of primary care are continuous and comprehensive care by the health care provider. It is important that schools of medicine teach a set of core competencies in primary care for all of their graduates regardless of discipline. There is also the significant problem of maldistribution of the physician workforce, and we have a responsibility to try to address this problem in our state.

—Objective 3.1: Increase exposure to primary care, and start it earlier in the curriculum.

—Objective 3.2: Provide students and residents the principles of and experience in managed care.

—Objective 3.3: Maintain the rural primary care requirements of the West Virginia Rural Health Education Partnerships (WVRHEP) for medical students.

* Emphasize the importance of disease prevention and health promotion. Preventive medicine is an important part of primary care. Because students will need to counsel their patients about healthy lifestyles, it seems only logical that we encourage our learners to adopt and practice healthy lifestyles. Students also need to appreciate the science behind disease prevention and health promotion and to learn to employ the knowledge base of epidemiology in the delivery of health care. Students will need to involve their patients in the decision process, understand the principles of screening populations for disease, interpret the relevant literature, and appreciate the costs and benefits of different approaches to prevention.

—Objective 4.1: Emphasize preventive medicine/health promotion.

—Objective 4.2: Apply the principles of epidemiology to disease prevention.

* Recognize and reward the teaching of students and residents. The accomplishment of the multiple missions of an academic health center creates a tension that is transmitted throughout the Health Sciences Center. To accomplish our mission most effectively, our reward and recognition systems must be congruent with our values, goals, and priorities.

—Objective 5.1: Create an environment that emphasizes a scholarly approach to curricular development, implementation, and evaluation.

* Foster programs where graduate students, medical students, and residents can be educated as scientists, researchers, and educators. Research is a fundamental component of the education we provide to all our students. Therefore, research theory and experiences should permeate the entire curriculum. Maintaining the vitality of research programs thus becomes an important educational priority. It is particularly important to highlight the educational value of research programs because it is a point of intersection between two components of our Strategic Plan.

—Objective 6.1: Enhance the research experiences and opportunities throughout all educational programs.

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Changes in Pedagogy

♢ The lengths of the first and second years of medical school were increased with no change in contact hours. The purpose of that strategy was to decompress the curriculum, to increase clinical material, and to allow students more self-learning time.

♢ Patient-related experiences and associate small-group discussions were provided in the second week of medical school and beyond.

♢ Lease/purchase of a laptop computer was required of every incoming first-year medical student, to help students learn and use the information technology essential to the modern practice of medicine and to urge faculty to use computers in their teaching.

♢ There has been a significant increase in the amount of small-group instruction.

♢ Problem-based learning now occurs weekly throughout the year in both first and second years. There are additional small-group learning experiences in the Human Function course (first year) and in pharmacology (second year).

♢ Cases are the foundation for the problem-based-learning sessions, and cases are used in the large-group presentations during the clinical clerkships.

♢ Standardized patients are used in the teaching of physician—patient communication and physical diagnosis. These skills are taught in the Introduction to the Patient course (first year) and in the Physical Diagnosis and Clinical Integration course (second year).

♢ Standardized patients are used in second- and third-year OSCEs.

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Application of Computer Technology

♢ Beginning in the fall of 1998, incoming medical students have been required to lease/purchase laptop computers. The student laptop program was begun to prepare students for the practice of medicine in the future and meet today's demanding instructional needs using the advantages that this tool can provide. Major advantages of the program are the use of standard computers with uniform hardware requirements for integration, HSC network support, and ease of service.

♢ Faculty have entirely revamped the first and second years, put up most of the course material on the Internet, and provided students with single-point-of-entry access to software resources. Where server-based materials were too slow to read, CD-ROM versions of the software were made available.

♢ Web-based materials include syllabi, notes, lecture materials (PowerPoint), access to instructional software, computerized discussion groups, and computer-based tests.

♢ The laptops are used for the problem-based learning sessions and students have overwhelmingly found them to be of educational and communicative value (e.g., for e-mail, discussion groups, and instructional software accessibility).

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Changes in Assessment

♢ The assessment methods to measure student achievement have not changed significantly over the past five years.

♢ During the basic science years, multiple-choice, matching, and short-answer examinations have migrated from paper to computer administration.

♢ Standardized patients are used for student teaching and assessment in the first-year Introduction to the Patient course and in the second-year Physical Diagnosis and Clinical Integration course.

♢ Faculty observation of clinical skills remains the mainstay of assessment during the clinical years.

♢ Some clerkships have begun to experiment with the use of OSCEs as an assessment method.

♢ An OSCE is being used in the second-year Physical Diagnosis and Clinical Integration course.

♢ It is envisioned that a school-wide OSCE will be designed in the near future to assess clinical competence before students graduate.

♢ Other examination methods include self-assessment (used during PBL) and Critically Appraised Topic (CAT) papers (used in the evidence-based medicine course).

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Clinical Experiences

♢ Much of the students' third- and fourth-year clerkships takes place in ambulatory care facilities.

♢ On the Morgantown campus, students see patients in the Physician Office Center (POC), a large multispecialty practice owned and operated by the WVU physician practice plan.

♢ During the third- and fourth-year rotations, students spend three months in community-based primary care settings as part of the West Virginia Rural Health Education Partnerships (WVRHEP).

♢ The WVRHEP consists of 13 training consortia of community-based clinics, private medical practices, and social and educational agencies covering 47 of West Virginia's 55 counties. Each of these consortia has its own local board of community members and providers who implement state policies at the local level. The network includes more than 250 community-based health, social, and educational agencies and almost 500 field faculty, teaching and practicing locally.

♢ While on rotation students spend 20% of their time in interdisciplinary case management sessions, community service learning, and community-based research.

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Curriculum Review Process

♢ The school has a formal process in place for the ongoing evaluation of courses and clerkships. Each year several in-depth course/clerkship reviews are scheduled.

♢ Significant features of the reviews include comprehensive self-study of the course/clerkship(s) conducted by the departments, the establishment of standards or expectations of performance by the departments, examination of a wide range of instructional data, external review, and a departmental retreat.

♢ At the end of a complete curriculum review cycle, estimated to be approximately six years, each required course and clerkship will have recieved an in-depth review, and the cycle will begin again.

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Future Goals

♢ The major issues likely to be addressed in the next five years are: (1) identification of short- and long-term student learning outcomes (academic and professional); (2) the assessment of clinical competence; (3) design of a longitudinal system for outcomes measurement; (4) review of the clinical clerkships for consistency, collaboration, and completeness; and (5) implementation of a common longitudinal conference series for the third and fourth years of the curriculum.

© 2000 Association of American Medical Colleges

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