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Academic Medicine:
doi: 10.1097/ACM.0b013e3181e91384
The Reports: United States: Massachusetts

Boston University School of Medicine

Levine, Sharon A. MD

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Year school was established: 1848. New England Female Medical College merged with Boston University in 1873 to become the first coeducational medical school.

School URL: http://www.bumc.bu.edu/busm/.

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Curriculum Management and Governance Structure

♢ The Medical Education Committee (MEC) is the governing body of the curriculum at BUSM. Its membership consists of the Chairs of the Preclerkship Curriculum Subcommittee, Clerkship Curriculum Subcommittee, faculty-at-large and alternates, student representation from all four years and their alternates, the Director and Associate Directors of the Office of Medical Education, the Dean of the Medical School, and the Associate Dean for Academic Affairs, who chairs the committee.

♢ Subcommittees of the MEC include the Preclerkship Curriculum Subcommittee consisting of all of the preclerkship course directors and student representation across all four years and the Clerkship Curriculum Subcommittee consisting of all required clerkship directors and student representatives and alternates from all four years.

♢ Other committees include the Research and Electives Subcommittee and the Educational Program Objectives Subcommittee. Vertical Integration Groups and other ad hoc Working Groups report to the MEC.

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Office of Education

♢ The Office of Academic Affairs, under the aegis of the Associate Dean for Academic Affairs, oversees the entire curriculum.

♢ The Office of Medical Education has a Director (the AD for Academic Affairs) and an Associate Director, who is a PhD evaluator. There are eight professionals/educators associated part time in the office and eight administrative and support staff.

♢ The OME is responsible for student evaluation of courses and clerkships; faculty development in medical education; course design, delivery, and evaluation of five nondepartmentally based courses; management and staffing of the Clinical Skills Center; residency program director survey administration and graduate evaluation; and administrative support for the Medical Education Committee and its subcommittees.

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Financial Management of Educational Programs

♢ BUSM has transparent mission-based budgeting. The formula is based on scheduled weeks fractions in the curriculum for each department/course/clerkship.

♢ The Associate Dean for Academic Affairs meets regularly with the Assistant Dean for Finance to ensure adequate resources for all nondepartmentally administered (i.e., centrally managed) courses and their evaluation, for faculty development programs, for clinical skills center management, and for evaluation of all courses and clerkships and graduation survey data carried out by the Office of Medical Education. The same is true for the programs administered by the Office of Enrichment.

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Value Teaching

♢ Boston University School of Medicine does not have an academy for educators. The Office of Medical Education administers a robust faculty development program in medical education, http://www.bumc.bu.edu/fd/.

♢ BUSM has a clinician educator track with defined scholarly requirements for promotion.

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Curriculum Renewal Process

♢ Changes in the curriculum were and are developed to facilitate students' acquisition of and ability to use basic science, clinical knowledge, and clinical skills; to incorporate a variety of teaching modes to stimulate and accommodate a variety of learning styles; to address AAMC initiatives; to meet LCME standards; and to respond to feedback from the Graduate Questionnaire and to other forms of student feedback.

♢ Curriculum renewal is facilitated through the MEC and its Preclerkship Curriculum and Clerkship Curriculum Subcommittees.

♢ Paths to revision included an education retreat in 2005, continued recommendations of the MEC and its subcommittees, vertical integration groups, and work groups and need for changes in schedules; changes in design and delivery of courses; evaluation of adequacy and continuity of content presented across four years; and examination of internal and external evaluations of students and graduates.

♢ Objectives are improved horizontal and vertical integration, decreased classroom lecture time, more self-directed learning, alternative modes of instruction, increased use of technology, improved clinical skills, teaching, and assessment.

♢ After the last LCME review in 2003, Vertical Integration Groups (e.g., neoplasia, nutrition, genetics) and Working Groups (e.g., Clinical Competencies Work Groups) were assigned on an ad hoc basis to meet identified gaps or areas for improvement in the curriculum.

♢ The MEC makes decisions about adoption of recommendations after discussion.

♢ More recent changes in the first year include the emphasis on Evidence-based Medicine and Bioethics in the Essentials of Public Health Course.

♢ Histology and Physiology now use an organ-based approach.

♢ Increased use of technology occurs in most courses.

♢ Other changes include addition of cell biology to biochemistry, addition of professionalism to the Human Behavior in Medicine course, and radiologic imaging in Gross Anatomy laboratory.

♢ In academic year 2008–09, BUSM inaugurated a horizontally integrated second year. The former courses Pharmacology, Microbiology, Pathology, and Biology of Disease (pathophysiology) were integrated as one 13-module systems-based course—Disease and Therapy (DRx).

♢ Interwoven with the above content was Health Law and Health Policy, Introduction to Clinical Medicine 2 (physical diagnosis course), and Integrated Problems 2 (the problem-based learning course). Multiple cases and small groups are part of the course. The DRx course is managed centrally through the OME, with comanagement and teaching by clinicians and basic scientists.

♢ There is ongoing vertical integration of content between years one and two courses (e.g., pathology and histology, radiology, and anatomy).

♢ In the third year, clerkships were relationally paired, and elective time has been introduced.

♢ Objective Structured Clinical Exams were introduced.

♢ There are no more than 3 hours of lectures per day, and students have two free afternoons per week.

♢ Multiple small-group sessions, independent study, computer-assisted instruction, and other nonlecture teaching are in place.

♢ Restructuring of student evaluation: Development of greater uniformity in evaluation methods and greater clarity in evaluation criteria.

♢ Inclusion of observations of student behavior and participation in evaluation processes throughout the curriculum.

♢ Supervised patient contact from the start of classes in the first year.

♢ Creation of options for continuity in the clinical experiences throughout the first three years.

♢ Increased layers and basic science and clinical faculty input for the curriculum planning and curriculum evaluation process.

♢ Creation of a longitudinal student advisory system.

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Learning Outcomes/Competencies

♢ BU CARES is the mnemonic for the Institutional Learning Objectives for all graduates.

The BU CARES Institutional Learning Objectives (the linked ACGME competencies are in parentheses) for the BUSM Graduate:

* Behaves in a caring, compassionate, and sensitive manner toward patients and colleagues of all cultures and backgrounds, using effective interpersonal and communication skills (Interpersonal and Communication Skills; Professionalism).

* Uses the science of normal and abnormal states of health to prevent disease, to recognize and diagnose illness, and to provide an appropriate level of care (Medical Knowledge; Patient Care).

* Communicates with colleagues and patients to ensure effective interdisciplinary medical care (Interpersonal and Communication Skills; Patient Care).

* Acts in accordance with the highest ethical standards of medical practice (Professionalism).

* Researches and critically appraises biomedical information and is able to contribute to the advancement of science and to the practice of medicine (Practice-based Learning and Improvement; Medical Knowledge).

* Exhibits commitment and aptitude for life-long learning and continuing improvement as a physician (Practice-based Learning).

* Supports optimal patient care through identifying and using resources of the health care system (Systems-based Practice; Patient Care).

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New Topics in the Curriculum Since 2000

♢ The Patient Safety online module and lecture occurs as part of the orientation to the third-year curriculum. Students are included in a patient safety curriculum in the internal medicine residency program at the Boston VA Healthcare System.

♢ Team-based learning is the focus of several courses (e.g., Integrated Problems, Genetics small-group sessions, case-based problem solving in Disease and Therapy, and Essentials of Public Health).

♢ Simulations have just begun with a Sim Man and torso as part of the Integrated Problems course but will be increasingly used in Introduction to Clinical Medicine and the clerkships. A new simulation center initiative between clinical training programs at Boston Medical Center and BUSM is in the planning stages.

♢ LGBT curriculum: There are 6 hours of formal curriculum throughout several courses/clerkships.

Cultural competency: A student-led workshop on cultural competency takes place during first-year orientation and is attended by all students. An online module in cultural competency with two accompanying lectures has been added to the ICM-1 curriculum, and a CurrMIT review of our curriculum demonstrates coverage of these issues across the entire preclerkship and clerkship experiences.

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Changes in Pedagogy

♢ We increased use of technology in the curriculum including Apreso video recording of lectures; Audience Response Systems for interactive quizzes; the use of radiologic imaging in Gross Anatomy laboratory; virtual microscopy; online modules for Disease and Therapy and Introduction to Clinical Medicine; and simulation center exercises as part of Integrated Problems.

♢ In the coming year, there will be a laptop requirement so that all students can access online and virtual teaching materials.

♢ We increased use of standardized patients for teaching and examination.

♢ We have ongoing increases in interactive small-group sessions and case-based sessions. There is decreased formal lecture time.

♢ The focus has increased on evidence-based medicine and critical appraisal.

♢ We have added in-class and online formative quizzes.

♢ Success has been measured by student satisfaction through student evaluation and whether curriculum performance expectations are met; there is constant feedback from Student Advisory Committees and the Graduation Questionnaire and peer review of courses.

♢ We will continue to follow national comparative data and Program Director Surveys as well as our internal assessment methods for students.

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Changes in Assessment

♢ The Clinical Skills Center conducts End-of-the-Year Assessments using standardized patients. These Objective Structured Clinical Examinations occur after years one, two, and three.

♢ Residency Program Director surveys for all graduates are conducted during the PGY 1 year.

♢ Online student logs and mid-clerkship evaluations are made available to the education program and to clerkship directors.

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Clinical Experiences

♢ A longitudinal experience, the Community Partnerships program involving the neighborhood health centers that begins in the first year and extends through the clerkships in the third year, is available to those students who select it.

♢ The program is based in several affiliated community health centers. A student in the program completes portions of his/her IP Course, ICM Course, and clerkships (Family Medicine, Internal Medicine, and Pediatrics) in the same health center.

♢ A student in the program consequently participates in patient care that is continuous over the three-year period and additionally has the advantage of being precepted by a faculty and staff who can tailor the experience to the student's needs.

♢ Clinical care occurs in multiple affiliated hospitals in Boston and nearby towns and cities and regionally as far as Maine and Cape Cod; it occurs at three Veterans Affairs hospitals; in community health centers in our very diverse city; and in private practices.

♢ Increased class size requires the constant development of new affiliations and sites; students get a robust experience of the spectrum of clinical care in urban and rural settings as a result of going beyond the borders of the medical campus.

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Highlights of the Program/School

♢ BUSM's major affiliate, the safety net hospital, Boston Medical Center, provides “Exceptional Care without Exception” to an extremely diverse population that spans the entire sociographic, ethnic, and linguistic spectrum. As a result, there are seminal programs like the Medical Legal Partnership that advocate for children and elders and medical interpretation in 57 languages. Students get a breadth and depth of clinical educational experiences as a result.

♢ BUSM's research programs and its relationship to the School of Public Health and School of Management provide the opportunity for MD–MPH and MD–MBA dual-degree programs: The MD–PhD program supports students choosing research as a career path.

♢ Students have a large array of Service Learning Opportunities, free time and formal electives, international health opportunities, and research opportunities from which to choose.

♢ The school has breadth and depth in research including basic, health services, and clinical epidemiologic research. There are several centers, including a new Pepper Center and CTSA.

* http://www.bumc.bu.edu/busm-osa/servicelearning/

* http://www.bumc.bu.edu/enrichment/

♢ Students are enthusiastic self starters and are constantly creating new learning opportunities for themselves and bringing content change to the curriculum through their participation in the MEC and its subcommittees or simply by coming forward with ideas.

© 2010 Association of American Medical Colleges

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