Pellegrino, Thomas R. MD; Ullian, John A. PhD
Curriculum Management and Governance Structure
♢ The Dean/Provost is the chief academic officer of the Eastern Virginia Medical School (EVMS).
♢ The Dean/Provost delegates responsibility for the content and structure of the predoctoral medical curriculum to the Medical Education Committee (MEC).
♢ The MEC is appointed by the Dean/Provost and includes members of the basic and clinical science faculties and a student representative from each of the medical school classes. Additional members include the Associate Dean for Medical Education, the Associate Dean for Library and Information Resources, the Director of Faculty Development, and the Instructional Design Specialist.
♢ The MEC reports to the Associate Dean for Medical Education, who is charged with implementation of the medical curriculum. The MEC appoints such ad hoc subgroups as needed.
Office of Medical Education
♢ There has been an Office of Medical Education (OME) at EVMS since its founding.
♢ The Office is directed by the Associate Dean for Medical Education and comprises eight full-time personnel: one physician (the Associate Dean for Medical Education), two PhDs (the Director of Faculty Development and a Longitudinal Curriculum Coordinator), two Master's degree personnel (the Director of Student Performance and Evaluation and the Instructional Design Specialist), and three others (the M1/M2 Curriculum Coordinator, the M3/M4 Curriculum Coordinator, and the Database Analyst).
♢ The mission of the OME is to support the curriculum in the following areas: curricular coordination and scheduling, test scoring, grade reporting, evaluation of courses/clerkships, liaison with the USMLE, support for the interdisciplinary curriculum, career advising, and faculty teaching skills.
♢ With the initiation of the five-year-long EVMS 2.0 project (outlined below) in 2010, additional support is being provided to increase the use of instructional technology and simulation in the curriculum, and to better prepare faculty for incorporating these tools.
♢ Administratively housed within the OME is the Office of Professional Development (OPD). The OPD provides support for the interdisciplinary M1/M2 courses “Introduction to the Patient” and the Longitudinal Generalist Mentorships.
* The OPD is directed by a physician who reports to the Associate Dean for Medical Education regarding issues pertaining to medical education.
* Also supporting the OPD is the Theresa A. Thomas Professional Skills Teaching and Assessment Center (TATC), which includes the EVMS Standardized Patient Program.
* In August 2011, a newly developed Simulation Center, incorporating a variety of computer-based simulators, will be added to the TATC.
* The mission of the TATC is to promote and provide high-quality clinical education experiences and reliable assessment of skills and procedures, with the ultimate goals of advancing patient care, increasing patient satisfaction, and promoting better health outcomes.
Financial Management of Educational Programs
♢ The OME receives core institutional funding for its activities in support of the curriculum.
♢ The TATC receives core institutional funding, and also receives funds from other educational institutions for their contracted use of its standardized patients and related programming.
♢ The OPD receives core institutional funding for the interdisciplinary M1/M2 “Introduction to the Patient” courses.
♢ All academic departments receive institutional core support for the courses and clerkships directed by their faculty. The extent of core support is reassessed each year by the Dean/Provost in consultation with department chairs.
♢ A decrease in public support for EVMS (and other educational institutions) due to the continuing financial crisis has been accommodated without compromising the quality of medical student education. In fact, there has recently been an increase in direct institutional support to the OME for implementation of the EVMS 2.0 project, and additional increases in state support for the institution in the future is anticipated.
♢ The newly adopted strategic plan for EVMS calls for substantial additional investment in medical and health professions education over the next three years.
♢ EVMS explicitly identifies education and teaching as scholarly activities for purposes of evaluating faculty for appointments and promotions.
♢ EVMS guidelines require that the Appointments and Promotions Committee and the Tenure Committee consider the proportion of time that each faculty member is allocated to perform his or her various roles (e.g., teaching, research, patient care, community service, administration) in evaluating the credentials of faculty candidates for promotion and tenure.
♢ For faculty heavily involved in education, the quantity and quality of teaching and the development of and publications describing educational programs and innovations receive substantial weight in promotion decisions.
♢ Since 1989, the Dean/Provost has awarded “The Dean's Faculty Achievement Awards” for performance in several areas, including teaching in the basic sciences and in clinical medicine.
♢ EVMS does not have an academy/institute for educators.
Curriculum Renewal Process
♢ A comprehensive review of the medical curriculum was initiated in late summer, 2007 in preparation for EVMS's application for reaffirmation of its accreditation by the Southern Association of Colleges and Schools (SACS). The application process also included a requirement that the school develop a comprehensive five-year Quality Enhancement Plan (QEP).
♢ After substantial discussion and debate involving the faculty, students, and administration, EVMS decided to undertake a program to effectively integrate technology-assisted education and modeling and simulation technologies into the educational program. The resulting program, titled EVMS 2.0, was accepted by SACS in December 2009.
♢ Following acceptance of the EVMS 2.0 program, a detailed review of the content and pedagogy of the curriculum was initiated.
♢ Key Objectives of curriculum renewal:
* Assure that curriculum content and evaluation are consistent with revised and updated Unified Competency Objectives (UCOs).
* Assure that curriculum content and evaluation are consistent with evolving LCME standards.
* Assure that curriculum resources are appropriate to accommodate increasing class sizes projected over the next several years.
* Assure systematic integration of educational technology, modeling, and simulation into medical curriculum as outlined in the EVMS 2.0 Quality Enhancement Plan (see www.evms.edu/about-evms-qep/qep.html).
* Assure that all students receive comparable education/training at different teaching sites.
♢ Key Components of curriculum renewal:
* The process began in the fall of 2009 with review and revision of the Unified Competency Objectives (UCO) to be achieved by all students prior to graduation. The UCO were revised to mirror the core competencies developed by the Accreditation Council on Graduate Medical Education. The new competencies were adopted by the MEC in March, 2010, and approved by the Dean/Provost in June 2010.
* During the 2010–2011 academic year, the MEC is conducting substantive reviews of individual courses, clerkships, and select M4 courses/rotations to assure that UCOs are being met.
* In addition, a review of the overall structure of the M3 and M4 clinical experiences is being led by the Associate Dean for Medical Education for the Medical Education Committee.
* The educational support mission of the OME is being enhanced through the QEP, through which an Instructional Designer, Educational Technology Specialist, and staff support person are being hired.
* Faculty development programs are being provided to assist faculty with curriculum review and renewal as well as how to increase the effective use of educational technology.
* The OME is leading an effort, in conjunction with the QEP, to promote standardization in the selection and adoption of educational technology applications in basic sciences and clinical education.
* The effectiveness of the educational technology applications that have been implemented will be evaluated.
♢ The Unified Competency Objectives (UCOs) for medical student education at EVMS were initially developed in 1990 and extensively revised in 2005. The MEC, after extensive consultation with the faculty, reevaluated and revised the UCOs during the 2009–2010 academic year. The latest revision was designed to assure that the UCOs could be more reliably assessed, and that they conformed with the expected competencies for MD graduates beginning their graduate medical education. (List 1 presents the UCOs.)
♢ The revised UCOs were adopted by the MEC in March 2010.
♢ The MEC is now reviewing the entire curriculum to assure that the desired competencies are being taught and evaluated.
New Topics in the Curriculum Since 2000
♢ Patient safety is emphasized at multiple points in the curriculum, beginning with the orientation of new students at matriculation and continuing through the “Introduction to the Patient” courses in years 1 and 2, as well as during clinical training in years 3 and 4.
♢ Opportunities for student participation in research (basic, applied, and translational) have been increased.
♢ An interprofessional elective course in Global Health (offered by the Masters in Public Health program) is now available to medical students.
♢ An interprofessional program in Professional Values in Health care (in cooperation with the School of Health Professions) is being developed and will be offered during the 2011–2012 academic year.
♢ All students receive instruction and experience in using a variety of electronic health records during clinical rotations at multiple training sites.
Changes in Pedagogy
♢ Audio recordings of lectures in M1/M2 years and visual aids (slides) are available to students for review and study. Use of video recordings is expanding.
♢ EVMS is increasing its use of computer-based self-teaching modules in multiple courses.
♢ A new Medical Education and Research Building is under construction, to be completed in the summer of 2011. It will provide new classrooms, new space and facilities for modeling and simulation (task trainers, manikins, standardized patients, Computer-Assisted Virtual Environment), and enhanced facilities for small-group teaching.
♢ The EVMS 2.0 project will better use educational technology to enhance student learning through:
* Use of course-management software (Blackboard) to provide course learning materials to students
* Use of virtual slides in pathology, histology etc.,
* Increased use of task trainers, anatomical and other models, and simulations
* Use of audience response systems to better maintain student engagement and assess student learning
♢ Beginning August 2011, each incoming student will purchase an EVMS-configured laptop computer to support teaching software and computer-based examinations.
Changes in Assessment
♢ The use of NBME subject exams to assess student performance will be increased. These are currently used in the Pathology, Pharmacology, Microbiology, and Physiology courses. NBME subject exams are currently used for assessment in all required M3 clerkships.
♢ EVMS has piloted and will utilize computer-based testing (ExamSoft) for all locally developed examinations beginning with the class entering in August 2011.
♢ Locally-developed examinations are being revised to conform to the USMLE-style question format.
♢ Audience-response systems (iClickers and Turning Point) are increasingly used for in-class formative evaluations and quizzes.
♢ The OME and Office of Student Affairs have jointly implemented a system for early identification and intervention for students who experience academic difficulty.
♢ The Student Progress Committee will continue to improve its regular and systematic review of student academic and professional progress and provide early intervention as required.
♢ Major Clinical Education Sites:
* Sentara Hospitals (Norfolk): Sentara Norfolk General and Sentara Leigh Memorial
* The Childrens Hospital of the King's Daughters (Norfolk)
* U.S. Naval Medical Center (Portsmouth)
* Veterans' Affairs Medical Center (Hampton)
* Multiple volunteer physicians' offices throughout the Hampton Roads area.
* Projected increases in medical school class size and increasing “competition” for clinical training sites from EVMS Health Professions Programs as well as other medical and health-professions programs in Virginia will require continued evaluation of clinical training programs to maintain current quality and variety.
* Effective integration of patient safety issues, cultural competency issues, and evidence-based medicine into already demanding clinical training.
* Effective use of modeling and simulation in clinical education.
* Redesign of the curriculum in geriatric medicine is currently in progress, since a planned integration of geriatric medicine into the Family Medicine and Internal Medicine M3 clerkships has not proven to be as effective as desired.
Highlights of the Program/School
♢ Extensive EVMS experience in the use of standardized patients for medical student education and assessment through all four years. This program began in 1994.
♢ Extensive student involvement in community service and evolving programs in service-based learning.
♢ Extensive involvement of volunteer community physicians in medical student education. Students begin regular contact with community physicians in their offices in January of the M1 year.
♢ Multiple opportunities for medical students to gain experience as teachers. For example, M2, M3, and M4 students serve as tutors, and as teaching assistants in laboratory exercises. Selected M4 students serve as co-facilitators with faculty in small-group teaching exercises for M1 and M2 students.
♢ Frequent and close interaction with faculty and administration.
♢ Very collaborative and friendly learning environment among students and between students and faculty.