Eggerstedt, Jane M. MD; Howells, Jeffrey MS, MBA
Curriculum Management and Governance Structure
♢ The Medical Curriculum Council (MCC) is the central body responsible for oversight, evaluation and revision of the medical school curriculum. (See Figure 1.)
FIGURE 1: Curriculum...Image Tools
♢ Faculty have approved the MCC to direct the school's curriculum management and oversight.
♢ Members of the MCC are senior faculty who are elected from major faculty governance groups, appointed by the Dean, or perform a leadership role in the major components (Module I, Module II, Foundations of Clinical Medicine, third year clerkships, fourth-year electives and selectives) of the curriculum.
♢ Those faculty members who sit on the MCC representing major components of the curriculum chair the subcommittees that oversee those areas.
♢ Subcommittees comprise course or clerkship directors responsible for the individual courses within a defined component of the curriculum.
♢ Student members of the MCC and of the curriculum subcommittees are selected from applicants from the third- and fourth-year medical school classes.
Office of Education
♢ The Office of Academic Affairs is the central source for educational support and leadership.
♢ The office is headed by the Associate Dean for Academic Affairs and is responsible for many important curriculum-related areas such as program outcomes assessment, curriculum mapping, course evaluations, education and assessment resources for students and faculty, educational facilities oversight, academic computer services, faculty development, and MCC support.
♢ At present, one full-time PhD educator, two curriculum coordinators, two technical support analysts, and two administrative assistants are associated with this office.
Budget to Support Educational Programs
♢ The medical school's education programs are financially supported through the Curriculum Program budget, a defined medical school fund overseen by the Dean.
♢ Additional support for medical school programs is also obtained through institutional support of faculty positions in all basic science and clinical academic departments and centers of excellence, which underwrite salaried faculty and support staff positions and also provide academic resources relevant to educational effort.
♢ Faculty excellence in teaching is acknowledged by means of student, departmental, and institutional awards.
♢ The Allen A. Copping award for Excellence in Teaching is the highest teaching award given in the LSU System and is awarded to one basic science faculty member and one clinician each year.
♢ Effort and excellence in teaching constitutes one of the three components for which faculty are evaluated for promotion and tenure.
♢ Faculty members must provide The Educator's Portfolio, an institutionally approved document, when submitting candidacy for promotion and tenure at every level and track. All teaching-related responsibilities and accomplishments are recorded in this official record.
Curriculum Renewal Process
♢ A curriculum review and renewal process grew out of a self-study process done in preparation for a 1999 LCME site visit. At a faculty curriculum retreat in January 2000, groundwork was laid for the creation of the MCC as the curriculum oversight body and for the initiation of a significant change in pedagogy for the medical school curriculum.
♢ The changes included an emphasis on self-directed and independent learning and a concerted effort toward developing an integrated curriculum rather than the existing subject-based, departmental-directed traditional curriculum.
♢ Shortly after its inception, the MCC created a strategy for ongoing curriculum planning, review of curricular objectives and outcome measures, consideration of faculty and student feedback in course development, and incorporation of applicable innovations in medical education.
♢ A timeline was established to implement the entire curriculum change in a sequential fashion, beginning with incorporation of the third- and fourth-year revisions in 2000, the first-year changes in 2001, and, finally, those for the second year in 2002.
♢ The curriculum is presently composed of a series of integrated Modules in the first two years, and required clerkships, electives, and selectives in years three and four.
♢ The Medical School Objectives guide the curriculum. From these objectives, courses are designed, student learning outcomes, related assessment tools, and criteria for success are determined, and assessment results are monitored to improve the curriculum. See List 1 for a description of the learning outcomes. The evaluation tools used for monitoring the success of the new curriculum include
* the tracking of annual and longitudinal outcome measures, including USMLE Step 1 and Step 2 scores;
* residency program “match” data for graduates (which takes into account graduates' success rate in “matching” for specialty of choice and preferred training institution);
* residency program director evaluations of the performance of our medical school graduates in their first postgraduate year of training (wherever they train);
* student feedback obtained as weekly course evaluations, compiled by the Office of Academic Affairs;
* end-of-course focus groups;
* objective evaluations of each of the clerkships;
* a fourth-year focus-group charged with review of the entire curriculum; and
* the annual Association of American Medical Colleges (AAMC) Graduation Questionnaire, which gathers graduating seniors' opinions concerning their education and compares these responses to national student opinion data.
♢ The curriculum is reviewed, discussed, and modified by the MCC regularly, utilizing these evaluation data as well as other assessment tools.
♢ The objectives, course content, course scheduling, assessment tools, and outcome measures are assessed by the MCC for indications of success or difficulties.
♢ Scheduled major reviews of each of the curriculum modules have been performed every few years using compiled course data, as well as student feedback.
New Topics in the Curriculum Since 2000
♢ Beginning in 2005, the Dean and the Office of Academic Affairs have worked together with a number of clinical departments to develop a Clinical Skills Center (CSC) at the LSU Health Sciences Center at Shreveport (LSUHSC-S).
♢ Currently, the CSC contains a Standardized Patient Lab, a Human Simulation Lab, a Technical Skills Lab, and a Surgical Skills Lab.
♢ The CSC is used for training in the undergraduate medical curriculum as well as for graduate and continuing medical education.
♢ Since 2007, the Human Simulation Lab of the Clinical Skills Center has been utilized in the medical school curriculum for student training in team-based acute care patient management scenarios. This is done in a required senior student course called Fourth Year Academic Clinical Training and Teaching Selective (FACTTS).
♢ The Harvey heart sound simulator has been utilized in the instruction of cardiac auscultation during the preclinical curriculum and in the FACTTS course.
♢ Several third-year clerkships and the fourth-year FACTTS course utilize the Technical Skills Lab to train and evaluate students in a variety of patient care skills, including airway management, lumbar puncture, management of labor and delivery, and suturing.
♢ At present, the third-year clerkship director's subcommittee is developing a proposal to establish a patient safety curriculum intended to be taught across the third year clerkships.
Changes in Pedagogy
♢ Although entering medical students had been required to purchase and use laptop computers since the mid-1990s, the major curriculum revision begun in 2000 brought an increased utilization of this tool with the increased incorporation of Web-based learning programs, course management systems, and testing.
♢ A computer education support program provides specific student training during the first week of school. In addition, this program offers user training for faculty as well as faculty development in areas related to computer-based teaching programs and other related aids.
♢ The Moodle course management system has been incorporated on which instructors post all PowerPoint lectures and other teaching materials for students.
♢ Recently acquired podcasting capability has made it possible for lectures to be recorded and available for students as a study tool. Students have been polled on their use of podcasting and generally applaud its availability, stating that it affords them the ability to review a lecture or portions of it at their own pace and frequently fosters comprehension of material misunderstood at the time of the “live” lecture.
♢ Small-group learning experiences have been made an integral part of each of the Modules and courses of the first and second years and are also a commonly used teaching form in the senior year FACTTS course.
♢ Computer-based clinical cases are used for individual and group student learning and assessment in several courses.
♢ Standardized patient cases are used for teaching and assessment throughout the four years.
♢ Simulation is used at many points in the curriculum to teach specific examination skills and technical skills, and in the fourth year, to teach acute management of patients as well as basic team building.
♢ Faculty instructors have made increasing use of the recently added Personal Response System (clickers), which provides a notable interactive feature to lectures.
♢ The MCC is considering the addition of a secure Web-based examination system for administration of course examinations.
Changes in Asssessment
♢ Standardized patient examinations are utilized in all four years of the curriculum.
♢ To ensure uniformity in skills assessment and provide a means by which many of the curriculum's learning outcomes can be measured and documented, checklists have been uniformly employed in formative small-group physical exam teaching sessions and summative examination of student clinical skills during standardized patient examinations. In addition, checklists are being developed for assessment of specific technical skills.
♢ The evaluation form used to assess student performance on clinical services during the third year has been standardized. In addition, faculty and residents receive instruction on use of this evaluation.
♢ Prior to the initiation of the small-group format in the new first-year curriculum, faculty participated in several workshops to learn useful techniques of small-group facilitation and methods to evaluate student performance in this setting.
♢ Online graded quizzes are utilized in some of the Module I courses.
♢ Logbooks have been incorporated for documentation of clinical experience in the third year.
♢ In the near future, trained standardized patients will be used for teaching as well as assessment of some clinical skills.
♢ Initiated with the major curriculum revision in 2000, integration of clinical experience into the preclinical years has been a primary focus. LSUHSC-S students are sent into the university hospital as early as the second week of the freshman year to interview a patient. As each Module and course proceeds through the first and second years, students are provided with numerous clinical experiences.
♢ Clinicians teaching in the first-year course, entitled Physiological Chemistry, Medical Genetics, and Developmental Biology, bring volunteer patients who have conditions exemplifying disorders of specific biochemical processes to student lectures to add a clinical “face” to the biochemistry topics being presented.
♢ In the second half of the first year, students participate in an “immersion” project during the Foundations of Clinical Medicine course. The purpose of this project is to expose students to a number of clinical settings.
♢ Students spend time with a practicing generalist physician in the Louisiana AHEC program, interview a geriatric patient in an extended care facility, and participate in two “electives” in which they are able to shadow a physician. Physicians from numerous clinical specialties participate as “immersion” preceptors.
♢ Students are required to perform histories and physical examinations (H & Ps) on patients in the hospital setting and report to their assigned clinical preceptor to give an oral presentation of the history and physical findings. Faculty preceptors review the patients with their students. Students then provide a written version of the H & P, which the preceptor critiques and grades.
♢ Standardized patient encounters provide additional clinical exposure for students in the first and second years.
♢ To assess student comprehension of the clinical material integrated into the preclinical curriculum, standardized patient examinations are employed.
♢ Over the course of the first two years, students are given nine standardized patient examinations. These examinations are constructed to incorporate recently taught clinical material and at the same time evaluate material previous learned.
♢ Standardized patients are also utilized to “role play” patients with different clinical conditions during small-group teaching sessions conducted during the Foundations of Clinical Medicine course.
♢ The third year encompasses required clinical clerkships, including Internal Medicine, Surgery, Obstetrics/Gynecology, Pediatrics, Neurosciences (Psychiatry, Neurology, Neurosurgery), and Family Medicine in a half-day per week Comprehensive Care clinic setting, and a four-week block of week-long surgical subspecialties (Ophthalmology, Orthopedic Surgery, Otolaryngology, Urology).
♢ The fourth year contains two required clinical rotations (Inpatient Subinternship, Outpatient Selective) as well as the mandatory FACTTS course. The remainder of the fourth year is completed in elective rotations, the majority of which are in a broad variety of clinical settings.
♢ Local sites used for clinical experience in the third and fourth years include the LSUHSC-S University Hospital, Overton-Brooks VA Medical Center, Willis-Knighton Medical Center in Shreveport, and E.A Conway Medical Center in Monroe, Louisiana.
Highlights of the Program/School
♢ The body-system-based preclinical curriculum is structured to have each course overseen by a basic science faculty member and a clinical faculty member functioning as co-course directors. In this way, essential basic science and clinical elements relating to a body system are integrated in preclinical education.
♢ NBME customized examinations are utilized through the first and second years to provide faculty a measure of curriculum content assessment and give students a tool by which they can identify strengths and weaknesses in comprehension and retention of subject material.
♢ The Clinical Skills Center has developed over time to become a state-of-the-art simulation center for teaching of students, residents, and practicing physicians. The Center has been granted accreditation by the American College of Surgeons as a Comprehensive Education Institute.
♢ Students receive early exposure to patients beginning in the first year. The majority of required clinical experience in third and fourth years is done at the University Hospital, where the patient-to-student ratio is excellent and faculty quickly make students comfortable in the patient care setting.
♢ The required Fourth-Year Academic Clinical Training and Teaching Selective (FACTTS) utilizes the Clinical Skills Center to provide students with a unique conglomeration of educational experiences in preparation for their PGY1 year.
♢ Beginning with an introduction to the ACGME Core Competencies, instructors in the FACTTS course provide students with training in many important areas, including acute care patient management situations, review and assessment of basic and advanced physical exam skills, technical skills training, critical review of the literature, and formal presentation of a clinical topic before a group.
♢ The Medical Student Research Program provides a venue by which students can participate in basic science and clinical research with faculty mentors. Although only four years old, this program has been an excellent resource for students wishing to explore basic science or clinical investigative projects with a faculty mentor. The work of a number of participating students has resulted in abstracts, papers, or posters accepted for presentation at regional or national meetings.