Curriculum Management and Governance Structure
♢ The Curriculum Committee, a standing committee of the School of Medicine, is responsible for oversight of the entire medical educational curriculum.
♢ There are subcommittees for each year of the curriculum, whose responsibilities are to continuously evaluate their respective years and integrate their years' content horizontally and vertically in support of institutional goals and objectives. (See Figure 1.)
Office of Education
♢ The mission of the Office of Medical Education is to develop the highest quality of medical education for its students in preparation for their roles as caring, compassionate, and competent physicians.
♢ The Office of Medical Education is responsible for support of the medical education program, including curriculum management, development, and student assessment, in concert with the Curriculum Committee and the Dean of the Medical School, who serves as the Chief Academic Officer.
♢ The Office of Medical Education has four full-time positions—three academic and one administrative—and one part-time position; among the personnel are two MDs and a BSN with a Certificate in Medical Education.
♢ The Office of Student Affairs provides support for admissions, career counseling, and advising and student support services.
♢ The Office of Academic Affairs monitors student academic progress and professional development.
Financial Management of Educational Programs
♢ A special $2 million state appropriation increase in FY 2008 that was subsequently built into the school's base funding has strengthened the long-term budgetary foundation of the school's educational programs.
♢ Despite a recession-induced cumulative 8% reduction in state funding in FY 2010 and FY 2011 ($1.1 million), all of these funds have been replaced by federal stimulus funding in the short-term; as a result, there has been no direct impact on educational programs.
♢ FY 2012 may pose budgetary challenges as the federal stimulus ends, but the state's general tax revenues are already beginning to rebound. While maintaining resident fees levels at less than 80% of the national average, Marshall has been able to increase educational funding through modest fees increases (3% to 5%) and, since 2005, through increased enrollment and a larger proportion of nonresident students.
♢ Marshall's Academy of Medical Educators, established in 2004, is a multidisciplinary support network that equips faculty members and residents with educational theories and techniques to promote educational skills, critical thinking, and innovative approaches to teaching.
♢ In addition to participating in bimonthly seminars and workshops, each member completes a self-selected project in an area of scholarly interest, educational research, or clinical practice.
♢ The promotion and tenure process values teaching by its emphasis in the annual review of faculty. The school is in the process of creating an educators track in the promotion and tenure process for faculty members who achieve excellence as clinicians and teachers.
♢ Assessment is based in part on an educator's portfolio that requires not only a synopsis of teaching assignments and evidence of teaching skills but also evidence of contributions to curriculum development, educational scholarship, and leadership.
Curriculum Renewal Process
♢ The major curriculum revision process began in 2007 with plans to transform the discipline-based curriculum in Years 1 and 2 into an integrated systems-based approach. Institutional learning objectives were revised in May 2009 in concert with the curriculum revision to strengthen focus on curriculum objectives. The systems-based curriculum was implemented in Fall 2008 for Year 2 and in Fall 2010 for Year 1.
♢ The key objectives for the curriculum renewal process involve integrating six institutional learning objectives (detailed in the Learning Outcomes section) into all four years of the medical education curriculum.
♢ The components of the renewal process involved retooling several facets of the educational program and evaluation process based on the institutional learning objectives.
♢ Syllabi for all required Year 3 and Year 4 courses and clerkships were revised to reflect the ways the courses and clerkships meet each of the institutional learning objectives. Evaluations of students, faculty, courses, and clerkships were revised to measure achievement of those objectives.
The School of Medicine's Institutional Learning Objectives include:
♢ Patient Care. Students must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
♢ Medical Knowledge. Students must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.
♢ Practice-Based Learning and Improvement. Students must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning.
♢ Interpersonal and Communication Skills. Students must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.
♢ Professionalism. Students must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
♢ Systems-Based Practice. Students must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on resources in the system to provide optimal health care.
♢ Students' performance in meeting these objectives is measured using a variety of learning outcomes, including:
* BLS and ACLS certification
* Clinical Competency Examination
* Evaluations in courses and clerkships
* Mentoring programs in Years 1 and 2
* NBME examinations–Steps 1, 2, CK, 2CS, and 3
* NBME subject examinations
* OSCE experiences
* Small-group discussion and presentation
* Team-based learning exercises
New Topics in the Curriculum Since 2000
♢ Patient safety. Included in the Introduction to Clinical Skills and Advanced Clinical Skills courses in Years 1 and 2; reinforced in clinical clerkships in Year 3
♢ Quality improvement. Included in clinical clerkships in Year 3
♢ Team-based learning. Included as an instructional method during Year 2
♢ Simulations/training in new surgical techniques. Included in Years 1–3 of the curriculum in the Introduction to Clinical Skills and Advanced Clinical Skills courses as well as clinical clerkships
♢ Law and medicine. Additional lectures added in Year 2
♢ Dental medicine. Additional lectures added in Year 2
♢ Clinical musculoskeletal injury and assessment. Using resources available through a new orthopedics department and residency program, an additional segment with both didactic and physical exam components added in Year 2
♢ Clinical nutrition. In collaboration with Marshall University's Department of Dietetics, additional nutrition lectures added in Year 2
♢ Ophthalmology. Additional lectures on pathological and clinical ophthalmology added in Year 2
♢ Neurology. Two-week rotation in neurology added in the Year 3 psychiatry clerkship
♢ Research. A lecture on the IRB and requirement for CITI certification along with translational research topics in the basic science years. These have strengthened the research curriculum.
Changes in Pedagogy
♢ Students are exposed to a wide variety of traditional pedagogical methods, including lectures, small-group teaching, case-based learning, and role-playing.
♢ The addition of a standardized patient program, including designated facilities equipped with video and audio recording equipment, has enhanced objective structured clinical exam performance and review. A partnership with the Marshall Theatre Department has improved the breadth of patient presentations to which students are exposed.
♢ Team-based learning has been introduced into the Year 2 curriculum for an integrated session on vaccinations.
Changes in Assessment
♢ Students are required to pass NBME Step 1 before advancing to Year 3. Students are required to pass Step 2 CK and CS before graduating.
♢ Students must successfully pass a Clinical Competency Exam given at the end of Year 3.
♢ Students must successfully complete standardized patient and procedure logs prior to graduation.
♢ Students rotate through three primary hospital sites, which include two local hospitals and the Huntington Veterans Affairs Hospital.
♢ Students spend time in a variety of mental health facilities, including two local psychiatric hospitals and several outpatient facilities.
♢ Students rotate through the Medical School's outpatient departments as well as several satellite offices throughout the region.
♢ Students also spend two months at approved rural sites throughout the state during Years 3 and 4.
♢ Students may opt to spend part of their summer between Years 1 and 2 with a rural preceptor, or engage in an international health care experience to broaden their clinical skills.
Highlights of the Program/School
♢ Early clinical exposure with personal mentors reinforces the need for acquisition of basic science knowledge for diagnosis and the management of patient care. The mentoring experience creates early bonds between students and faculty that last throughout students' training, often serving to positively influence their career choices.
♢ Marshall continues to successfully accomplish its mission of providing primary care physicians to serve the needs of West Virginia and underserved populations throughout the country.
♢ Marshall's family-friendly atmosphere and small class size promote close-knit classes of students who know and have easy access to their professors and clinical faculty. Marshall students spend a great deal of time working directly with and being supervised by attending physicians on clinical rotations.