Porter, Barbara L. MA; Grande, Joseph P. MD, PhD
Mayo Medical School began the planning for a comprehensive reorganization of its curriculum in early 2005. The goals of our curricular reform were to
1. focus on health care of the future,
2. establish a greater patient focus,
3. provide greater integration and coordination of material,
4. employ more effective didactic methods, and
5. address student concerns regarding curricular density and stress.
♢ The new curriculum was launched at the start of academic year 2006-07.
♢ The curriculum has been transformed from a course-based curriculum into a highly integrated block-based curriculum in which four longitudinal themes—Scientific Foundations, Clinical Experiences, Principles of Pharmacology and Therapeutics, and Improving the Public's Health—are interwoven throughout the entire four-year curriculum.
Curriculum Management and Governance Structure
♢ The Board of Trustees is the governing body of the Mayo Clinic. The Board of Trustees has overall responsibility for the educational, research, and clinical practice functions of the Mayo Clinic. A diagram of the curriculum management and governance structure is provided in Figure 1. The Mayo Clinic Education Committee (MCEC) governs educational activities within the College of Medicine.
FIGURE 1: Curriculum...Image Tools
♢ The College of Medicine, Mayo Clinic, has five schools:
* Mayo Medical School grants the MD degree, the MD–PhD degree jointly with the Mayo Graduate School, and the MD–OMS degree jointly with the Mayo Graduate School of Medicine. In addition, the Medical School has partnerships with Arizona State University in providing several joint degrees, including a joint MD–JD and with the University of Minnesota for a joint MD–MPH degree.
* Mayo Graduate School grants the PhD degree in biomedical sciences. It grants the joint MD–PhD degree in collaboration with Mayo Medical School.
* Mayo Graduate School of Medicine includes all of the residency and clinical fellowship training programs, and research-based postdoctoral fellowship programs.
* Mayo School of Health Sciences provides training in the allied health professions. It currently has 27 Certificate, Associate, Bachelors, and Masters Degree programs.
* Mayo School of Continuous Professional Development oversees, organizes, and accredits all of the continuing medical education activities at Mayo Clinic.
♢ The total enrollment of students and trainees in the five schools within the College of Medicine, Mayo Clinic, is over 2,000 students. The Continuous Professional Development programs enroll over 25,000 registrants each year.
♢ Each school is governed by an Education Committee, which is chaired by the Dean of the school.
♢ The Dean of Mayo Medical School is responsible for setting the vision of the medical school and reporting to the Mayo Clinic Education Committee and other components of Mayo Clinic and outside organizations. The Dean is responsible for fiscal management of the medical school.
♢ Mayo Medical School has five Associate Deans:
* Associate Dean for Academic Affairs is responsible for the organization and management of the curriculum for the Medical School.
* Associate Dean for Student Affairs is responsible for admissions, financial aid, and counseling.
* Associate Dean for Faculty Affairs is responsible for faculty development and promotion.
* Associate Dean for Undergraduate Education on the Arizona Campus has comprehensive responsibility for oversight of medical student activities at Mayo Clinic Arizona.
* Associate Dean for Undergraduate Education on the Florida Campus has comprehensive responsibility for oversight of medical student activities at Mayo Clinic Florida.
♢ Mayo Medical School has three Assistant Deans:
* The Assistant Dean of Student and Academic Affairs is responsible for outreach efforts to promote a highly qualified and diverse student population, and for implementing strategic initiatives in medical school governance, administration, academic affairs, and student affairs.
* The Assistant Dean for Assessment is responsible for maintaining the quality of formative and summative assessment of students, and facilitating mid- and end-of-block student evaluation of the curriculum.
* The Assistant Dean for Curriculum Development and Innovation is responsible for designing and implementing novel approaches to medical student education.
♢ The Mayo Medical School Executive Committee is chaired by the Dean of the Medical School and consists of the Associate and Assistant Deans. This committee is ultimately responsible for oversight of the curriculum, policy, strategic planning, and all issues related to governance and management of the Medical School.
♢ The Mayo Medical School Advisory Committee, consisting of faculty with extensive involvement in education at all three Mayo sites (Minnesota, Arizona, and Florida), the Admissions Committee, the Finance Committee, and the Academic Affairs Executive Committee report directly to the Mayo Medical School Executive Committee.
♢ Several committees with responsibility for various aspects of the curriculum report directly to the Academic Affairs Executive Committee. These include the Basic Science, Clinical Experiences, Improving the Public's Health, and Pharmacology Theme Committees, the Block Leader Committee, the Clerkship Director Committee, the Selective Advisory Committee, the Curricular Advisory Committee, the Student Assessment Committee (a committee responsible for review of every student's record every six months), and the Student Promotions Committee (responsible for oversight of student status).
Office of Education
♢ The Mayo Medical School administrative staff has responsibility for support of the medical student educational program.
♢ Mayo Medical School does not have a designated Office of Medical Education or Department of Medical Education.
Financial Management of Educational Programs
♢ The Mayo Medical School budget is negotiated with the Mayo Clinic Education Committee on an annual basis.
♢ The Mayo Clinic Education Committee, in recognizing the importance of education at Mayo, has continued to provide generous support for the Mayo Medical School during the current financial crisis.
♢ The Dean chairs a Mayo Medical School Finance Committee. This group is responsible for fiscal matters of the school. This committee reports to the Medical School Executive Committee.
♢ There is a separate Student Finance Advisory Committee, which is comprised of student members from all four years and is chaired by one of the Assistant Deans. This committee serves to provide input to the Medical School Finance Committee.
♢ Mayo Medical School does not have an academy or institute for educators.
♢ Our outstanding faculty are recognized through special awards including Teacher of the Year, Faculty Service Awards, Dean's Recognition Awards, and Distinguished Educator Awards.
♢ Decisions related to promotion are made by an institutional, non-departmentally-based promotions committee.
♢ There is an active dialogue between the Promotions Committee and members of the medical school administration to ensure that excellence in teaching and educational scholarship are considered in decisions related to promotions.
Curriculum Renewal Process
♢ The Mayo Medical School curriculum underwent an extensive revision in July 2006. As a part of this revision, infrastructure for continuous improvement of the curriculum was established. This infrastructure includes student participation on committees, systematic mid and postevaluation of all blocks, postclerkship student feedback, and graduation questionnaires.
♢ All feedback is regularly reviewed in the Block and Theme Committee meetings, and further discussed at the Academic Affairs Executive Committee, with recommendations for changes provided to the Mayo Medical School Executive Committee.
♢ Key objectives for curriculum renewal process include the following:
* responsiveness to student feedback,
* responsiveness to faculty feedback,
* careful consideration of overall curricular architecture.
♢ During our curricular reform process, our faculty developed 26 learning outcomes, which were mapped to the ACGME Competencies (Table 1).
TABLE 1: Student Out...Image Tools
TABLE 1: (Continued)...Image Tools
New Topics in the Curriculum Since 2000
♢ Patient safety and quality improvement: These are important components of our Improving the Public's Health theme. Students receive an introduction to these topics at the beginning of their training.
♢ As a part of the Evidence-Based Medicine course, students are expected to submit brief write-ups based on situations encountered during their clinical clerkships. These write-ups are expected to include a critical appraisal of data related to therapy, harm, diagnosis, prognosis, systematic review of a topic, and clinical practice guidelines, as applied to patient care.
♢ Team-based learning is an integral component of the Human Structure block, during which students have well-defined team-based roles in dissecting human cadavers in the Anatomy course and working with physical therapy students to learn musculoskeletal anatomy.
♢ Our curriculum makes extensive use of simulation, both to reinforce preclinical training, reinforcement of basic science concept, and in performing clinical evaluation of patients.
♢ The Internship Boot Camp, taken by fourth-year students, makes extensive use of simulation to put students through scenarios requiring teamwork and excellent communication skills in working through patient scenarios that they are likely to encounter as house staff officers.
♢ The addition of the “Improving the Public's Health” curriculum blocks has provided an opportunity to integrate topics designed to prepare students for health care of the future.
♢ Content within these blocks includes social determinants of health, exploration of health systems and health reform, professionalism, health communications and cultural competency.
Changes in Pedagogy
♢ Major changes include the following:
* integrated block-based rather than course-based curriculum
* overall decrease in time spent in lectures by 25%–33%
* renewed emphasis on small-group and team-based instruction
* success of pedagogical changes measured through assessment and feedback system
Changes in Assessment
♢ A formalized system of student, block/clerkship, and curricular performance has been implemented.
♢ Key features include systematic mid- and end-of-course/clerkship evaluation by students, regular review of block/clerkships in committee meetings, with reporting of results to the Medical School Executive Committee.
♢ Sites for clinical education include Mayo Clinic Rochester, Mayo Clinic Arizona, and Mayo Clinic Florida. Recent affiliations with Maricopa County Hospital in Phoenix, Arizona, and the Good Samaritan Health Clinic in Rochester, Minnesota, provide students provide new and diverse patient populations for students to experience during clinical clerkships.
♢ Primary challenge is to find the appropriate balance of hospital-based versus clinic-based education for our students.
♢ Mayo Clinic Rochester, Mayo Clinic Arizona, Mayo Clinic Florida, and the hospitals and clinics that comprise the Mayo Health System are all legal entities of Mayo Clinic. As such, there are no regional campuses associated with our educational program.
Highlights of the Program/School
♢ Integrated curriculum: Our educational program is highly integrated, with infrastructure to support overall integration of clinical experiences with scientific foundations, principles of pharmacology and therapeutics, and improving the public's health.
♢ Diversity: Mayo Medical School is among the most diverse medical schools in the country.
♢ The school works to embed support for and promotion of diversity in all aspects of its operation. Recruitment, selection, and retention of a diverse student body are priorities.
♢ Medical school staff work to insure that all students are provided the support needed to advance and excel during the medical school years.
♢ Flexible curriculum: We currently provide 19 weeks of selectives during the first two years of student training, during which there are no competing educational activities. Students may use this time for career exploration, research, shadowing, or volunteer work in the community or in other countries.
♢ Selectives are among the most valued training experiences reported by our students.
♢ Promotion of academic enrichment opportunities: In recent years, up to 25% of our class has taken advantage of opportunities to pursue dual-degree programs, including MD–PhD, MD–JD, MD–MPH, and MD– MBA.
♢ Access to Mayo Clinic: Reforms to the curriculum have focused on maximizing the utilization of the vast clinical and faculty resources of Mayo Clinic.
♢ The curriculum structure dictates engagement of many members of the large clinical staff at Mayo. Students have access to over 2000 physicians and scientists for selective and research experiences. Faculty readily welcomes the opportunity to mentor and support medical students.
♢ Peer teaching: The schools employs an active “Students as Educators” program that provides extensive teaching opportunities in the preclinical curriculum.