Curriculum Management and Governance Structure
♢ Mercer University School of Medicine adopted a series of schoolwide educational principles from which a competency-based curriculum was developed.
♢ The opening of a sister campus in Savannah, Georgia, required a restructuring of the governance structure to include representation of faculty and students from both campuses on all committees.
♢ The curriculum is delivered in the same manner on both campuses.
♢ The faculty and Dean's office work closely together on development of policy and implementation of the curriculum.
♢ From the Dean's Office, the Dean delegates the bulk of responsibility for oversight, management, and implementation responsibility for the education programs to the Associate Deans for Academic Affairs (ADAAs), one on the Macon campus, and one in Savannah. These individuals work closely with faculty committees on curriculum policy and design and with various administrative chairs on implementation of the major components of the academic program.
♢ Curricular policy development resides primarily in the faculty and is overseen by the faculty-elected Curriculum and Instruction Committee (CIC).
* This committee consists of 17 voting members. The elected members include three members from the clinical departments, three from the biomedical science departments, one from the community medicine department, and one from the library faculty. The clinical and basic science faculty members must include one representative from each campus. The appointed members include two community members who are appointed by the Dean and all five program directors (Biomedical Problems, Fundamentals of Clinical Medicine, Community Medicine, and Year 3 and Year 4 program directors).
* Four medical students, one from each class, are elected by the students. The student representatives have two votes, one from the preclinical representatives and one vote from clinical representatives. There must be at least one student member from each campus.
* Ex officio members include the ADAA of each campus and the assistant directors of each program.
♢ The duties and responsibilities of the Curriculum and Instruction Committee are stated in the Bylaws of the Faculty. They are as follows:
♢ To evaluate and make recommendations to ensure that:
* The overall predoctoral educational program fulfills the mission of the School.
* The School has defined its educational objectives/student competencies and the methods for assuring that those objectives/competencies have been achieved for both the educational program as a whole and the component programs/courses/clerkships/electives comprising the overall program.
* Curriculum content in programs/courses/clerkships/electives and the curriculum as a whole are sufficient to meet the educational objectives/student competencies of the program as a whole.
* All those who teach or supervise students are familiar with the educational objectives of their respective course/clerkship/elective and are prepared for their educational roles.
* Students have mastered under direct observation the core skills list that is specified in the School's objectives and competencies.
* The core education skills expected of learners in the educational program are mastered.
* All programs, courses, clerkships, and electives provide formative and summative feedback to students in a timely manner.
* Remediation policies and procedures for the educational program as a whole and its components are administered in a manner consistent with the remediation policies of the School.
* Comparable educational experiences are maintained on geographically separated campuses.
* Equivalent methods of evaluation and standards for evaluation are maintained on geographically separated campuses.
* The methods used to evaluate the effectiveness of the educational program as a whole and the component programs, courses, clerkships, and electives are monitored and that evaluation and improvement cycles occur.
* Student workload is monitored and conflicting curricular demands are managed within the academic calendar.
♢ To evaluate the following:
* Competencies, objectives, content, and pedagogy of each component of the curriculum, as well as the curriculum as a whole, making recommendations for revisions as needed.
* The effectiveness of the educational program by ensuring that the educational objectives of the School are met, that student competencies are achieved, that omissions are identified and corrected, and that undesirable redundancies are eliminated, making recommendations where needed.
* The performance of students and graduates in the framework of national norms of accomplishment.
♢ To review and make recommendations on the quantified criteria for patient encounters needed to achieve the School's overall objectives and competencies.
♢ To monitor the content provided in each discipline in the context of achieving the educational objectives of the curriculum and student competencies and to make recommendations for revisions where needed.
♢ To monitor and make recommendations to adjust, where needed, student workload in order to balance educational opportunity and learner fatigue.
♢ To make recommendations on student performance criteria and standards to the Dean.
♢ In the first two years, a knowledge base in basic medical science is presented in a clinical-problem-based interdisciplinary manner. In the clinical years, emphasis on basic science knowledge is replaced with an emphasis on clinical information.
♢ Development of clinical skills is begun the first week on campus with the Clinical Skills Program, which extends over the first two years. These skills are reinforced in a community-based outpatient experience and expanded by the clinical experiences of the third and fourth years.
♢ A longitudinal Community Medicine curriculum includes practical training in the areas of chronic disease and population-based medicine.
Office of education
♢ There is an Office of Academic Records, which has responsibility for support of the medical student education program.
♢ The preclinical and clinical curricula are centrally administered through the Office of Academic Records.
♢ Each of the five educational programs is headed by a Program Director and an Assistant Program Director located on the sister campus. Each Program Director assists the ADAA in management of the curriculum. These Directors are appointed by the ADAA and report directly to him or her.
♢ Each Program Director chairs a committee consisting of faculty members responsible for the day-to-day administration of the curriculum within that program. Each of these program committees are subcommittees of the CIC and report directly to the CIC. As an example, the Phase Coordinators Committee is composed of the Phase Coordinators from each of the 12 Phases of the BMP curriculum. Phase Coordinators are chosen by the Program in consultation with the Departmental Chairs and the ADAA from the basic science and clinical faculty who participate in the BMP program. Hence, in reality one role of the BMP Director becomes the “Coordinator of Coordinators.”
Financial management of educational programs
♢ Although a private institution, MUSM receives considerable support from the State of Georgia for the fulfillment of our educational mission.
♢ In addition, we are diversifying our approach to deal with the current financial crisis. We have strengthened the research infrastructure in order to increase extramurally funded basic science and clinical research, we are developing synergistic educational programs in the health sciences, and we are restructuring the medical practice plan to maximize returns.
♢ Teaching has remained the primary focus of our faculty since the school's inception. The PBL method has been very successful, but it is a faculty-intensive process. The Faculty have an open-door policy, and students are expected to engage faculty members in discussions as they learn the material. Generous state funding has enabled the school to provide protected time for both basic science and clinical faculty to teach.
♢ Accomplishments in the teaching domain are heavily emphasized in the promotions process. All current promotion and tenure tracks have teaching as a primary component of the evaluation process.
♢ Recruitment of community physicians and clinical faculty from our affiliated hospitals to participate in the preclinical educational programs has been extremely successful.
Curriculum Renewal Process
♢ There is an ongoing curricular renewal process in which each curricular component is reviewed once every three years. Student and faculty input is aggregated and presented to the CIC for evaluation.
♢ In addition to ongoing renewal, the Preclinical Curriculum underwent a thorough revision in 2006, at which time the content of the phases was reassessed, the cases used in the PBL curriculum were updated, and the phases were rearranged.
♢ Currently, we are undergoing a revision of the third- and fourth-year curriculum. We have developed a series of principles that serve as a framework for curricular structure, content, and methods of instruction and evaluation.
♢ Key objectives for the renewal process include increasing the ambulatory component of the clerkships; a strong presence of the community medicine program; and the introduction of horizontal, interdisciplinary components throughout the year.
♢ The primary educational objectives of Mercer University School of Medicine are to educate primary care physicians for rural and other undeserved areas of Georgia and to instill in these students a commitment to lifelong learning.
♢ MUSM has extensive outcome objectives developed for all of its programs.
♢ Admissions criteria and curricular components are designed to foster this mission.
♢ Specific educational objectives are grouped into the broad areas of knowledge, skills, attitudes, and mission. (A copy of the objectives was included, but space does not allow their publication. They are available from the authors.)
♢ The preclinical curriculum is integrated and multidisciplinary and organized into 12 Phases, which are distributed over two years. The basic science knowledge is assessed each phase using an integrated, USMLE -formatted multidisciplinary exam (MDE).
♢ The student's ability to effectively communicate a critical analysis of a biomedical case is assessed in an oral exam [Student Oral Case Analysis [SOCA)] at the end of each phase. Each student presents the case to a single faculty member. While the exam is formative in nature, students are evaluated against an exam standard and are assessed as being either satisfactory or unsatisfactory. Students who are unsatisfactory on a given exam are required to undergo a remediation process.
♢ The format is basically as follows: A case similar to those presented during the phase is given to the student for review 45 minutes prior to the presentation. The student has approximately 20 minutes to present an analysis and discussion of the case to a faculty member (tutor) other than their own from the phase.
New topics in the curriculum since 2000
♢ The third and fourth years of the program tend to reflect a fairly traditional educational pedagogy. We are in the process of developing a longitudinal integrated curriculum for the third year to be implemented in new clinical sites throughout Georgia.
♢ The traditional third- and fourth-year programs are currently being reviewed with the goal to incorporate curriculum to better prepare our students to practice medicine in 2020.
♢ Professionalism has been integrated throughout the four-year curriculum since 2009.
Changes in pedagogy
♢ MUSM is a relatively young medical school, admitting its first class in 1982. The curricular methodology was defined early in our history. However, it took several years for the complete curriculum to be “institutionalized.” With only minor modifications, it has been a relatively stable program over this time.
♢ The focus on clinical skills has led to the development of the Designated Standardized Patient (DSP) program, in which students learn basic clinical skills from a highly trained standardized patient in a continuity setting. Students work with one DSP during the first year and another of the other gender during the second year. Very strong relationships have formed between the DSPs and the students, providing a model for their future role as a physician.
Changes in assessment
♢ Since its inception, the Student Oral Case Analysis (or SOCA) has been given at the end of each phase of the preclinical curriculum.
♢ In the last three years, extensive work has been done to improve the reliability and validity of this assessment. Extensive faculty development has been introduced into the methodology. Faculty work together to create a case that assesses the learning objective pertinent to the given phase. They then prepare and agree upon an exam standard and evaluate that standard against an actual exam presentation prior to administering the oral exam. Reliability is assessed by faculty independently evaluating recordings of a subset of student oral exams. Very high inter-rater reliability has been achieved.
♢ The clinical education at MUSM is conducted at our affiliated community hospitals—the Medical Center of Central Georgia in Macon and Memorial University Medical Center in Savannah. Both hospitals have a long tradition of serving the local and regional community with state-of-the-art care but in a smaller, community-focused environment than the traditional large academic center.
♢ The community nature of the hospitals is a great match for the mission of MUSM—to produce physicians for rural and underserved Georgia.
♢ The result is a student with a very practical education, adept at integrating basic science concepts into the clinical setting.
♢ In 2008, the Savannah campus was expanded from a two-year clinical campus to a full four-year campus.
♢ As such, all resources that are available in Macon are also available in Savannah.
♢ A small, core group of faculty from the Macon campus formed the initial cohort of faculty for the Savannah campus. Additional faculty were hired and trained in the facilitation methods for the basic science curriculum in Macon prior to starting in Savannah. Additional faculty have subsequently been recruited and trained for both campuses.
♢ Test scores and student satisfaction surveys have been virtually equivalent in comparisons between the two campuses.
Highlights of the program/school
♢ The first two years of the program are dedicated to delivering a solid foundation in Basic Science, clinical skills, and community medicine relevant to the practice of medicine.
♢ We use a problem-based, student-centered, small-group discussion model to deliver the education program in Basic Medical Sciences.
♢ We use a well-developed standardized patient program to teach and assess clinical skills.
♢ Applicants must be a resident of the State of Georgia to apply, and two thirds of our graduates are practicing in Georgia after finishing their graduate medical education.
♢ The small campuses and small-group curriculum lead to very close relationships among the students and between the students and the faculty.
♢ This curriculum has been very successful, enabling our students to achieve much higher scores on the USMLE Step 1 and 2CK exams than would be predicted based on their MCAT scores.
♢ The success of our program is due, at least in part, to the tutorial experience and the highly interactive environment that exists between students and the tutor in group. This unique PBL experience is evaluated highly by the students and is what attracts many applicants to MUSM.