Thomas, John X. Jr. PhD; Green, Marianne MD; Sanguino, Sandra MD, MPH; Curry, Raymond H. MD
Curriculum Management and Governance Structure
♢ The dean for education is one of the six deans (the others are responsible for research, faculty affairs, clinical affairs, development, and regulatory affairs) reporting to the dean of the medical school.
♢ The school's educational programs all report to the dean for education with the exception of the graduate (PhD) programs in the life sciences, which report to the dean for research.
♢ The programs reporting to the dean for education include the undergraduate medical education program, combined BA–MD program, graduate medical education, continuing medical education, physical therapy (DPT), Masters in Physician's Assistant Studies, and a prosthetics/orthotics certificate program. Several masters-level programs (public health, genetic counseling, health care quality and patient safety, and so on) report jointly to the university's graduate school and the medical school dean for education.
♢ The educational administration, directly reporting to the dean for education, includes four deans (senior associate dean for medical education, senior associate dean for graduate medical education, associate dean for admissions, and the associate dean for minority and cultural affairs) and two program/center directors (Medical Humanities and Bioethics and Simulation Technology and Immersive Learning).
♢ The senior associate dean for medical education is responsible for the undergraduate medical education program and medical student programs, assisted by the associate dean for student programs and career development and the associate dean for medical education and competency achievement.
♢ The Curriculum Committee (see Figure 1) is composed of 12 faculty appointed at large from among medical school faculty actively involved in medical student teaching and four student members. All 16 members have voting privileges. There are a number of other attendees at each meeting who serve in an ex officio capacity (academic deans, other students, staff members from the library and the Office of Medical Education).
FIGURE 1: Curriculum...Image Tools
♢ The emphasis on having faculty members at large rather than departmental representation, adopted in 1988, has been a major factor in enabling the development of a centrally administered curriculum with many interdisciplinary features.
♢ The Curriculum Committee (see Figure 1) reports to the senior associate dean for medical education.
♢ Actions by the Curriculum Committee affecting educational policy are referred to the dean; any policy that changes graduation requirements must also be approved by the Medical Council, composed of the deans, department chairs, center/institute directors, and the University provost.
Office of Education
♢ The Office of Medical Education was established in 1984 to provide support for essential scheduling and assessment functions in a departmentally based curriculum. Concurrent with the development of a centrally managed first- and second-year curriculum that debuted in 1993, the office was expanded to provide administrative support for all aspects of the preclinical curriculum and some components of the clinical curriculum.
♢ In 2007, this office was further expanded to include Student Programs, Registration, and Records, the Honors Program for Medical Education, and the Clinical Education Center, and was renamed the Augusta Webster, MD, Office of Medical Education. The senior associate dean for medical education is responsible for the overall management of the office. Each of the associate deans (described above) supervises specific programs and the associated staff.
♢ The office includes (1) Student Programs: two program coordinators, two clerical staff, one financial aid counselor; (2) Registration and Records: registrar, two assistants; (3) Honors Program for Medical Education: one assistant; (4) Curriculum Support: five curriculum coordinators, two professional educators, two project managers, and an administrative manager.
Financial Management of Educational Programs
♢ Budgets for each of the divisions of the educational administration, including the Augusta Webster, MD Office of Medical Education, are developed and monitored by the dean for education.
♢ The educational programs are funded by a combination of appropriations from the medical school dean's office, extramural grants, service revenue, and income from several endowments devoted to specific programs.
♢ Due to the economy, we have cut back significantly on virtually all nonessential budget items (food for faculty and student meetings, travel, and so on) and have chosen not to replace existing computers, digital cameras, and so on, on the recommended schedules.
♢ The Feinberg Academy of Medical Educators (FAME) was created in January 2010.
♢ Over 120 medical school faculty including course and course unit directors, clerkship directors and associate clerkship directors, College Mentors (leaders of student learning communities), and competency leaders receive stipends from the dean's office for their leadership roles in the curriculum.
♢ Additionally, a “Core Teaching Faculty” program is being launched in 2010. Stipends will be provided to selected additional faculty with teaching roles that span multiple curriculum components.
♢ Income from two endowments is used to support the work of exemplary educators.
* The Augusta Webster, MD, Grants for Innovation in Medical Education provide funds for educational research and/or program development by Feinberg School faculty.
* The Jacob R. Suker, MD, Chair in Medical Education supports the work of a senior faculty educator for a term of five years.
♢ Secondary faculty appointments in Medical Education are awarded to selected faculty with significant roles in educational administration and/or research.
♢ Each year, the student body selects one faculty member from the first-year basic sciences course, one from the second year, two from the Patient-Physician-Society course, and one from the third year clinical clerkships to receive the George W. Joost, MD, Award for Outstanding Teaching. In addition, students select a faculty member to receive the Michael M. Ravitch, PhD, Award recognizing an outstanding PBL facilitator.
♢ A minimum of three Dean's Awards for Teaching Excellence (for basic science faculty, full-time clinical faculty, and volunteer clinical faculty) are provided each year.
♢ Outstanding teaching pins are available for course and clerkship directors to recognize faculty within their component of the curriculum.
♢ Several departments also recognize their faculty for their expertise in education on a yearly basis at a departmental meeting or grand rounds.
♢ Comprehensive and detailed information about every faculty member's teaching performance is available for review by course leadership, departmental leadership, and the dean's office.
Curriculum Renewal Process
♢ Feinberg embarked on a curriculum renewal process in the fall of 2009. The target date for implementation is the fall of 2012.
♢ The goal of the renewal process is to build a more learner-centered educational program that (1) fully integrates scientific principles in a clinical context; (2) stimulates inquiry and investigation; (3) has an assessment system that comprehensively evaluates student achievement in each of the core competencies; (4) reinforces a culture of learning, teamwork, and excellence; (5) is flexible and able to meet the unique needs of individual students as they learn and differentiate.
♢ The Feinberg School of Medicine has adopted a competency-based education framework (http://www.feinberg.northwestern.edu/AWOME/Competencies/index.html) that explicitly defines our educational expectations and goals. Ultimately, we expect that a student's progress in his/her undergraduate education will be defined by achievement of competence rather than time spent in curricular activities.
♢ The eight Feinberg competencies are Patient-Centered Medical Care, Effective Communication and Interpersonal Skills, Medical Knowledge and Scholarship, System Awareness and Team-Based Care, Personal Awareness and Self-Care, Community Engagement and Service, Continuous Learning and Quality Improvement, and Professional Behavior and Moral Reasoning.
New Topics in the Curriculum Since 2000
♢ A new course, “Interdisciplinary Medicine,” meets one day per month throughout the third year. All students are relieved of clerkship duty for the day and meet for lectures and in small group settings within their Colleges to address Advanced Physical Diagnosis, Nutrition Skills, Health Law, Complementary and Alternative Medicine, Geriatric Medicine, Palliative Medicine, Career Development, Medical Decision Making/Evidence-Based Medicine, Difficult Conversations/Advanced Communication Skills, Ethical Legal and Social Implications of Medicine, and Practice-Based Learning, Patient Safety, and Quality Improvement.
♢ A focus on patient safety has also recently been incorporated into the pediatric, obstetrics and gynecology, and primary care clerkships.
♢ A required fourth-year clerkship in intensive care principles and practice involves two weeks of full-time clinical experience and two weeks of learning in the clinical simulation laboratory and small group didactic sessions.
♢ A required fourth-year clerkship in emergency medicine provides opportunity for students to participate in the initial evaluation of undifferentiated patients with direct faculty supervision and also includes a focused curriculum utilizing clinical simulation.
♢ A Teaching Selective consisting of a minimum of 12 hours of teaching supervised by a faculty member has been added to the fourth year. Students may fulfill this requirement with clinical skills teaching, problem-based learning facilitation, or laboratory instruction in gross anatomy or microscopic anatomy.
♢ An innovative educational collaboration with Northwestern's engineering, law, and business schools provides students with an opportunity to participate in medical innovation and new product development in a team-based learning setting.
Changes in Pedagogy Since 2000
♢ Concept Mapping is now utilized beginning in the first-year Problem-Based Learning blocks to organize the groups' synthesis of the material. Beginning in the third of the seven blocks of PBL, students are asked to present the learning issues in a manner that that will prepare students for clinical presentations. Faculty reviewers external to the PBL group observe selected presentations and provide feedback to students.
♢ Clinical simulation methods are now employed in the teaching and evaluation of students in the Emergency Medicine, Neurology, Surgery, and Intensive Care required clerkships.
♢ Task trainers with haptic sensors, developed at our institution, are used in preclinical and clinical teaching of the breast, pelvic, and prostate exams.
♢ A content delivery system and searchable database of the curriculum allows students and faculty to search for relevant information in the required components of the curriculum. The curricular elements are mapped to the competencies. This system, eMERG (the Electronic Medical Education Resource Gateway), also allows access to and downloading of all syllabus materials, PowerPoint presentations, audio files of lectures, and other supplemental material. It was developed as a collaborative effort by students and the curricular leadership group.
Changes in Assessment
♢ Beginning in the 2009-10 academic year, each assessment for first year medical students is mapped to competencies and allows students to view their assessment not only in each unit but also across competency standards. This will continue as the student progresses.
♢ Comprehensive clinical skills assessments occur at the end of the first and second year clinical skills curriculum. Clinical skills examinations are required components of each third year clerkship.
♢ National Board of Medical Examiners subject examinations are used in each of the required third-year clerkships with the exception of the primary care clerkship, as part of the final assessment.
♢ Each of the required third-year clerkships have implemented criteria for the basis of their summative grades.
♢ A web-based Performance Tracking System has been developed that allows the Education deans and the student's College Mentor to monitor their progress in every aspect of the curriculum.
♢ The major sites for clinical education are the member institutions of the McGaw Medical Center of Northwestern University: Northwestern Memorial Hospital, Children's Memorial Hospital, the Rehabilitation Institute of Chicago, and, through its affiliation with the Feinberg School of Medicine, the Jesse Brown Veteran's Administration Medical Center.
♢ Other institutions participating in the required third and fourth year clerkships include the John H. Stroger Hospital of Cook County (obstetrics and gynecology, orthopedics, otolaryngology), MacNeal Hospital (general surgery), Norwegian American Hospital, and Erie Family Health Center (primary care).
♢ Preservation of the faculty's ability to participate in clinical education, in the face of continually increasing clinical productivity pressures, is a major challenge.
Highlights of the Program/School
♢ The Medical Student Summer Research Program has been expanded to offer summer research stipends to every student with a meritorious application.
♢ The Research Thesis Program provides an avenue for students to commit to a longitudinal, mentored research training program with a culminating project.
♢ Our combined degree programs (Master of Public Health; Master of Arts in Medical Humanities and Bioethics) are designed to allow receipt of both degrees in four years. Additional opportunities to study toward a graduate degree are available in patient safety and health care quality, clinical investigation, epidemiology and biostatistics, medical informatics, and business/management.
♢ Feinberg has a longitudinal Patient-Physician-Society Course that now spans all four years. This allows students to continue to reflect and share with their peers and mentors the successes and challenges within this domain.
♢ An active program in global medicine and global public health includes over a dozen formal affiliations with universities and NGOs in other countries. These programs, in conjunction with Northwestern University's multischool program in global public health and with the Feinberg School's Center for Global Health, become an integral part of the medical education of over a third of Feinberg students.