Curriculum Management and Governance Structure
♢ The Medical Education Committee, illustrated in Figure 1, is the standing faculty committee responsible for the curriculum.
♢ The charge of the overall committee is to develop, implement, and coordinate curriculum, evaluate program effectiveness, and oversee learner assessment methods. The curriculum and assessment subcommittee reviews new course proposals and evaluates assessment methods that cross disciplines. The evaluation subcommittee oversees annual centralized course and clerkship evaluations.
♢ A committee of course directors and committee of clerkship directors meet regularly to coordinate educational programs and each elect two representatives to serve on the Medical Education Committee.
Office of Education
♢ The Office of Medical Education was created in 2001 and includes the dean of medical student education, the associate director of education services, and the director of evaluation and assessment.
♢ The office provides a wide range of educational services and consultation to the faculty and the Medical Education Committee in order to develop, coordinate, integrate, and evaluate the educational program. These services include curriculum development, program evaluation, learner assessment, faculty development, information systems management, and the oversight of special programs in ambulatory education.
♢ The dean of medical student education reports to the medical school dean/vice president of health affairs, and sits on the school's administrative council.
Financial Management of Educational Programs
♢ The school's overall program budget is derived from state funds and medical student tuition and this amount has remained essentially the same over time. A special budget allocation for Ambulatory Education began in 1996 and also has remained flatly funded since that time.
♢ The current economic environment has resulted in no employee raises for three years and a 3% reduction in operating budget for 2010–2011.
♢ While the medical school does not have an academy for educators, there are a number of coveted awards for outstanding teachers.
♢ The committee on promotion and tenure recognizes the diverse expertise of faculty both on and off a tenure track, and the definition of scholarly work has been expanded to include innovations in education. The academic educator and academic clinician tracks, especially, allow for appropriate consideration of the faculty member's contribution to the education mission.
♢ As a community-based medical school in a predominantly rural state, educational programming depends on volunteer physician faculty in multiple communities.
♢ In 2006, the position of dean of clinical faculty was created to recruit and mentor faculty. An important role for this individual is to be an advocate for physician-faculty rank and promotion actions that reflect recognition for teaching and other educational service.
Curriculum Renewal Process
♢ Following successful reaccreditation in 2009, the medical school embarked on curriculum reform of the entire four-year MD program in 2010. The anticipated date of phased-in implementation is 2012 or 2013.
♢ Objectives for curriculum reform include (but are not limited to):
1. Provide graduates who meet the health care needs of the state and region and address the mission of the institution.
2. Meet the current LCME accreditation standards, specifically ED-11 and ED-15.
3. Address the recommendations of the recent Carnegie Foundation report on medical education (Cooke M, Irby DM, O'Brien BC. Educating Physicians: A Call for Reform of Medical School and Residency. San Francisco: Jossey-Bass—Carnegie Foundation for the Advancement of Teaching; 2010):
a. Standardize learning outcomes through assessment of competencies.
b. Individualize the learning process within and across levels.
c. Integrate basic, clinical, and social science so that learners may connect formal knowledge with clinical experience.
d. Support development of skills of inquiry and improvement.
e. Focus on professional identity formation.
4. Enhance interdisciplinary team and lifelong learning skills.
5. Enhance learning engagement of faculty and students.
6. Engage learners in challenging problems, and allow them to participate authentically in inquiry, innovation, and improvement of care.
7. Offer feedback, opportunities for reflection, and assessment of professionalism in the context of longitudinal mentoring and advising.
8. Create collaborative learning environments committed to excellence and continuous improvement.
♢ Key components of curriculum reform to date include:
* The study of curricular models nationally and internationally by the Medical Education Committee and course directors
* The convening of several faculty retreats and constituent focus groups
* Efforts to engage faculty interest and develop consensus through technology and face-to-face meetings
♢ Sanford School of Medicine has a set of medical student education objectives as well as a list of clinical clerkship competencies which are mapped against the curriculum. These can be found in Appendix 1.
New Topics in the Curriculum Since 2000
♢ Complementary and alternative medicine
♢ Cultural competence and immersion
♢ Emergency preparedness and disaster management
♢ Evidence-based medicine
♢ Healer's Art course
♢ Health care systems
♢ Interprofessional team workshop
♢ Law in medicine
♢ Team-based learning
Changes in Pedagogy
♢ Medical students learn alongside students in the physician assistant, physical therapy, and occupational therapy programs for courses in human anatomy and embryology.
♢ Clinical correlations and case-based learning exercises have been introduced in the basic science courses.
♢ In 2002, the Medical Education Committee directed faculty toward instituting active learning techniques in courses and clerkships. Faculty development programs provided training in evidence-based innovations, and modest incentives were developed including paying lecturers higher rates for active learning.
♢ The use of online and computer-based learning activities has expanded throughout the curriculum, including library database resources and case-based programs such as WISE-MD, fmCASES, and CLIPP.
Changes in Assessment
♢ Standardized NBME subject examinations are used in nearly all courses and clerkships.
♢ The OSCE at the end of the third year is similar in format to that of the USMLE Step 2-CS, with expanded assessment of students' skills in diagnostic testing and choice of therapy. Simulation manikins are used to a limited extent.
♢ A Web-based electronic log known as Student Patient Experience Log (SPEL) is used to monitor numbers and types of patients encountered in all of the required clinical experiences.
♢ The primary sites for clinical education include the Avera McKennan, Sanford, and VA Medical Center Hospitals in Sioux Falls, Rapid City Regional Hospital in Rapid City, and Avera Sacred Heart Hospital in Yankton. Additional sites include Avera Behavioral Health, the Mikkelson Human Services Center in Yankton, the VA Medical Center at Fort Meade, and numerous small rural hospitals. A large number of clinics are used for ambulatory education.
♢ Challenges in clinical education include maintaining the involvement of high-quality clinical faculty who face increasing pressure to be clinically productive. Addressing this challenge requires frequent discussions with clinic and hospital leaders to raise awareness of the value of medical education.
♢ Clinical education takes place on three campuses in Sioux Falls, Rapid City, and Yankton, all of which are distant from the site of preclinical courses in Vermillion.
♢ The Yankton campus maintains a longitudinal integrated clerkship program, which was the first in the nation in 1991. Outcome evaluation shows that the Yankton program leads to comparable Step 2 test scores, similar or better retention of knowledge, and excellent recruitment and retention for the campus community.
Highlights of the Program/School
♢ Excellent one-on-one teaching is provided by practicing clinicians, and strong ties exist between medical school leadership and the community.
♢ Concepts of professionalism and appropriate monitoring of the learning environment are integrated throughout the program.
♢ All third-year students complete a three-day cultural immersion experience.
♢ A new optional scholarly concentration track, the Scholarship Pathways Program, provides four-year opportunities for students in education, research, and service.
♢ Approximately one half of graduates return to practice in South Dakota, and one half of South Dakota's physicians attended this medical school.