Curriculum Management and Governance Structure
♢ The Vice Dean for Academic Affairs provides management support for the curriculum while the Curriculum Committee (CC), which is a standing committee appointed by the Dean, governs the curriculum, sets educational policy and provides direction.
♢ Five standing subcommittees report to the CC: the Curriculum Study Group (CSG), which evaluates courses, phases, and the curriculum as a whole; Phase I (first 20 weeks); Phase II (55 weeks); Phase III (48 weeks); and Phase IV (40 weeks).
♢ The CC also receives reports from several task forces and groups including the Scholarly Thread Group, Professionalism Thread Group, and task forces to address specific issues such as faculty or course evaluations.
Office of Education
♢ The Office of Educational Development (OED) was established in 2004 and resides under the Vice Dean for Academic Affairs. OED's primary activities include (1) central monitoring and reporting of academic achievement, (2) central monitoring of student, faculty, and director evaluations of courses, clerkships, and electives, (3) support for the CC in evaluating all curriculum components, (4) assisting in curricular innovations, teaching, and evaluations, (5) development of faculty development programs for College of Medicine (COM) faculty, and (6) promotion of educational research. OED was closely involved in the planning and evaluation of dual campus expansion in 2007–2008.
♢ OED is led by a part-time PhD educator/director and a part-time MD educator. Expansion in 2011 will include a full-time PhD educator/director and a new PhD educator to coordinate and expand faculty development, teaching evaluation, and the promotion of excellence in teaching and learning.
Financial Management of Educational Programs
♢ The Dean and Vice Dean for Academic Affairs determine the budget for education. Funding comes from state appropriations, tuition and student fees, philanthropy, and grants and contracts.
♢ State budgets have reduced funding to the college during the current economic downturn. However, the COM has chosen to protect educational funding relative to other missions of the school.
♢ The school annually grants two teaching awards to basic science faculty and two to clinical science faculty.
♢ A teaching academy is being formed in 2011 and a master's in medical education program is planned for 2012.
♢ Several faculty have attended national faculty development programs, including Harvard Macy and fellowships at UNC and Stanford.
♢ The promotion and tenure process values teaching, and several faculty members have been promoted through the educator track.
Curriculum Renewal Process
♢ Curriculum reform has been an ongoing process at the COM since 2000. The initial objectives were better horizontal and vertical integration of curriculum content, improved coverage of topics mandated by the LCME, and the expanded use of active learning modalities.
♢ The curriculum was based on general learning objectives prior to 2009. Curriculum revision included development of Competency-Based learning Objectives (CBLOs) in an effort to behaviorally define what students should know and be able to do. Six general competencies (Medical Knowledge, Patient Care, Interpersonal and Communication Skills, Professionalism, Systems-based Practice, and Practice-based Learning and Improvement) encompassing 49 learning objectives guide course content and evaluation.
♢ The full CBLO document may be found at: http://medicine.tamhsc.edu/elective/.docs/competency-based-learning-objectives.pdf.
New Topics in the Curriculum
♢ Evidence-Based Medicine
♢ Human Sexuality (including GLBT issues)
♢ Medical Informatics
♢ Emergency Medicine
♢ Critical Care
♢ Interdisciplinary Ethics
♢ Cultural Competency
♢ Alcohol and Drug Dependency
♢ Patient Safety
Changes in Pedagogy
♢ In the preclinical curriculum, case-based learning and small-group learning has been added. Simulations and standardized patients are used during clinical skills instruction.
♢ The core clerkships have added simulation, standardized patients, and electronic cases to augment the curriculum.
Changes in Assessment
♢ In the preclinical Phases of the Curriculum, customized NBME exams have been used since 2006 in place of the standard subject exams.
♢ Student performance is measured in the six CBLOs during the clerkships and fourth-year rotations. Simulations and standardized patients are used as part of this assessment.
♢ Student professionalism is assessed throughout the four years, and a satisfactory evaluation is required for advancement. Assessment of professionalism is separate from course grades in the preclinical phases.
♢ Step I and Step II passage is required for student graduation.
♢ Over the past five years our entering class size has expanded from 80 to 150 students, necessitating the rapid development of new clinical education venues.
♢ We now offer core clinical experiences in multiple sites in Central Texas, North Texas, and Southeast Texas:
* Temple, Texas- Primary clinical campus, which utilizes Scott & White Health Care, Central Texas Veteran's Hospital System, and Darnall Army Hospital.
* Round Rock, Texas- Seton system, St. David's system, Scott & White Health Care, Lone Star Circle of Care, Dell Children's Medical Center of Central Texas, Austin State Hospital, and several community settings.
* College Station, Texas- St. Joseph's Hospital, College Station Medical Center, The Physician' Center Hospital, and several community outpatient settings.
* Houston, Texas- MD Anderson Cancer Center, Methodist Hospital, St. Joseph's Hospital, and Memorial Southwest Family Medicine Program.
* Dallas, Texas- Baylor University Medical Center.
* Corpus Christi, Texas- Driscoll Children's Hospital.
* Outpatient sites in several communities in the region above.
♢ There are a number of challenges utilizing multiple educational sites:
* Coordination and oversight of curriculum.
* Faculty development for many part-time community faculty from significantly different health care systems.
* Adequate supervision of students by faculty in all clerkship locations.
* Communication across campus sites and within the same clerkships.
* Making students and faculty at multiple, very different campuses feel part of a single College of Medicine.
* Consistent quality of instructional technology and distance education across campuses.
♢ There are also a number of strengths in using multiple educational sites:
* Students can choose educational locations based upon their interests utilizing the varied strengths of the individual campuses.
* For example, they can elect traditional academic health center rotations where they function as part of an attending, fellow, resident, and student team or go to community hospitals and clinics where they typically work one-on-one with a community-based attending physician.
* Student academic performance at the different campus locations has been virtually identical, and USMLE scores are improving, even though the class size is rapidly increasing.
* Students like the flexibility of moving between campuses for clinical rotations.
♢ The COM has regional campuses in College Station, Temple, and Round Rock, Texas.
♢ All three campuses offer full clinical training. College Station and Temple offer all four years of medical school education.
♢ All three offer extensive training with medical simulation.
♢ Clinical rotations are also offered in Houston, Corpus Christi, Beeville, and Dallas.
Highlights of the Program/School
♢ Betweeen 2000–2010, the COM has expanded from a class size of 64 to 150.
♢ The COM was an early adopter of simulation and offers it throughout the curriculum.
♢ Students can pick the best clinical campus that meets their career needs.
♢ Students can learn in both urban and rural settings.
♢ With expansion, the COM has significantly increased its research opportunities and now offers students joint degrees including the MD/PhD, MD/MPH, and MD/MBA degrees.
♢ The COM has always emphasized primary care and rural medicine. However, with recent expansion that emphasis has decreased. New leadership is expecting the COM to rediscover this mission and increase the number of graduates serving in health care shortage areas in Texas.