Maguire, Gerald A. MD; Clayman, Ralph V. MD
Curriculum Management and Governance Structure
♢ For a diagram of the curriculum management and governance structure, please visit the office of medical education Web site at http://www.meded.uci.edu/.
♢ Curriculum oversight is provided by the standing Curriculum Education Policy (CEP) committee which is an academic-senate appointment organization. The CEP committee meets monthly and has ad hoc membership from administration in medical education.
♢ Quarterly, the CEP meets with the faculty directors of all the courses and clerkships.
♢ In addition, a separate clinical clerkship directors' meeting is convened monthly to review topics pertinent to the clinical aspects of the curriculum.
Office of Education
♢ The Office of Medical Education serves under the direct supervision of the dean. A senior associate dean of medical education has oversight of the office and its separate divisions of student affairs, admissions, curricular affairs, simulation center, skills center, instructional technology, and diversity/community engagement.
♢ The dedicated office of medical education has one senior associate dean, five associate deans, and the specialty faculty directors. The office has 42 full-time dedicated support staff.
♢ There are 46 educators who are directly funded by the Office of Medical Education with 734 full-time faculty based in their respective departments.
♢ The office of medical education centrally manages all aspects of student education with approval from the CEP.
♢ The office of medical education serves the central role of managing all aspects of the education program from medical student education to graduate medical education through continuing medical education.
Financial Management of Educational Programs
♢ Despite financially hard times, the medical school has actually increased funding toward the educational program to support medical education. We continue to accomplish this financial goal by focused philanthropic campaigns, grants, dedicated state support for the PRIME-LC (Program in Medical Education—Latino Community) class expansion, and increases in student fees. These are explained in more detail in Program/School Highlights below.
♢ Through philanthropic donations, we have initiated the iMedEd initiative where each of the first-year medical students received, at no cost, an iPad with their curriculum (textbooks, syllabus and lecture notes) fully loaded.
♢ We received grants from HRSA and industry to purchase high-fidelity simulators, whose utility has been integrated into the curriculum as early as the first year.
♢ In addition, the school received an industry grant to support a novel bedside ultrasound curriculum education project.
♢ For the seventh year we received dedicated state support for the PRIME-LC expansion.
♢ The student fees have increased on average 7% per year the last three years.
♢ The Dean's College of Medicine Educators consists of the course directors/clerkship directors who meet monthly with key education faculty members. This group provides insights to the medical education office and CEP in the formation of new educational initiatives.
♢ The committee on academic promotion greatly values teaching in the promotion process.
♢ The University of California conducts formal evaluations of all faculty members on a regular basis (every two years for Assistant/Associate Professors and every three to five years for Professors).
♢ The areas of evaluation are teaching, university service, professional competence, and research (if required). Excellence is expected in each area.
♢ For teaching, evaluations from students, residents, fellows, and/or postdoctoral scholars are required.
♢ Each successful evaluation results in a “merit increase” or promotion (usually after six years in rank). The merit increase or promotion carries with it an increase in base salary.
♢ Teaching is one of the key components that determine the base salary of faculty members of the University of California, Irvine School of Medicine.
Curriculum Renewal Process
♢ When the current senior associate dean was appointed in 2007, he began an initiative to integrate the curriculum across all the years.
♢ The first step was to begin a new Clinical Foundations (CF) course, which provided further clinical applicability of the basic science curriculum beginning in the first year and continuing throughout medical school.
♢ CF is taught by 18 dedicated core teachers who provide year-long instruction to the first- and second-year students as well as mentorship and career advising in all four years. These core teachers receive financial support and protected time from the Office of Medical Education.
♢ The key objective of the curricular renewal process was to integrate the curriculum both horizontally and vertically across the courses/clerkships/years and to instill more small-group active learning into the basic science curriculum.
♢ The key components of the renewal process include clinical and basic science integration and significant increases in active learning modalities.
♢ In addition, the basic science curriculum has undergone significant integration across courses.
♢ The school has also achieved a significant increase in small group, active learning during the first two years of the curriculum. Much of this active learning occurs in the simulation center and is part of the ultrasound instruction program (see Highlights of the Program/School below).
♢ The institution has competencies and learning outcomes identified for the graduates. These can be found online at www.meded.uci.edu/Students/index.html.
♢ All students must pass Step 1, Step 2 (CS and CK) of the USMLE, shelf exams in every course and clerkship that is offered, objective structured clinical examinations in the first three years, and the Clinical Performance examination (CPX) at the end of the third year.
New Topics in the Curriculum since 2000
♢ Bedside ultrasonography and clinical examination is now offered to augment the physical examination and to provide clinical correlations in Anatomy, Physiology, and Clinical Foundations 1, 2, 3 and 4. Further description of the ultrasound program can be found under School Highlights below.
♢ There is a Clinical Foundations course spanning all four years of the curriculum.
♢ The PRIME-LC (Program in Medical Education—Latino Community) was initiated; this is a novel five-year curriculum with combined MD/Master's (various options exist for the Master's including MBA, MPH).
♢ There is simulation training in the following courses: Clinical Foundations 1, 2, 3, 4, Physiology, Pharmacology, and the following Clerkships and Rotations: Surgery, Intensive Care Unit, Emergency Medicine, and Anesthesiology.
* High-fidelity patient simulators are used to simulate clinical cases pertinent to each course or clinical specialty.
* Part task trainers are used during clinical rotations to teach medical students common procedures in each specialty.
♢ Business of Medicine – Clinical Foundations 1, 2, 3 and 4.
♢ Patient safety –Clinical Foundations 3, 4 and Medicine Clerkship.
♢ Quality improvement –Clinical Foundations 3 and 4.
♢ Team-based learning–Clinical Foundations 3 and 4.
Changes in Pedagogy
♢ UC Irvine's School of Medicine is reinventing the traditional medical school curriculum for the 21st century, becoming one of the first in the nation to build a completely digital, interactive learning environment for the entering class of 2014.
♢ The overall strategic plan at UC Irvine to alter medical education is to make full use of today's technology. The pattern of the passive education experience is changing at UC Irvine into an active, technologically driven platform that stresses individual learning styles and small-group interaction.
♢ Since 2007, the school has implemented this new strategy for significant increases in active learning through small-group teaching, case-based discussions, advances in instructional technology, and simulation education.
♢ Beginning in 2010, the first-year students were all provided an iPad that includes their entire curriculum in an easily accessible format.
♢ Through Sonic Foundry, courses are video-pod cast, allowing students to access and archive material.
♢ The school has instituted the curricular management tool Knowledge Map, which identifies redundancies and deficiencies in the material and allows for a searchable database to easily retrieve information.
♢ With the innovative use of bedside portable ultrasound machines, students are learning anatomy, physiology, and bedside clinical skills with the assistance of over 50 portable ultrasound machines. These machines also populate the clinics and hospital, providing students clinical application throughout the course of their curriculum.
♢ In 2010, the school opened its 65,000-square-foot advanced medical education building funded through a State of California bond-fee proposition. This $40 million structure houses 16 small-group teaching rooms, one 120-seat colloquial room, and a 90 seat televideo theater with sync to the hospital Operating Rooms(OR), a 17-suite video/B-line equipped clinical skills center, and the 3,000- square-foot simulation center with mock OR and intensive care unit (ICU). The building is one of the most-environmentally friendly on campus, with outside ventilation/convection and significant natural lighting.
♢ The facilities in the new medical education building provide unparalleled ability to incorporate active, small-group learning into the curriculum.
♢ See Highlights of the Program/School below for more detail.
Changes in Assessment
♢ Assessments include the following: All students must pass Step 1, Step 2 (CK and CS) of the USMLE boards, shelf exams in every course and clerkship that are offered, objective structured clinical examinations (OSCE) in the first three years, and the Clinical Performance examination (CPX) at the end of the third year. The OSCE examination in the first and second year is a biyearly multistation examination with detailed feedback and video observation.
♢ The new Douglas Hospital, opened in March 2009, is central to the overall UC Irvine Medical Center, which includes services for 422 beds, 19 operating rooms, the only Level I trauma center in Orange County, and an eight-bed burn unit.
♢ In addition to UC Irvine Medical Center's new Douglas Hospital, the clinical experience offers varying settings based additionally at the Long Beach VA Health System, Children's Hospital of Orange County, Miller's Children's Hospital, Long Beach Memorial Health Center, and various community clinics, including the FQHC Family Health Center in Santa Ana.
♢ The school recently entered into an affiliation with Children's Hospital of Orange County (CHOC) that now allows the students the unique opportunity to conduct clinical rotations at two excellent pediatric facilities.
Highlights of the Program/School
The following are highlights of the educational program and unique features of the medical school:
♢ Program in Medical Education – Latino Community – PRIME-LC is one of the signature programs at the UC Irvine School of Medicine and a national model for meeting the health care needs of the growing Latino population. In response to an increasing need for highly qualified, culturally sensitive and linguistically competent physician-leaders, PRIME-LC graduates will impact health care access and outcomes in the local communities they serve as Latinos become the largest population group in California. The specialized five-year MD/Master's program is training future physicians to be leaders in providing care to the underserved Latino patient population.
♢ Medical Scientist Training Program (MSTP or MD/PhD). The MSTP program at the University of California, Irvine has been structured to incorporate the greatest diversity of training and to allow the greatest flexibility of scheduling. We believe that the best way to train individuals who can understand and apply the latest research results is to combine a solid medical education with in-depth research training in a specialized field. Since advances in medicine today can come from any of a wide variety of fields of research, students in the UC Irvine MSTP can pursue their PhD studies in any graduate program at the university. The graduate programs include all of the Medical School departments, all of the Biological Sciences departments, and graduate programs in Chemistry, Physics, Engineering, Computer Sciences, and Social Ecology, to name just a few.
♢ Students can choose to pursue their research in an interdepartmental program, such as the program in Molecular Biology, Genetics and Biochemistry, the Beckman Laser Institute, or the Research Imaging Center. Since each area of study has different requirements, we have incorporated as much flexibility as possible into the program. Some students choose to begin their studies with the two basic-science years of medical school; others begin with graduate courses and research, while others have integrated medical school courses and research throughout their graduate career.
♢ The goal of the MD/PhD program is to train individuals who can both carry out research and apply it in a translational manner to patient care.
♢ MD and Master of Business Administration (MBA) dual degree. The UC Irvine MD/MBA joint degree program is aimed at individuals who are exceptional in ability and motivation and who seek a career as physicians with major responsibility for administration and management in health care organizations and institutions.
♢ Students in this program pursue a combined curriculum for an MD degree from the UC Irvine School of Medicine (SOM) and an MBA degree from the UC Irvine Paul Merage School of Business.
♢ For more information about dual-degree programs, visit www.meded.uci.edu/EdAffairs/DualDegree.html.
New Medical Education Building with Clinical Skills and Simulation Centers
♢ The Clinical Skills Center at the University of California, Irvine School of Medicine is located at the medical education building. Offering state-of-the-art training, the Center was developed to teach and assess the clinical skills of medical students, residents, and other health care professionals in an environment that simulates an actual clinical setting with standardized patients.
♢ Participants are monitored and recorded to evaluate their clinical performance in obtaining a medical history, conducting an appropriate physical examination, and developing treatment management plans. All clinical practice examinations (CPX), objective structured clinical exams (OSCE), and other clinical assessments are done in this facility.
♢ The research programs at UC Irvine Medical Education Simulation Center focus on the assessment of performance and competency of physicians-in-training using simulation technology. The current simulation courses for medical students can be found at www.medsim.uci.edu.
♢ UC Irvine's iMedEd Initiative fosters highly individualized and small-group learning for a richer medical school experience. The program transforms the classic lecturer–passive listener model into a technologically advanced individual/small-group experience with digital textbooks, online curricula, audio and video libraries, podcasts, and other technological advances such as digital stethoscopes and portable ultrasound units.
♢ We have created the country's first totally electronic first-year medical school curriculum based on the Apple iPad technology.
♢ The pilot program uses Apple's iPad to digitally house the entire first-year curriculum including outlines, lecture slides, handouts, and first year textbooks. Through a philanthropic effort, the devices are provided without charge to each entering student. The devices also are loaded with medical applications, note-taking and recording capabilities, and many other tools that complement diverse learning styles. Short, topic-based podcast lectures can be reviewed as often as desired as preparation for small-group discussions. In addition, the encrypted tablet is a platform for complimentary technologies that enhance the curriculum and enable the use of HIPAA-compliant patient information ranging from narrative to radiographic data. Students using digital stethoscopes can listen to a patient's heart, then transmit the audio and visual data for comparison with a library of heart sounds, allowing for better interpretation and increased comprehension.
♢ The iMedEd Initiative also involves a novel partnership with Sonosite to integrate portable ultrasound devices into the curriculum, providing students with a noninvasive bedside diagnostic tool to examine internal organs and blood flow. Specially designed applications let students consult video tutorials as they perform bedside ultrasounds as part of a routine physical examination, thereby enabling them to review normal and abnormal examinations and track procedures for quality assurance. This is part of the initiative to enhance the basic physical examination and promote the commitment to proactive personalized medicine.
♢ Another integral component of the iMedEd Initiative is simulation training. The School of Medicine recently launched a new state-of-the-art high-fidelity simulation center in the new Medical Education building. The center has a designated director with support from another physician and two full-time technicians. The center has five bays, including a fully outfitted operating room. A detailed simulation curriculum has been developed and is incorporated into the student curriculum.
♢ For further information, please refer to www.imeded.uci.edu/.
Bedside Ultrasound Teaching Initiative
♢ We believe that the highly portable, bedside ultrasound unit will be a “tipping point” in proactive personalized medicine. For the first time, with an ultrasound based routine physical examination, the physician will be empowered to diagnose a host of diseases or afflictions in advance of their causing human suffering. This will enable the physician to provide effective, minimally invasive or noninvasive interventions thereby affecting the arrest or cure of a disease while the individual is asymptomatic. The current bedside ultrasound teaching curriculum is detailed on the website. Please visit http://www.meded.uci.edu/.