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Academic Medicine:
doi: 10.1097/ACM.0b013e318217a21a
Addendum: United States: Puerto Rico

The University of Puerto Rico School of Medicine

Santacana, Guido E. PhD; Silva, Debora MD, Med

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Author Information

Year school was established: 1950.

School URL: http://www.md.rcm.upr.edu/.

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Curriculum Management and Governance Structure

♢ Curricular management rests with the school's Curriculum Committee (see Figure 1). This committee has 20 members, including the presidents of the Years I to IV Committees, student representatives, and elected members representing the faculty of medicine.

FIGURE 1: Curriculum...
FIGURE 1: Curriculum...
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♢ Each Year Committee oversees the curriculum of each academic year and is composed of the coordinators for all the courses offered in the respective year plus one student representative.

♢ The Curriculum Committee is a standing committee and is responsible for the entire educational program of the school of medicine.

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Office of Education

♢ The Curriculum Office provides the necessary support for the medical student educational program. It is under the auspices of the Office of the Associate Dean for Academic Affairs.

♢ The Curriculum Office is the designated office of medical education and has a full-time staff. The director of the curriculum office has a master's degree in education. The Curriculum Office organizes and assists all curricular changes and program design. This includes course creation and curricular redesign and restructure.

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Financial Management of Educational Programs

♢ Adjustments have been made in many areas of the school of medicine budget but at the same time we have protected the budget dedicated to the educational program in order to minimize any impact of the current budgetary constraints in the educational program.

♢ The integration of educational technology into the curriculum was originally planned as a self-supporting program. This area has continued to develop as planned with little impact if any from other budgetary constraints.

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Valuing Teaching

♢ There is no academy or institute for education in the school.

♢ The promotion and tenure evaluation system provides for the evaluation of the faculty in three areas: research, education and service. Each area has an equal weight in the evaluation.

♢ The faculty is evaluated in all the aspects of his or her educational endeavor including teaching skills, student and faculty evaluations, preparation of teaching materials, and publication of books and/or class manuals.

♢ Each year the school of medicine celebrates a night of achievements where clinical and basic science faculty, selected by the students, are recognized for their teaching.

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Curriculum Renewal Process

♢ Major curriculum renewal processes occurred in 1998 and more recently in 2009. The 1998 renewal affected mainly the first two years of medical school, while the 2009 one was focused mainly on the third- and fourth-year curriculum. The 2009 curriculum renewal implementation started in August of 2010.

♢ The renewal process of 1998 significantly reduced the lecture hours in the basic science courses to a maximum of two hours per day in the mornings with the rest of the morning being used for active learning activities that include small-group discussions and clinical correlations. At least three afternoons a week are left open for self-directed studies. The other two afternoons are used for courses in which all the teaching is done by active learning using a problem-based approach. In the 2009 renewal process the objective was for the third year of medicine to be only 11 months in length, giving time for students to be better prepared for their electives and have further training in the fourth year in preparation for their residencies.

♢ In the third year, the Internal Medicine Course was reduced from twelve to ten weeks, the Radiology Course was modified to be delivered completely in an online format and will be longitudinal. In the fourth year, the Family Medicine Clerkship was moved from the third to the fourth year, a Neurology Course of two weeks was added (in substitution for the two weeks lost in the third-year clerkship that had been assigned to Neurology) and a two-week Capstone Course was created (this will be implemented for the 2014 class).

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Learning Outcomes/Competencies

♢ The competencies and learning outcomes are available on the school Web site at http://www.md.rcm.upr.edu/index.php?option=com_content&task=view&id=77&Itemid=86.

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New Topics in the Curriculum since 2000

♢ Patient safety. Included in the Clinical Skills courses of the first and second year

♢ Team-based learning. Included in the Pharmacology course and Integration Seminar II

♢ Simulations/ training in new surgical techniques. Included in the Surgery Clerkship

♢ Public and Population Health. Included in the first, second, and fourth years as a longitudinal curriculum

♢ Clinical and Communication Skills. Offered through the four years as a longitudinal curriculum

♢ Medical Ethics, Professionalism, and Humanism. Offered during the four years of medical school as a longitudinal curriculum with the creation of a Humanities Center in the school of medicine

♢ Clinical and Translational Research. Offered during the first year as a stand-alone course and extended to the second year in 2011

♢ Evidence Based Medicine. Integrated into the second-year Integration Seminar Course and all third-year clerkships

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Changes in Pedagogy

♢ Since 2000 there have been more contact hours dedicated to active learning activities than to passive learning activities.

♢ Lecture hours are limited to two hours per day with the rest of the time dedicated to small-group discussions (PBL and TBL), self-directed studies, laboratory sessions, clinical correlations, and, more recently, the integration of high-fidelity simulators in educational activities.

♢ Students have been given all their textbooks online, and most of the first- and second- year lectures are available through streaming videos. Archives of streaming videos are being produced and are available for students to use as an additional study tool.

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Changes in Assessment

♢ Since 2000 multiple assessment methods have been implemented including (1) OSCE examinations through the four years of medicine, including formative and summative assessments (2); professionalism evaluations in small groups throughout the four years (3); self assessment activities (4); formative evaluations in all courses at midpoint; and (5) online examinations and the use of Turning Point technology. In addition, the faculty are being constantly trained in how to write clinically relevant questions.

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Clinical Experiences

♢ Clinical teaching sites include Auxilio Mutuo Hospital, Dr. Ramón Fernández Marina Hospital, El Maestro Hospital, First Pan American Hospital, La Concepción Hospital, Pavia Hospital, Perea Hospital, San Antonio Hospital, San Juan City Hospital, Administración Servicios Médicos de Puerto Rico (ASEM), University District Hospital, Pediatric University Hospital, UPR Hospital Dr. Federico Trilla, Veterans Affairs Medical Center, Castañer General Hospital, and Bella Vista Hospital.

♢ The most important challenge is to find enough outpatient and ambulatory sites and community-based sites for the students' clinical experiences.

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Highlights of the Program/School

♢ Complete immersion of the standardized patient program and simulator program throughout the four years of the curriculum

♢ Reduced lecture time and increased active learning activities

♢ Emphasis on student research activities, including training in translational research

♢ Integration of the humanities as an integral part of the curriculum

♢ Requirements of specific laptops and online books for all students

♢ Wide variety of patients conditions readily available for all students

♢ Faculty student ratio 1:1 so that very close supervision and modeling is provided

♢ Emphasis of the school administration on ethics, professionalism, and humanism that influences positively the learning environment

© 2010 Association of American Medical Colleges

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