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Academic Medicine:
doi: 10.1097/ACM.0b013e3181ea9910
The Reports: United States: Texas

The University of Texas Medical School at Houston

Butler, Patricia M. MD; Ownby, Allison R. PhD, MEd

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Year school was established: 1969.

School URL: http://med.uth.tmc.edu/.

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Curriculum Management and Governance Structure

♢ The Medical School Curriculum Committee is a standing committee of the Faculty Senate and is responsible for the management of the entire medical school educational program (Figure 1).

FIGURE 1: Curriculum...
FIGURE 1: Curriculum...
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♢ The Curriculum Committee is composed of faculty members from medical school departments including course and clerkship directors, representatives from the Office of Educational Programs and the Office of Admissions and Student Affairs, and student representatives from each year. Faculty members are approved for three-year terms, renewable once. The Chair and Vice Chair are appointed for three-year terms.

♢ The Chair and Vice Chair of the Curriculum Committee are members of the general medical school faculty.

♢ The Curriculum Committee has six subcommittees: Educational Policy Subcommittee, MSI and MSII Evaluation Subcommittee, MSIII and MSIV Evaluation Subcommittee, Curriculum Integration Subcommittee, Technology in Education Advisory Committee, and Scholarly Concentrations Advisory Committee.

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Office of Education

♢ There is a designated Office of Educational Programs (OEP) to support the educational activities of the school, course and clerkship directors, and teaching faculty.

♢ The OEP works cooperatively with the Curriculum Committee in the development, implementation, and evaluation of all curricular offerings.

♢ The OEP provides faculty development and resident teaching workshops in the areas of educational theory and practice, including curriculum design, program evaluation, and learner assessment.

♢ The Associate Dean for Educational Programs, who is also responsible for Graduate Medical Education and Continuing Medical Education, reports directly to the Dean of the Medical School.

♢ There are four Assistant Deans who support various aspects of the educational program. They also hold leadership positions on the Curriculum Committee and its subcommittees and direct the Pre-Entry Program, the Summer Research Program, the UTMS-H Academy of Medical Educators, and the Scholarly Concentrations Program.

♢ The Director of the OEP is a full-time (PhD) medical educator.

♢ The OEP is supported currently by three medical educators (one of whom is the director), a director of educational technology, an education specialist (PhD), two health education coordinators, an instructional developer, a special programs coordinator, a director of the standardized patient program, and a training specialist for the standardized patient program; in addition, there is a senior executive assistant and a staff assistant.

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Financial Management of Educational Programs

♢ The undergraduate medical education program is supported in part by funding from the State of Texas.

♢ Support for the Office of Educational Programs is primarily from state funds.

♢ In response to a decline in state support for education and reduced growth in clinical income, and to emphasize and preserve the educational mission of the Medical School, an educational relative value unit system was developed initially for clinical departments in FY2005 and implemented for all departments in FY2007.

♢ This method of funding was designed to provide an equitable distribution of state funds to basic science and clinical departments for teaching activities.

♢ The system has been relatively successful in correctly aligning the allocation of state funds with departmental teaching activities.

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Valuing Teaching

♢ In 2008, the Dean appointed seven faculty as charter members of The University of Texas Medical School at Houston Academy of Medical Educators (AME).

♢ The AME was designed to enhance and focus attention on the educational mission of the medical school. The AME began accepting applications from full-time basic science and clinical faculty in the spring of 2010.

♢ Faculty are recognized for their contributions to the educational program through the promotion and tenure process.

♢ Members of the UTMS-H full-time faculty, whose professional and scholarly activity involves a major commitment to clinical service and teaching, may be appointed and promoted on the Clinician/Educator (tenured) Pathway.

♢ Members of the faculty whose major professional and scholarly activity involves research and teaching may be appointed and promoted on the Scientist/Educator (tenured) Pathway.

♢ Faculty whose professional activities involve patient care, teaching activities related to patient care, and clinical administration with limited research or other scholarly activities may be appointed and promoted on the Clinician (nontenured) Track. Full-time faculty with training or clinical backgrounds, but who are engaged primarily in teaching and educational activities may also be promoted on this track.

♢ Full-time faculty whose primary professional activity is research, with limited teaching or institutional service, may be promoted on the Research (non-tenured) track. Full-time faculty with training or research backgrounds, but who are engaged primarily in teaching and educational activities may also be promoted on this track.

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Curriculum Renewal Process

♢ During 2005-06, the Curriculum Committee approved the transition of the required four-week Neurology clerkship from the fourth-year curriculum to the third-year curriculum (effective during the 2006-07 academic year).

♢ The Obstetrics and Gynecology and Psychiatry clerkships were each reduced from eight weeks to six weeks to accommodate this change.

♢ Additionally, several revisions to the fourth-year curriculum were approved including three required four-week selectives (Ambulatory Medicine, Advanced Patient Care, and Critical Care) and a required Transition to Residency Month.

♢ The Transition to Residency Month, held in March of the senior year, was designed to help prepare the students for entering their residency programs. The revised fourth-year curriculum was implemented during the 2007-08 academic year.

♢ Clinical Applications was added to the first-year curriculum as a separate course during the 2007-08 academic year.

♢ This course consists of seven 90-minute team-based learning sessions. Each session integrates content from at least two basic science courses with a clinical case presented in the Introduction to Clinical Medicine course.

♢ During each session, students work in teams (6–7 students) to solve problem sets within the context of clinical scenarios.

♢ The course is a joint effort of all the first-year course directors, supported by the Office of Educational Programs. The course is positively received by the first-year students.

♢ Scholarly Concentrations were introduced in the spring of 2010. These Scholarly Concentrations are not a required component of the curriculum, but they provide interested students an opportunity to receive an expanded and enriched learning and scholarly experience in a non-specialty-based area of emphasis while completing the four-year medical school curriculum.

♢ The Scholarly Concentrations will include a defined combination of elective and selective student experiences during the four-year curriculum, culminating in completion of a required scholarly project.

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Learning Outcomes/Competencies

♢ The Curriculum Committee approved Core Competencies for the undergraduate medical education curriculum in June 2006.

♢ Competency areas include patient care, clinical procedures (routine and specialized), medical knowledge, interpretation of medical data/practice-based learning and improvement, interpersonal and communication skills, and professionalism.

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New Topics in the Curriculum Since 2000

♢ Patient safety and quality improvement topics are integrated throughout the curriculum beginning in the second-year Integrated Clinical Experience/Problem-Based Learning (ICE/PBL) course and continuing through the third-year required clerkships, the fourth-year required Critical Care selective, and the Transition to Residency Month.

♢ Specific topics include the following:

* Problem-Based Learning (PBL) Cases: Need for appropriate medication dosing in the elderly and in patients with renal disease; drug–drug interactions; delayed diagnosis; poor communication between physician and patient resulting in nonadherence to prescribed medication regimen; inappropriate drug dose (medication error) in an infant; missed diagnosis; poor communication with non-English-speaking parent; disclosing medical error; and root cause analysis.

* Critical Care: During the fourth-year required Critical Care selective, students are introduced to recognizing patient safety issues during their daily rounds with the ICU team.

* At the conclusion of the month, students participate in a 2-hour session on patient safety, which includes a 30-minute discussion on human error and the factors that can contribute to errors in the medical environment.

* The ICU teams then present two to three cases encountered during the month; each case is analyzed based on the type of patient safety concern and factors that contributed to the issue.

* The goal is to have students actively identify patient safety issues in daily practice and become engaged in system processes to address quality concerns and to emphasize the importance of disclosure.

* Transition to Residency Month: Instruction includes patient safety, reducing medical errors, and common prescribing errors.

Team-Based Learning: Team-based learning is used in four of the first-year courses including the Clinical Applications course (see description under “Curriculum Renewal Process”), Histology and Cell Biology, Immunology, and Physiology.

♢ Simulations/training in new surgical techniques

* Third-year pediatric clerkship: Students spend one half day in the Surgical and Clinical Skills Center (SCSC) during the third-year pediatric clerkship.

* During this session, students practice venipuncture and interosseous line placement on infant simulators and lumbar punctures on adult-sized trainers.

* Students have presession reading material available that explains the procedures, anatomic landmarks, indications, contraindications, and complications.

* During the session students are encouraged to repeat the procedure several times until they feel comfortable performing the procedure.

* The session is facilitated by the Clerkship Director and two other general pediatric faculty members.

* Third-year surgery clerkship: Students spend 3 hours in the SCSC during the third-year surgery clerkship.

* During the session, students practice Foley catheter insertion, nasogastric tube insertion, and IV insertion. In addition, students use simulators to learn the suturing of lacerations and knot tying.

* The session is facilitated by the Surgery Clerkship Director and other surgical faculty.

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Changes in Pedagogy

♢ Gross Anatomy and Introduction to Clinical Medicine: Several years ago, the Gross Anatomy course implemented a change in the format of its Anatomy Laboratory in order to integrate the teaching of Gross Anatomy with the Introduction to Clinical Medicine (ICM) course.

♢ By coordinating the schedules of the two courses, students were able to learn the physical examination that correlated with dissection of a particular region. For example, the cardiopulmonary examination was coordinated with dissection of the thorax.

♢ To better coordinate the time-sharing arrangement, two teams were assigned to each cadaver. This new arrangement introduced the students to the professional responsibilities involved in teamwork. The first 30 minutes of each laboratory was devoted to demonstration of the previous dissection under faculty supervision. This peer teaching provided the student an opportunity to practice creating positive expectations within and between the teams.

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Changes in Assessment

♢ In May 2004, the Comprehensive Clinical Competency Examination (CCCE) was developed. The examination is designed to assess students' skills in history-taking, physical examination, communication, and diagnostic reasoning at the conclusion of the required third-year clinical clerkships.

♢ The examination consists of 10 common primary care cases that students should have encountered during their clerkships.

♢ The CCCE replaced the fourth-year clinical skills examination.

♢ A committee of faculty from each of the third-year clerkships with support from the Office of Educational Programs oversees and manages the examination.

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Clinical Experiences

♢ Clinical education occurs in multiple sites:

* inpatient wards

* outpatient clinics

* preceptors' offices

♢ Challenges associated with the clinical education of our students are related to large ward team sizes and faculty time for education. The latter is a result of administrative demands on faculty and the increasing pressure on faculty to maintain clinical/research income.

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Highlights of the Program/School

♢ The location of The University of Texas Medical School at Houston in the Texas Medical Center, the largest medical center in the world, provides a high volume and rich diversity of patient care and research experiences for students.

♢ The medical school basic science and clinical faculty are committed to medical student education that includes providing opportunities for shadowing, precepting, and research.

♢ The Medical School, including the Curriculum Committee, supports and encourages innovation in education. The Medical School is relatively young and therefore not hampered by longstanding educational traditions. Faculty are encouraged to be creative and innovative in their educational activities.

♢ UTMS-H's Surgical and Clinical Skills Center combines a well-established clinical training program with sophisticated surgical and clinical procedure simulation in one state-of-the-art learning center.

♢ The facility houses a surgical suite and a clinical suite, which combined includes the UTMS-H standardized patient program, two operating rooms, two conference rooms, a virtual reality personal computer (PC) laboratory, a microsurgical skills laboratory, nine surgical skills stations, 14 patient examination rooms, two conference rooms, and two multipurpose skills laboratories.

♢ Students begin their clinical skills training with standardized patients during the first-year Introduction to Clinical Medicine course.

♢ To emphasize clinical skills education throughout the curriculum, the Dean of the Medical School has recently appointed a core group of 26 clinical faculty members who are charged with the responsibility for assisting students practice and refine their basic clinical skills during the required third-year clerkships.

© 2010 Association of American Medical Colleges

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