The UC Davis School of Medicine is committed to student-centered education with patient- centered outcomes. Our goal is to train the next generation of fully competent physicians to meet the demands of an increasingly complex health care system, a diverse patient population, and a rapidly expanding knowledge base in medicine. We emphasize collaboration and interprofessional education, the acquisition of sophisticated communication and interpersonal skills, the development of critical analytic skills, a commitment to quality improvement and patient safety, and the use of information technology to achieve these curriculum goals.
Curriculum Management and Governance Structure
♢ The University of California has a tradition of shared governance whereby the faculty and the administration partner with our students to achieve excellence in education.
♢ Institutional responsibility for oversight of the curriculum by the faculty rests with the Committee on Educational Policy (CEP), a standing committee of the Faculty Executive Committee (FEC).
♢ The Associate Dean for Curriculum and Competency Development serves as an ex officio member of CEP. Medical student representatives from all four years are elected by their colleagues and serve as nonvoting members of CEP.
♢ CEP is charged with design, management and evaluation of the curriculum and is responsible for ensuring that objectives and teaching methods are linked to graduation competencies. (See Figure 1 for a diagram of the curriculum structure.)
♢ CEP assigns the responsibility for the teaching of content areas to medical school departments and provides direct oversight for integrated courses.
♢ The CEP has three subcommittees:
* Block Council–Promotes horizontal and vertical integration across the four-year curriculum.
* Level 2 Evaluation Subcommittee–Conducts periodic, in-depth, peer evaluation of courses and clerkships.
* Fourth Year Oversight Committee–Recommends fourth-year curriculum requirements and approves fourth-year programs of individual students to ensure breadth, depth, and vigor.
♢ CEP, in consultation with the Associate Dean for Curriculum and Competency Development, appoints a “curriculum liaison” for each major block of curriculum (five Preclerkship blocks, Doctoring for years 1–4, and Year 3 core clerkships).
♢ The seven curriculum liaisons provide a link between CEP and the individual courses or clerkships within their blocks to advance integration and encourage collaboration between educational leaders.
Office of Medical Education
♢ The mission of the Office of Medical Education (OME) is to partner with the faculty to create a supportive and stimulating learning environment that nurtures the requisite and enduring attitudes, skills, and knowledge required of excellent physicians. (See Figure 2.)
♢ OME is directed by the Associate Deans for Admissions, Curriculum and Competency Development, and Student Affairs. The Associate Deans report as a team to the Executive Associate Dean for Academic and Clinical Affairs.
♢ OME consists of an interdisciplinary group of academic, technical, and administrative staff who deliver centralized expertise, services, and instructional resources to faculty and students. The staff offers services typically provided by Dean's Office administrative units (admissions and outreach, financial aid, student records, student advising, curricular scheduling, facilities management, and staffing of faculty committees).
♢ In addition, OME provides centralized (versus departmental) support to all Instructors of Record (IORs) and faculty in the planning, delivery, evaluation, and enhancement of courses and clerkships.
♢ Academic support functions in OME have been recently expanded through the appointment of directors and professional educators with formal expertise in academic services, student and career development, diversity, wellness, curriculum affairs, curriculum evaluation, multicultural learning, research, and rural health.
♢ Recent projects include the development of a paperless admissions system and a fourth-year scheduling system, incorporation of the multiple-mini-interview (MMI) into the admissions process, and expansion of the student advising system in the colleges.
♢ Work is under way to create a comprehensive student information system to support expanded academic functions and educational research.
♢ The Office of Medical Education works closely with other administrative and educational units within the Dean's Office and the UCD Health System to enhance the educational resources available to all Health System educational constituencies.
♢ Common goals include coordinated faculty and curriculum development, facilities planning and oversight, and strategic development of information and educational technology.
♢ Recent examples of collaboration include use of the Clinical Skills Center by FNP/PA students and residency programs, and the use by medical student programs of high-fidelity simulators located in the Center for Virtual Care.
Financial Management of Educational Programs
♢ OME is supported by a direct budget from the UC Davis Health System, and services are available without charge to the School of Medicine faculty and departments.
♢ Sources of funding for OME operations include a blend of state funding, student professional fees, philanthropy, and additional resources provided by the Vice Chancellor for Human Health Sciences. This budget is administered by the OME Manager, in conjunction with the Associate Deans and Assistant Dean for Administration.
♢ Severe fiscal challenges have motivated us to focus on mission-critical areas and organize resources more efficiently.
♢ The Dean's Office has remained committed to the support and development of educational resources throughout this period.
♢ Teaching is essential for faculty advancement in the promotion and tenure process in all faculty series at the University of California.
♢ The School of Medicine has created a compensation plan for IORs for required courses and clerkships in the curriculum.
♢ A monetary stipend is provided to faculty through their departments for teaching activity. Additionally, some departments credit teaching activity in their faculty compensation plans and others have created Endowed Chairs and Professorships to support medical education.
♢ The development of an Academy of Master Educators is under way to provide additional support to core teaching faculty and to promote educational scholarship, faculty development, and curriculum enhancement.
Curriculum Renewal Process
♢ The School of Medicine faculty approved a new block-based curriculum in 2005, which was targeted primarily at the preclerkship years. Objectives of this curriculum reform effort included competency-based curriculum development and assessment, content integration, expanded opportunities for self-directed, active, and collaborative learning, and decreased time devoted to traditional lecture-based teaching.
♢ Subsequent curriculum reform efforts have focused on enhanced content integration, increased use of competency-based assessments, and new initiatives in interprofessional education.
♢ The School of Medicine faculty have generated a comprehensive list of graduation competencies and educational program objectives used to guide curriculum development. These are reviewed for every course during the Level 2 Evaluation process conducted by CEP.
♢ The graduation competencies and educational program objectives are available for viewing at http://www.ucdmc.ucdavis.edu/mdprogram/curriculum/overview.html.
New Topics in the Curriculum Since 2000
♢ A Scholarly Project or Special Study Module requirement was added to the fourth-year curriculum.
♢ The Scholarly Project requires students to focus in depth on a topic of interest, to learn methods of scholarly inquiry and to conduct meaningful research. Scholarly projects are presented as posters in the spring of the fourth year at an annual student research day.
♢ The Special Study Module requirement allows students to choose from one of several four-week selective offerings that combine basic science with clinical medicine, such as clinically oriented anatomy or physiology in the ICU. The Special Study Modules use classroom learning, literature review, and clinical activities to achieve their goal of bringing fourth-year students back to basic science content.
♢ A three-day clerkship transition course has been added to the end of the second year to better prepare students for the transition to clinical rotations.
♢ Other new topics in the curriculum include pain management, palliative care and end-of-life issues, medical economics and health care systems, physician wellness, electronic medical records, medical error, and quality improvement.
Changes in Pedagogy
♢ The goal of the faculty is to increase teaching methods and activities in the curriculum that promote active and self-directed learning.
♢ New pedagogies that have been introduced or increasingly utilized to achieve this goal include team-based learning, problem-based learning using virtual groups, calibrated peer review, case-based learning with standardized patients, interactive cases with concept-based learning, Web-based curriculum, e-Doctoring with blogs, lectures with audience response system, and mannequin simulations at a simulation center.
♢ As a result of these efforts the proportion of lecture-based teaching has seen a steady decline and now represents less then half of the total contact hours of faculty with students in the curriculum.
Changes in Assessment
♢ There have been a number of significant changes in assessment in both the preclinical and clerkship curriculum.
♢ Preclerkship blocks have introduced integrated, case-based questions in their end-of-block examinations. The preclerkship blocks also provide biweekly, integrated quizzes for students to monitor their progress and learning.
♢ Peer assessment has been added to many courses and is an integral part of calibrated peer review and team-based learning teaching methods.
♢ Standardized patients and mannequin simulations at the simulation center have been added to the clinical clerkships and to some preclinical courses.
♢ Oral examinations and OSCEs are used by several clerkships, and all core clerkships have students maintain a logbook of patients seen and related clinical activities to ensure learning objectives are met.
♢ End-of-year assessments that involve clinical simulations with standardized patients are used to test interviewing and physical exam skills in Doctoring at the end of years 1 and 2, and an eight-station Clinical Performance Examination (CPX) is conducted at the beginning of the fourth year.
♢ Required clinical experiences are conducted in a variety of hospitals, clinics, and offices in the greater Sacramento region. The core site for clinical training is the University of California, Davis Medical Center (UCDMC). We use major affiliated hospital systems for preceptorships and clinical clerkships, including the VA hospitals, Kaiser, Sutter, and Mercy, each of which includes clinical sites.
♢ Volunteer clinical faculty located at smaller community hospitals, clinics, and private practices make major contributions to clinical teaching.
♢ Seven student-run community clinics are used for required preceptorships, and over 80% of students participate in the clinics for elective credit.
♢ During the past three years the school has recruited and developed excellent clinical sites for our Rural Prime program, where students are assigned for all or part of their clerkships in Primary Care, Pediatrics, Psychiatry, and Obstetrics-Gynecology.
♢ The assignment of students to non-UCDMC sites for some of their clinical experiences has many benefits, including (1) exposure to a variety of practice environments, from small community clinics to large, managed care organizations (2); opportunities to encounter a wide mix of patient populations, cultures, and clinical presentations; and (3) ability to interact with physicians and allied health professionals from a variety of disciplines.
♢ The Rural Prime program requires training in rural hospitals and clinics because we believe these experiences will positively influence career choice toward rural medicine.
♢ There are many challenges associated with using nonmedical school sites for clinical training. These include (1) variability in teaching skills of participating volunteer clinical faculty (2); uneven access to key technologies, such as EMR and videoconferencing; and (3) travel and housing expenses for students.
♢ The school uses several strategies to minimize these problems, including (1) a centralized evaluation system to help identify problems and target faculty development (2); patient logs and midpoint evaluation to monitor clinical experiences (3); investment in videoconferencing technology and provision of free student housing at rural sites.
Highlights of the Program/School
♢ A new education building and library were occupied in December 2006 on the UC Davis Medical Center Campus in Sacramento. The state-of-the-art building has rapidly become the center of gravity for teaching programs in the UC Davis Health System.
♢ Immediately adjacent to the education building, construction is underway on the California Telehealth Resource Center, which will include high-tech classrooms as part of a telemedicine learning center, an entire floor devoted to medical simulation training, and customized telemedicine consultation rooms.
♢ Seven student-run community clinics are affiliated with the School of Medicine and provide culturally-competent, free care to the underserved populations in our region. Medical students and undergraduates from UC Davis with voluntary faculty and resident preceptors staff the clinics.
♢ The student-run clinics have been described as the “safety net for the safety net” for medical care in the Central Valley region.
♢ The School of Medicine has a strong commitment to diversity and to minority, rural, and underserved populations exemplified by our student-run clinics, a Center for Health Disparities, an Office of Diversity, and our Rural-PRIME and UC Merced San Joaquin Valley-PRIME programs, which each enroll six students a year.
♢ The PRIME programs provide a five-year curriculum with a rural-focused enhancement to the preclinical curriculum, and clerkship rotations and preceptorships at affiliated rural hospitals and clinics.
♢ Telemedicine and virtual care are strengths of the UC Davis Health System with outreach to rural settings. As a result of this expertise we have significantly incorporated distance learning and simulation technologies in education.
♢ Students in all four years of the curriculum are exposed to simulation-based teaching at our Center for Virtual Care, and all students engage in some aspect of distance learning through the use of teleconferencing technologies during assignments at rural sites.
♢ Interprofessional health sciences education is central to our strategic vision for medical education at the UC Davis School of Medicine, with an emphasis on team and collaborative learning in the curriculum.
♢ The new Betty Irene School of Nursing and programs in public health, informatics, family nurse practitioner/ physician assistant, pharmacy, nutrition, and other health professions provide abundant opportunities to create multidisciplinary teams to advance education and research.