Curriculum Management and Governance Structure
See Figure 1 for details.
Office of Education
♢ The Office of Medical Education was formed in the 1970s for support of the medical student education program. Since its inception, this has included both educational and technology support.
♢ The Office currently consists of the Director, holding an MD degree, a PhD in Education Psychology, a currently vacant spot for a PhD with education research interests, and two master's degree-holding staff in program evaluation and instructional technology.
♢ The Office has six IT personnel to support the technology initiatives.
♢ The Office of Medical Education is responsible for evaluation of the curriculum, support for the educational committees, support and guidance for students in academic difficulty (in coordination with the Office of Student Affairs), professionalism initiatives, Prematriculation Summer Program, medical school orientation (with the office of Student Affairs) and medical education and research.
♢ Over the last 15 years, the Office has also developed and managed the information technology structure throughout the medical student curriculum, operating as a separate node within the School's IT structure.
♢ OME and OSA have developed a computerized student management database for all educational administrative tasks.
Financial Management of Educational Programs
♢ State support of the Medical School has diminished, including furloughs of state workers. Nevertheless, educational programs have continued with no meaningful reduction in funding or staffing.
♢ The University of Maryland began an academy of educators two years ago. Faculty members are selected by their peers based on total educational excellence, not solely classroom performance measures. As this group expands, they will assume leadership in faculty development and new educational initiatives.
♢ Teaching quality, as well as quantity, is strongly factored in the promotion and tenure process. Teaching quality is assessed by peers and students. Faculty teaching awards at the departmental, School and campus level are an integral part of the promotion packets. The faculty members submit summaries of teaching activities at both the departmental and the school level with many cases of promotion based primarily on teaching accomplishments.
Curriculum Renewal Process
♢ The University of Maryland committed to major curriculum renewal in the years 1994–98. At that time, interdisciplinary blocks replaced the traditional discipline-based courses in years I and II.
♢ Family Medicine was added to the third-year clerkships as well as major commitments to ambulatory teaching by all third-year clerkships.
♢ Laptop computers were introduced in 1996 with an Introductory Informatics Course.
♢ In accord with adult learning principles, contact hours were significantly shortened in years I and II with a basic structure of 2 hours of lecture and 2 hours of small group, problem solving, or laboratory each day.
♢ The key objectives for the next renewal process are changes to reflect new scientific information in medicine, the changes in health care delivery, and the increased interdisciplinary nature of clinical and research endeavors.
♢ The School is currently beginning the next renewal process following a highly successful LCME accreditation visit, managed within the curriculum governance structure as noted in Figure 1.
♢ The targeted areas for this next renewal include further integration of knowledge within blocks as well as across years of the curriculum, changes in clinical teaching to reflect the changes in health care delivery and the changes in residency training, teaching in the ambulatory setting, individualizing the curriculum to reflect our students' wide range of interests including academic careers, the globalization of our society including healthcare, and the formal and informal relationship of our faculty to our students. These areas were selected after a self-assessment process and surveys of faculty and students.
♢ The Introduction to Clinical Medicine course for year I and II students involves one afternoon per week. This structure allows other afternoons for research, clinical mentoring, and community service.
♢ The educational program objectives are as follows:
* to educate students intensively and broadly in the cultural, clinical, and scientific aspects of medicine.
* to prepare students to engage in a lifetime of learning.
* to have students achieve a high level of professional competence and social awareness.
* to provide opportunities for students at every level of training to pursue areas of special interest for intellectual stimulation and/or career advancement.
* to develop highly competent primary care physicians, clinical specialists, and scholars in basic and clinical research, teaching, and academic administration.
♢ All courses and clerkships incorporate learning outcomes and competencies within the framework of the MSOP.
New Topics in the Curriculum Since 2000
♢ A major initiative in professionalism was undertaken in 2001 throughout the curriculum.
♢ Beginning with the admission process through graduation, professionalism is a focus of activity in classrooms, the clinical sites, and the evaluation of our students.
♢ Activities include lectures, panels, small-group discussions and experiential activities including topics such as the doctor–patient relationship, cultural diversity, the stress of the profession of medicine, relationship with other healthcare professionals, and response to unprofessional behavior in the clinical setting.
♢ Students have been actively involved in all aspects of the professionalism initiative.
♢ Simulation, mechanical, computer-based, and cognitive, has been added to the educational program in several settings.
♢ Simulation is introduced during orientation to the first year of medical school and plays a particularly significant role in the surgery clerkship with training in laparoscopic technique, minimally invasive surgery, and emergency management.
♢ A new combined MD/MPH track has begun to meet the needs of students interested in community health and take advantage of the global presence of the School of Medicine. This program will serve as a focus of increased medical student research.
♢ Genetics and genomics have been expanded and strengthened throughout the curriculum.
♢ Imaging has been expanded across the entire curriculum.
Changes in Pedagogy
♢ The University of Maryland continues to transform itself into a paperless educational environment.
♢ Lecture material is recorded electronically for later review with communication between faculty and students largely electronic as well.
♢ Special computer-based modules, linked to supporting websites, video materials, and teaching materials found by students themselves are placed in the central website, MedScope, developed and managed by the Office of Medical Education.
♢ MedScope has developed to become the key to the medial student curriculum.
♢ Standardized patients have become an integral part of both the education and evaluation programs.
Changes in Assessment
♢ Students are assessed across the four-year curriculum with standardized patients. This includes a fourth-year OSCE examination, required for graduation.
♢ All evaluations and year I and II examinations are delivered electronically. This has allowed real-time feedback for the students and real time, ongoing evaluation of courses and clerkships.
♢ Students are rated in all classes and clerkships on measures of professional behavior.
♢ The University of Maryland Medical Center and Baltimore VA serve as the main sites for clinical education.
♢ Major affiliations with community hospitals, Mercy Medical Center, Franklin Square Hospital, Sheppard and Enoch Pratt Hospital, Union Memorial Hospital, private physicians' offices and four AHEC sites throughout the state of Maryland provide a diverse, rich environment across a spectrum from community-based ambulatory care to tertiary care employing cutting edge technology.
♢ Of particular note are the Shock Trauma Center, the statewide medical emergency network, and global health initiatives.
♢ Electives in the fourth year include opportunities at a wide variety of sites throughout the world with particular excellence in infectious disease.
♢ The challenges for clinical education include increased administrative demands on clinicians resulting in decreased time for teaching, continuity of care and education with the changes wrought by the 80-hour work week, and ensuring quality of teaching across decentralized ambulatory sites.
♢ If class size is increased, new clinical sites will be required.
♢ Student debt increasingly affects student specialty choice.
Highlights of the Program/School
♢ A highly dedicated teaching faculty
♢ A robust information technology infrastructure to support medical student education
♢ A growing simulation program, including cognitive simulation
♢ A wide variety of research and international clinical opportunities
♢ A rich educational environment that takes advantage of research within the School of Medicine as well as the vast medical and biotechnology resources of the Baltimore–Washington metropolitan area.