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Academic Medicine:
doi: 10.1097/ACM.0b013e3181e91599
The Reports: United States: Minnesota

University of Minnesota Medical School

Henson, Lindsey MD, PhD

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Year school was established: 1888.

School URL: http://www.med.umn.edu/.

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Curriculum Management and Governance Structure

♢ The standing committee structure was revised in 2008 to provide more effective governance for curriculum revision.

♢ Two committees were added (see NEW in Figure 1) and responsibilities and membership of the Twin Cities subcommittees were modified to encourage coordination throughout the curriculum.

FIGURE 1: Curriculum...
FIGURE 1: Curriculum...
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♢ By the school's bylaws, governance of the curriculum resides with the Education Council, which is advisory to the Dean and recommends principles and policies for implementation by the educational programs. Its voting members include faculty, department heads, course directors, and students from both campuses. Representatives from the Dean's Office serve ex-officio as nonvoting members.

♢ The Education Steering Committee has direct management oversight of medical student education for both campuses and is charged to implement the curriculum according to principles and policies recommended by the Education Council, to ensure that programs at Twin Cities and Duluth achieve comparable outcomes, and to report regularly on progress to the Education Council. The Education Steering Committee is chaired by the Vice Dean for Education; additional members are appointed jointly by the Vice Dean and the Chair of the Education Council.

♢ The Student Assessment Committee is responsible for oversight of student competency assessments for both campuses.

♢ The Curriculum Committees (Twin Cities and Duluth) are responsible for ongoing quality improvement, coordinating curriculum, and determining policies for day-to-day curriculum management on their respective campuses. These committees include course and clerkship directors and students and Office of Medical Education representatives from both campuses.

♢ The two subcommittees on the Twin Cities campus manage their curricular areas across all four years of the program. The Scientific Foundations Committee currently is focused on Years 1 and 2, which are undergoing major revisions.

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Office of Medical Education

♢ The Vice Dean for Education oversees strategic planning for all undergraduate, graduate, and continuing medical education in the Medical School.

♢ The school has two medical education offices—one at the Twin Cities responsible for all years of the program and one at Duluth responsible for students enrolled in that two-year track.

♢ At the Twin Cities there are offices of Admissions, Students and Student Learning, Curriculum and Evaluation, and Academic Technology.

♢ The Office of Students and Student Learning is directed by an Associate Dean and provides academic, career planning, residency application, advisory, personal, and financial aid guidance to students; supports the Office of Minority Affairs and the International Medical Education and Research program; and organizes all major Medical School ceremonies and events. The Associate Dean will direct the Faculty Advising program in our revised curriculum.

♢ The Office of Curriculum and Evaluation is directed by an Associate Dean and has five other professional educators assigned to support curriculum, program evaluation, learner assessment, educational scholarship, faculty educator development, and instructional design. The curriculum office has staff devoted to course support on the Twin Cities campus and clerkship support for students from both campuses and provides program evaluation and faculty educator development for both campuses.

♢ There are separate offices of Admissions, Student Affairs, and Medical Education/Curriculum on the Duluth campus to serve the specific needs of medical students matriculating in Duluth. Each of these offices is the responsibility of a designated Duluth campus Associate Dean.

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Financial Management of Educational Programs

♢ The Medical School is addressing the impact of the current economic crisis on all aspects of its mission.

♢ A Financial Resources Task Force has met frequently since fall 2009 to develop a new financial model for the Medical School, which will lead to evaluation of our entire portfolio of educational and research activities.

♢ Concurrent with this effort we developed a new Dean's Allocation Methodology for state appropriations and tuition revenues.

♢ The new methodology will provide a clear connection between the level of funds distributed and a department's participation in education and research. Departments will receive funds for medical student teaching, advising, and course direction and for undergraduate, graduate, and other professional teaching.

♢ Our current policy is to hold tuition constant once a student matriculates. This unique “cost of degree” program provides a competitive advantage and supports our Flexible MD program, which allows students to graduate in up to six years without incurring additional tuition expense.

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Valuing Teaching

♢ The University sponsors an “All-University Award for Outstanding Contributions to Postbaccalaureate, Graduate, and Professional Education.” Candidates are nominated through their colleges on all University of Minnesota campuses. Award winners become Distinguished Teaching Professors and members of the University Academy of Distinguished Teachers, which currently has 16 Medical School members.

♢ Recently, the Academic Health Center (AHC) created a new Academy for Excellence in Scholarship of Teaching and Learning, and one of our faculty has been inducted.

♢ Each of these academies provides stipend support to the selected faculty members for a defined period as part of the award.

♢ Teaching is a requirement for promotion on all faculty tracks at the Medical School. Teaching may occur at the undergraduate, medical school, other professional school, graduate student, resident, or continuing medical education level.

♢ Depending on the track, the candidate's specific job responsibilities, and proportion of time dedicated to teaching, teaching performance must be rated as “satisfactory” or “outstanding.” Teaching evaluations and evidence of outcomes (such as the current status of learners) are included in the P&T dossier.

♢ The tenure track has a distinct pathway for faculty with exceptional teaching credentials. These include documented educational scholarship, such as external peer-reviewed funding for educational programs, peer-reviewed publications on educational topics, and national visibility as innovators in an area of education.

♢ The Medical School recently adopted a Teaching Track in which faculty are not eligible for tenure, but exceptional educator qualities, including educational scholarship, may form the basis for promotion.

♢ For the Teaching Track, scholarship may include nontraditional forms of scholarship such as items published electronically through MedEdPORTAL, curricula presented nationally and adopted by other medical schools, or specific educational projects that gain widespread dissemination.

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Curriculum Renewal

♢ The Medical School began the process of curriculum renewal with a series of visioning retreats in 2005-06, with a target date for launching major revisions in 2010. Some of these initiatives will begin in 2010 in Years 1 and 2 on the Twin Cities campus and Year 1 on the Duluth campus (with a rollout of the revised Year 2 at Duluth in 2011).

♢ The key objectives of the revisions are to link student progress to demonstrated achievement of competencies, to provide greater flexibility for students to pursue unique interests, to create a more learner-centered environment characterized by professionalism, and to better integrate among disciplines and between scientific foundations and clinical sciences throughout the program.

♢ Principles to guide the revision were developed and approved by the Education Council (http://www.meded.umn.edu/curriculum/principles.php). The revision maintains distinct curricular structures in Years 1 and 2 at the Twin Cities and Duluth, in keeping with the different missions of the two campuses. However, students from both campuses will be required to demonstrate comparable achievement of institutional competencies at key intervals.

♢ At the Twin Cities, at least three half days are set aside weekly for students to engage in independent learning and preparation for classes. Numerous separate courses are being integrated across disciplines, with organ-systems-based human disease courses in Year 2.

♢ The new clinical curriculum will move clinical skills mastery into Year 1, provide rotations into different care settings where students will focus on direct patient care and learning about the health care system and the process of care, and provide an elective period in Year 2.

♢ A series of Foundations of Critical Thinking Cases (akin to problem-based learning cases) will occur throughout the first two years and provide student-directed learning to enhance links between clinical scenarios and scientific foundations content.

♢ At Duluth, in addition to protected time for independent learning and more case-based teaching, the existing integrated organ-systems curriculum is being revised and reorganized to include new blocks of time dedicated to rural health and social and behavioral medicine.

♢ A key element of the curriculum revision for both campuses is ensuring that every student has a faculty advisor throughout the program. Duluth will retain its Learning Community Leaders and enhance their roles, whereas entering students at the Twin Cities will be assigned to one of our new faculty advisors. The role of these advisors will be similar to that at other schools with “advising deans” who track student progress throughout the program.

♢ Finally, the Medical School is developing a series of institutional, integrated competency assessments called “Milestones,” which students will be expected to pass to be promoted and graduate. The assessments will occur during Year 1 and at the end of Years 2 and 3, will be the same for students on both campuses, and will include a wide range of assessments in addition to OSCEs.

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Learning Outcomes/Competencies

♢ In 2002, the Medical School Clinical Skills Committee developed and approved a comprehensive list of graduation competencies that are currently being reviewed, updated, and linked to the seven domains of competence established through the curriculum revision efforts in 2007-09.

♢ Each course in Years 1 and 2 is designed around defined learning objectives.

♢ The goal is for each course objective to align with a specific competency and for each competency to roll up to one of the seven domains of competence. When this work is completed, each learning objective will cross reference electronically to a specific component of the curriculum and to a specific domain.

♢ See also http://www.meded.umn.edu/students/competencies and http://www.meded.umn.edu/curriculum/competencies/domains.php.

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New Topics in the Curriculum Since 2000

Patient safety: Year 2 Physician and Society

Quality improvement: Year 2 Physician and Society, Years 3/4 Primary Care Selective, Years 3/4 UCAM (Urban Community Ambulatory Medicine)

Team-based learning/learning in interprofessional teams: Year 1 Physician and Society includes small-group discussion of ethical challenges with medical and nursing students. Year 2 Physician and Society holds a simulation session focused on a flu pandemic in groups with medical and public health students. Year 3/4 Emergency Medicine Clerkship (required since 2004) includes several team simulations with medical and advanced practice nursing students and discussions of reflections on observed team interactions in the clinical sites. In fall 2010, entering students in all seven AHC schools will participate in a hybrid course called Foundations of Interprofessional Communication and Collaboration.

♢ Simulations/training in new surgical techniques

* Throughout the curriculum: Increased use of standardized patients for simulation of history taking and physical examinations. SPs and patient educators are used in Years 1 and 2 to teach and assess clinical skills. Various clerkships incorporated OSCEs into their assessments, recently replaced with a Year 4 institutional Comprehensive Competency Assessment. In 2008-09, the Duluth campus established a medical simulation center, and high-fidelity human patient simulators have now been incorporated into five courses in Years 1 and 2.

* General surgery clerkship: Simulation is used to teach basic surgical skills. Students participate in 9 hours of direct instruction, practice, and feedback in the simulation skills laboratory. The curriculum covers orientation to the OR, basic bedside procedures, and advanced bedside procedures. Before each session, students are assigned readings and procedural videos. To pass the course, students must pass a performance examination in which they must prepare and close a simple laceration in an emergency room setting.

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Changes in Pedagogy Since 2000

Twin Cities campus

♢ WebCT or Moodle Course Management Systems for all courses and education staff

♢ Online modules for teaching biostatistics, epidemiology, research methods, and critical reading of the literature

♢ Required community service learning projects and quality improvement projects with an emphasis on reflection in groups

♢ Required student poster presentations on group projects

♢ Inclusion of patient panels in basic science courses

♢ Interactive lectures using audience response systems

♢ Increased number of small-group activities during the first two years

♢ Interprofessional courses and sessions

Duluth campus

♢ Lecture, laboratory, and small-group content available electronically; for use on required laptop computers; from a dedicated content download site; and supplemented by Web-based content, including extensive atlases and images in histology, neuroanatomy, and radiology

♢ Team-based learning in two Year-1 courses on a pilot basis

♢ Faculty “Learning Community Leaders” assigned to groups of 10 entering students to teach small groups, review learning portfolios, and advise students throughout the first two years

All students

♢ Primary Care Selective (four-week clerkship) with an emphasis on chronic disease management, preventive care, and quality improvement

Measurement of success

♢ Program evaluation process with end-of-course evaluations, lecture feedback cards, periodic focus groups, faculty/student retreats, and institutional survey administered to all Year 3 students

♢ Ongoing analysis of student performance through review of grades and USMLE scores

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Changes in Assessment Since 2000

Twin Cities campus

♢ Anonymous peer evaluations for student feedback regarding performance in small groups

♢ Clerkship objective revisions, multiple OSCE assessments within the clerkship rotations, and an OSCE during Year 2 Physician and Patient course

Duluth campus

♢ All examinations in a dedicated computer testing facility

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Change in Accreditation Since 2000

♢ A major change for the Medical School occurred in 2004 when the two separately accredited University of Minnesota medical schools—Twin Cities with a full four-year program and Duluth with a two-year program—were consolidated as one accredited Medical School with a geographically separate track in Duluth.

♢ This change involved revision of the Medical School's Bylaws and Constitution to reflect new reporting relationships and committee structures, redesign of admissions, and closer communication and planning across campuses while maintaining Duluth's unique mission.

♢ The Duluth campus enrolls 60 first-year medical students (about one fourth of the entering class), who matriculate on that campus for the first two years. These students are enrolled on the Twin Cities campus after successful completion of Years 1 and 2.

♢ The mission of the Duluth Campus is to be a leader in educating physicians dedicated to family medicine, to serve the health care needs of rural Minnesota and American Indian communities, and to discover and disseminate knowledge through research.

♢ The curriculum structure, which differs from that on the Twin Cities campus, is an integrated, multidisciplinary, systems-based curriculum throughout Years 1 and 2.

♢ The rural preceptorship is an integral part of the preclinical training years, providing clinical experiences in Duluth and multiple rural practice sites in the state of Minnesota.

♢ There are also opportunities for Year 3 and 4 students to have some clinical clerkship experiences in Duluth.

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Highlights of the Program/School

♢ Successful merger of the University of Minnesota Medical School, Twin Cities, and the University of Minnesota School of Medicine, Duluth. The two-year program continues on the Duluth Campus with an educational focus on rural and Native American health.

♢ Educationally sound inpatient and outpatient clerkships in several national award-winning health care systems.

♢ Flexible MD program, which allows students to graduate in 3.5–6 years and pursue unique educational interests during Medical School without paying increased tuition. About 8% of students each year take advantage of the Flexible MD.

♢ The Rural Physician Associate Program, which provides longitudinal rural primary care education for up to 40 students during Year 3. The program has been in place since 1971 and has a strong track record of producing physicians for rural Minnesota.

♢ Our Center of American Indian and Minority Health (CAIMH) program, which recruits and educates American Indian students, has produced more than 125 American Indian graduates over the past 30 years.

© 2010 Association of American Medical Colleges

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