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Academic Medicine:
doi: 10.1097/ACM.0b013e3181ea9787
The Reports: United States: Texas

University of Texas Medical Branch School of Medicine

Ainsworth, Michael MD; Asimakis, Gregory PhD; Frye, Ann PhD; Lieberman, Steven MD; Rowen, Judith MD

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Year school was established: 1891.

School URL: http://www.som.utmb.edu/.

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Curriculum Management and Governance Structure

♢ A single standing Curriculum Committee oversees education throughout the four years (Figure 1).

FIGURE 1: Curriculum...
FIGURE 1: Curriculum...
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♢ Each of 12 courses in Years 1 and 2 and each of eight clerkships in Years 3 and 4 have committees, led by faculty directors, who are responsible to the Curriculum Committee for their educational programs.

♢ The Curriculum Committee conducts reviews of every course and clerkship to ensure adherence to curriculum objectives.

♢ A Curriculum Operations Committee consisting of the Vice Dean for Academic Affairs, Associate Dean for Educational Affairs, Assistant Dean for Years 1 and 2, Assistant Dean for Years 3 and 4, Assistant Dean for Educational Development, and the Curriculum Committee Chair assist the Curriculum Committee by prioritizing agenda topics, providing background information on complex issues, and conducting special projects.

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Office of Education

The Associate Dean for Educational Affairs oversees the efforts of three offices related to medical student education.

♢ The Office of Educational Development (OED), led by the Assistant Dean for Educational Development, assists teaching faculty and course/clerkship directors in their roles of curriculum planning, instruction, and evaluation.

* The office consists of a full-time director, two doctorate-level professional faculty, and two data entry and analysis staff.

* The Standardized Patient Program, a component of OED, consists of a full-time program director, half-time medical director, two standardized patient trainers, and support staff.

♢ The Instructional Management Office, led by an Assistant Dean for Educational Affairs, provides coordination and support to course directors of Year-1 and -2 courses, all of which are interdisciplinary.

♢ The Office of Clinical Education, led by an Assistant Dean for Educational Affairs, provides coordination of interdisciplinary activities in Years 3 and 4 and supports the effort of each department-based clerkship.

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Financial Management of Educational Programs

♢ In 2006, in order to protect the education mission, the SOM implemented a methodology for allocating state education funds to departments based on faculty efforts in teaching medical students.

♢ The methodology establishes effort equivalents (fractional FTEs) for each teaching role in Years 1 and 2 (e.g., small-group facilitation, lecture, laboratory) based on contact hours.

♢ In Year-3 and -4 allocations to departments are based on the number of student months of education provided by each department and a literature-based estimate of the decrease in clinical productivity incurred by medical student education (converted to fractional FTEs).

♢ Course and clerkship directors also earn credit for their department. Although the use of these funds by departments remains at the Chair's discretion, the intent is to provide departments with funds to compensate them for their faculty teaching efforts.

♢ The system's transparency has led most departments to provide direct credit to faculty members for these efforts and has facilitated the recruitment of faculty for various education roles (e.g., small-group facilitation, medical school interviews).

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Valuing Teaching

♢ The Academy of Master Teachers (AMT) was established in 2006 as a service organization to support the efforts of junior faculty through grants and workshops and as a recognition program to highlight the outstanding achievements of the UTMB community of educators. It comprises six service teams working in tandem to complete the mission of the Academy and is overseen by a director and an outside Advisory Committee.

♢ Educational contributions (direct teaching, educational administration, and educational scholarship) are explicitly identified in current promotion and tenure guidelines.

♢ Teaching is central to the mission of the School of Medicine and the University and is an essential consideration for appointment or promotion to any rank or to the granting of tenure. It is assumed that, except in special situations, all tenure-track faculty members will be involved in teaching.

♢ To ensure proper documentation, submission of a teaching portfolio that tracks direct teaching activities, educational leadership, and educational scholarship is strongly suggested.

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Curriculum Renewal Process

♢ In addition to continuous quality improvement by courses and clerkships under the auspices of the Curriculum Committee, in the past decade there have been two major curriculum renewal initiatives.

♢ Beginning in 2001, planning for revision of the clinical curriculum began, with implementation in 2003.

♢ Major changes included increasing the emphasis on basic science education in clerkships, adding a requirement for a scholarly project in Year 4, adding a community-based ambulatory requirement in Year 4, adding a Clinical Skills Week before Year 3, establishing standards for rigor of selectives and electives in Year 4, establishing elective time in Year 3, and improving coordination and communication among clerkships.

♢ An education strategic plan completed in 2006 focused on the need for more coordinated education in nontraditional topics (“Longitudinal Themes” described later).

♢ In addition to these two major initiatives, the landfall of Hurricane Ike on Galveston Island in 2008 prompted a rapid-response planning effort to address the consequences of temporary loss of campus educational and clinical facilities.

♢ Immediate changes included developing distance education techniques for dispersed clinical students, development of a Year 3 formative standardized patient examination, and conversion of two Year-4 required clerkships to selective experiences due to effects of the storm on clinical operations.

♢ Through the assistance of sister institutions throughout the state and hard work on campus, no student's advancement or graduation was delayed as a consequence of the storm.

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Learning Outcomes/Competencies

♢ UTMB uses the 29 curriculum goals of the AAMC Medical School Objectives Project.

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New Topics in the Curriculum Since 2000

♢ Patient safety and quality improvement are included as longitudinal curricular “themes” with the goal of appropriate inclusion of these topics within courses and clerkships throughout the four-year curriculum.

♢ Faculty Theme Directors are responsible for coordinating this effort and are provided 0.25 FTE salary support for these duties.

♢ Documentation of Theme topics inclusion is part of periodic course and clerkship reviews conducted by the Curriculum Committee.

♢ Team-based learning is the chief didactic method for the Psychiatry and OB/Gyn Clerkships in Years 3 and 4. It is also used in Year 1 as part of the Neuroscience/Human Behavior and the Practice of Medicine courses.

♢ Second-year medical students are introduced to cardiovascular pharmacology using a high-fidelity, portable patient simulator with realistic anatomy, and computer-simulated functionality. A 1-hour interactive lecture challenges the students' clinical and basic science knowledge and their clinical decision making skills.

♢ Medical students have a clinical skills week immediately prior to their third-year clinical rotations where they are introduced to the following basic topics:

* hand washing and gloving,

* clinical note writing,

* presentation skills,

* wound care,

* IV and ABG skills,

* Foley and NGT skills,

* suturing,

* clinical-based laboratory testing,

* SIM-man human patient simulation scenarios,

♢ Additional training then takes place during their third-year Surgery clerkship rotation.

♢ The Surgery Skills laboratory is made available to all the students during their clerkship, where they may practice basic suturing, knot tying, and even basic laparoscopic skills.

♢ A skills laboratory for new surgical techniques mainly serves the resident and faculty surgeon learners, but medical students (both third- and fourth-year elective students) may participate in the skills laboratory.

♢ Industry supports our laboratory with the introduction and practice of new surgical technologies or techniques (i.e., stapling devices, energy sources, single incision laparoscopy skills, and even robotic surgery).

♢ The education strategic planning initiative in 2006 identified five themes to be incorporated longitudinally throughout required courses and clerkships:

* public health and prevention,

* health care economics and policy,

* evidence-based medicine,

* health care delivery (including quality improvement/patient safety, interprofessional teams, electronic health records),

* professionalism.

♢ Coordinated instruction and assessment of these topics have occurred through their integration into ongoing course activities (e.g., problem-based learning) and addition of new activities (e.g., team-based learning) under the leadership of “Theme Directors,” who receive educational credit and funding for their efforts analogous to course/clerkship directors.

♢ Phased implementation of the themes has occurred over several years.

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Changes in Pedagogy

♢ Small-group problem-based learning (PBL) has been part of the curriculum in each Year-1 and −2 course since 1998, averaging 6 hours per week.

♢ Courses are required to have a minimum of 50% of scheduled time in active learning settings, such as PBL and laboratories.

♢ Total student contact time is limited to 25 hours per week.

♢ Standardized patient-based teaching of clinical skills has been emphasized for decades.

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Changes in Assessment

♢ To emphasize problem solving skills development, all first- and second-year multiple-choice examinations have been modified to include a significant number of higher-order questions with clinical stems.

♢ Graded discussion exercises are included in the small-group PBL sessions, where the group (eight to nine students) works as a team to answer difficult questions in an open-book, open discussion format.

♢ Since 2000 all major examinations have been sequestered and used for assessment only. After the examination, the only information provided to students is their scores, the general topic (course objective) of each examination item, and the examination items they missed. The sequestered examination policy helps improve examination quality by allowing reuse of test items with superior statistics.

♢ To allay students' concerns about sequestered examinations, each course provides a pre-examination practice test with faculty feedback. These practice tests are equivalent to the real examinations in quality and degree of difficulty.

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Clinical Experiences

♢ In the first year, visits to a community physician's office are integrated into the clinical skills course. Students also make a home visit along with students from the School of Nursing and/or School of Health Professions.

♢ Clinical preceptorships are available in many disciplines between Years 1 and 2; these are voluntary, but >75% of the class participates. Many of these placements are in community ambulatory sites.

♢ In the second year, clinical experiences are scheduled through hospital departments and academic subspecialty outpatient clinics.

♢ Third-year students complete clerkships in a variety of settings, including UTMB hospitals, Austin and Houston affiliated hospitals, UTMB outpatient clinics, and community- based ambulatory practices. Third-year students complete at least one four-week elective and have an option for a second such experience.

♢ The fourth year of training includes an ambulatory community selective that may be in any specialty but must focus on outpatient care.

♢ More than 350 community faculty participate in the education of our students. This is a strength of our program that also leads to challenges in faculty development.

♢ Hurricane Ike presented new challenges in 2008 for clinical education as inpatient beds were reduced in number. We seized on this as an opportunity to increase our use of ambulatory sites for education, especially in the Internal Medicine, Psychiatry, and Neurology courses.

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Regional Campus

♢ The Austin regional campus offers all required Year-3 and -4 courses and also has a broad range of options for elective and selective clinical courses.

♢ Clinical sites are offered through the Seton Family of Hospitals, including Brackenridge Hospital and Dell Children's Medical Center of Central Texas.

♢ A cadre of students opt to complete their entire third year in Austin; an additional number of students complete one or more individual courses there.

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Highlights of the Program/School

♢ Students have the option of pursuing special Scholarly Program Tracks that provide five to six months of extensive education and experience in a wide range of fields:

* Global Health: More than 400 international rotations have been completed by UTMB students since 2003.

* Aerospace Medicine: Students learn about the pathophysiologic consequences of space travel in conjunction with scientists at UTMB and NASA's Johnson Space Center, 25 miles north of Galveston.

* Rural Medicine: Interested students are provided the opportunity to become part of a community during required rotations and electives in a rural setting of their choosing.

♢ HABLE Program (Healing in A Bilingual Learning Environment) provides first- and second-year students with instruction in clinical skills and cultural competency in both English and Spanish and opportunities for rotations at domestic and international sites where Spanish is the primary language.

♢ UTMB's John P. McGovern Academy of Oslerian Medicine was founded to recognize physicians in the faculty of medicine who personify these qualities and to encourage the teaching and modeling of such care to medical students. The Academy of Oslerian Medicine is fully dedicated to the principles of excellence, compassion, integrity, and respect in patient care exemplified by Sir William Osler. Created in 2001 and generously supported by the John P. McGovern Foundation of Houston, the McGovern Academy sponsors a wide range of academic events, recognizes outstanding faculty teaching and student scholarship, supports the Osler Student Societies, and awards prestigious scholarships to students who emulate Oslerian ideals.

♢ The Osler Student Societies provide structure, financial support, and encouragement to help medical students bring their altruistic leanings to fruition through a wide variety of activities including fundraisers, health fairs, food drives, blood drives, toy drives, senior citizen services, science fair judging, beach clean-up, recycling, and World AIDS Day activities.

♢ Community service is a pillar of UTMB student life. UTMB students have initiated two community-based health facilities: St. Vincent's Clinic in Galveston and Frontera de Salud in Cameron Park, Texas, along the border with Mexico. These facilities provide venues for students to express their altruism and service orientation while developing both their clinical skills and their professional identity.

♢ In addition to professional behavior being incorporated into the grading of each preclinical course (through problem-based learning session faculty evaluations) and each clinical clerkship, faculty also have the opportunity to report student behavioral issues through an Early Concern Note (ECN) process.

♢ The ECN process is designed to bring matters that raise concern about professional behavior to a student's attention, to provide a progressively formal series of actions that allow such incidents to be tracked over time, and to allow intervention when a pattern of behaviors is identified. Multiple ECNs can form the basis for formal academic consequences.

♢ Practice of Medicine Year 3 (POM-3) is a one-year, longitudinal course available on a voluntary basis for clerkship students. More than two thirds of the class participates. Through assigned readings, reflective essays, and evening small-group discussions, students explore topics important to the delivery of health care such as medical errors, health care financing, physician burnout, and domestic violence. Many students go on to complete related projects during Year 4.

© 2010 Association of American Medical Colleges

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