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Academic Medicine:
doi: 10.1097/ACM.0b013e318217a491
Addendum: United States: Texas

University of Texas Southwestern Medical School

Cannon, Stephen MD, PhD; Wagner, James MD

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Date school was established: 1943.

School URL www.utsouthwestern.edu.

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Curriculum Management and Governance Structure

♢ The curriculum committees (see Figure 1) are organized by year of the curriculum, with the Medical Education and Curriculum Committee (MECC) having responsibility for the entire educational program. The chief academic officer is the Dean/Provost, who has ultimate individual responsibility for the design and management of the entire educational program.

FIGURE 1: Curriculum...
FIGURE 1: Curriculum...
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♢ The Associate Dean for Medical Education has been empowered by the Dean with operational responsibility for curriculum oversight and supervision of the medical education program and is also Designated Institutional Officer for GME and CME programs.

♢ The Office of Medical Education (OME) provides the academic support for undergraduate programs.

♢ The Director of the OME is the Associate Dean for Undergraduate Medical Education.

♢ The Dean appoints the chairpersons for the committees organized by year and the Associate Dean for Undergraduate Medical Education serves as the chairperson of the MECC.

♢ The effectiveness of curriculum planning relies on consistent and sustained communication among faculty members within and among the individual courses or clerkships.

♢ Coordination of curriculum content among the courses/clerkships occurs mainly, though not exclusively, at the monthly meetings of the MS1, MS2, and MS3/4 Curriculum Committees, with vertical integration through the MECC.

♢ A detailed, searchable database of the curriculum is an important resource in planning course content and in identifying and correcting gaps and unwanted redundancies. This database is accessible by all faculty and students. It provides the complete syllabus of each course and, in many cases, slide presentations of individual lectures. (See http://medschool.swmed.edu.)

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Office of Education

♢ The OME has the following four divisions with professional staff:

* The Clinical Skills/Sim Center is staffed by four persons, three of whom are professionals/educators and the fourth, an administrative assistant.

* Curriculum and Instruction Design/Evaluation is staffed by a full-time faculty member with a doctorate in education.

* Student Academic Assistance Services is currently staffed by a Learning Specialist (faculty level, PhD in Educ. Psych.), one M.Ed, and an administrator.

* Web-Curriculum has seven technical or administrative staff and one professional educator serving as the director.

♢ The primary mission of the OME is to enhance undergraduate medical education through the following activities of the four divisions:

* The Clinical Skills division assists various university departments in training standardized patients and developing examinations to assess the clinical skills performance.

* Curriculum and Instruction Design/Evaluation provides consultation and support for faculty in activities related to medical education. Areas of support include teaching skills, curriculum assessment, oversight of the Effective Teacher Series, statistical analysis to support evaluation, and assessment and educational research.

* The Web Curriculum division maintains a site for posting of course schedules, administrative policies, course content (syllabus, video streaming, audio files, supplemental materials), and links to student satisfaction surveys.

♢ The purpose of Student Academic Assistance Services is to promote the retention and advancement of medical students through their four-year curriculum. Goals specific to various programs in SAAS include:

* Tutoring, to facilitate student adaptation to challenging coursework and promote retention.

* The Summer Enrichment Program, to provide a diverse group of new medical students the opportunity to participate in a challenging academic program designed to help develop skills needed to successfully enter into, and complete, our medical school curriculum.

* USMLE Step-1 Preparation, to provide guidance and support to second-year medical students as they prepare for the first national licensure exam.

* Academic Counseling, to assist students in developing academic skills for the successful completion of medical school.

* Support for Students with Disabilities, to provide screening and referral services for students who may have learning issues, and if those issues are diagnosed, to provide testing accommodations.

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Financial Management of Educational Programs

♢ Undergraduate medical education is supported by tuition and state allocations from the UT Board of Regents.

♢ The Dean/Provost oversees the allocation of funds to the OME, the Office of Student Affairs, course/clerkship directors, and the Student Computing Committee.

♢ In addition, extramural funding through grants supports individual projects, such as our Southwestern Aging and Geriatrics Education program.

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Valuing Teaching

♢ The UT Southwestern Academy of Teachers was established in November 2005 with the following mission statement: “The UT Southwestern Academy of Teachers will enhance the educational mission of the institution by supporting the scholarship, mentoring, recognition, and recruitment of faculty members who strive to raise the quality of education within all of the schools that constitute the medical center. The Academy will provide an academic and organizational environment that fosters excellence in teaching at all levels (students, fellows, and colleagues), rewards superb teachers, stimulates innovation in education, and promotes scholarship in education.”

♢ In June 2005, the then-dean hosted “Excellence in Education: A Reception and Award Ceremony.” This was the first occurrence of what is now an annual event that recognizes the accomplishments of the dedicated and talented teachers in the medical school at UT Southwestern.

♢ The promotion and tenure process values teaching; the guidelines state, “Serious commitment to teaching is expected of all faculty members.” Specifically, “The candidate must participate actively in the teaching mission of the institution and be an excellent educator.”

♢ Participation includes delivery of lectures; laboratory and/or clinical instruction of students, housestaff, fellows, and/or faculty; participation in small-group and ward teaching; administrative work related to courses (director/organizer); and/or active participation in one or more Grand Round series.

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Curriculum Renewal Process

♢ The last curriculum renewal began in 2004 and involved the integration of the second year of medical school, followed by the creation of Academic Colleges in 2007.

♢ The current curriculum renewal began in 2009.

♢ The key objectives for the current curriculum renewal process are:

* Transform the academic culture of UT Southwestern Medical School.

* Develop and implement a competency-based curriculum. (Competency is defined as “the knowledge, skill or attitude that enable an individual to learn and perform in medical practice and to meet or exceed the standards of the profession.”) Current standards for medical student competencies include the those found in the AAMC Medical School Objectives Project and the AAMC-HHMI Scientific Foundation for Future Physicians report.

* Adapt the eight competencies identified in the HHMI-AAMC report that are focused on competencies in the sciences basic to medicine and that students must gain by the completion of medical school.

* Add the following competency to the HHMI-AAMC report list above: Demonstrate compassion and empathy in caring for patients as well as provide sound ethical medical care. Identify and establish the core curriculum based on professional and societal needs.

* Integrate the curriculum across disciplines and departments (i.e., integration of the sciences with clinical topics).

* Increase vertical integration of basic sciences (revisit basic sciences in the MS4 year).

* Earlier entry to clinical clerkships (spring of MS2).

* Design the future curriculum with flexible themes and tracks to meet disparate needs of primary care practitioners, subspecialists, health policy administrators, and medical scientists.

* Review and update current prerequisites for admission.

* Design and implement innovative methods for learning.

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Learning Outcomes/Competencies

♢ School-wide educational objectives are reviewed by all curriculum committees as well as the faculty council. The level of understanding at all levels is good.

♢ Annually all administrators, faculty, instructional staff, and residents receive an electronic notification from the Dean emphasizing the Objectives from the Medical School including a link to the appropriate Web pages.

♢ Students are apprised of UT Southwestern Medical School Educational Objectives in several venues, using several methods.

♢ Central to the process is the maintenance of the Educational Objectives on the UT Southwestern Web site. Annually in September, an e-mail regarding the Objectives, including a link to the appropriate Web pages is sent to all medical students, residents, and Course and Clerkship Directors.

♢ The course objectives guide the development of course syllabi.

♢ Students have the opportunity to provide real-time feedback to individual instructors through structured, electronic feedback on how the objectives are met.

♢ Additionally, the students can provide evaluative feedback to their curriculum representative. Such feedback then guides updates in the annual review of the objectives.

♢ Objectives/Competencies: The Objectives (see the database referred to above) are displayed in a matrix that shows the relationship to the appropriate UT Southwestern course(s) that currently covers the subject and current evaluation methods.

♢ Each Educational Objective is linked to the appropriate ACGME Competency and LCME Standard.

♢ Students are well prepared for the next step in training– residency. Measurement of external outcomes, such as USMLE scores and student performance in residency, indicate that the objectives are being achieved.

♢ Internal assessments by exams, OSCEs, and clinical performance also indicate achievement of these objectives.

♢ Several years ago a project was instituted to evaluate the quality of the UT Southwestern Medical School curriculum through annual surveys of residency directors and graduates regarding UT Southwestern Medical School's preparation of graduates for the practice of medicine. The goal was to identify group behavior resulting from enrollment in UT Southwestern Medical School. The results of these surveys indicate that students are being very well prepared for the next stage of their training.

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New Topics in the Curriculum Since 2000

♢ Patient safety is introduced in a series of skills clinics that occur in the context of the Academic Colleges (see below). In these clinics, students participate in a series of interactions with standardized patients that are digitally recorded. Each subsequent clinic is increasingly complex; for example, after learning basic history-gathering techniques, students learn how to deal with anxious or angry patients while taking the history. These clinics culminate in situations that focus on patient safety like caring for patients who speak a different language, disclosure of errors, teamwork, and delivery of bad news.

♢ Simulation technology has also been incorporated into the curriculum since 2000.

♢ A simulation center with two high-fidelity METI manikins and a neonate manikin has been constructed, and structured experiences in this center have been added to the curriculum. For example, second-year students practice teamwork and resuscitation skills in a skills clinic.

♢ Geriatrics education has been enhanced through the University of Texas Southwestern Aging and Geriatrics Education Program (SAGE). Through support from the Reynolds Foundation, the overall goal is for all UT Southwestern medical students to achieve proficiency in 26 geriatric competencies for medical students with integration of a competency-based geriatrics curriculum into all four years of the medical school curriculum emphasizing safety, quality, and patient-centered care. Already, several enhancements have been implemented. Examples include:

* Train-the-trainer curriculum revisions were implemented for the Colleges program with “SAGE Tips” integrated into the weekly Colleges mentor faculty development sessions prior to all relevant MS1 sessions.

* “SAGE tips” were also added to the MS1 student syllabus, and two new hours of student lecture were added (one on social and spiritual history with focus on older adults and the other on Chronic Disease/Functional Assessment in Geriatrics).

* Two new hours of lecture time in the Anatomy class were added. The first session, “Your SAGE Cadaver,” is presented early in the year, prior to the second anatomy lab session and serves as the launch to our SAGE curriculum for the MS1 class. The second session, “Clinical Anatomical Correlations of Aging,” introduces key concepts such as frailty, sarcopenia, and normal age related changes. For the Cell Biology/Histology course, the course director was selected as one of our SAGE scholars and is developing a normal-changes-of-aging curriculum that will be a mandatory part of the cell biology course and become an interactive online product. The first section, on aging skin, has been completed.

* Two geriatric OSCE stations were created for the family medicine and internal medicine components of the Clerkship OSCE (see below). Two other OSCEs (OB/Gyn and Psychiatry) are in process and will soon be implemented.

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Changes in Pedagogy

♢ Academic Colleges at UT Southwestern are learning communities that were implemented in 2007 to bring together gifted faculty mentors with small groups of students to mirror the professional clinical skills, behaviors, and attitudes of a physician.

♢ Students are assigned to one of six Colleges on their first day of medical school and remain in that College for all four years.

♢ Colleges create an environment where groups of students (typically six) and one clinical faculty mentor share the experience of being a physician. Professionalism, communication, and clinical skills are taught in a bedside setting. The group engages in deep discussions of many topics including clinical medicine, clinical reasoning, ethics, professionalism, and human behavior.

* Faculty mentors. Each College has a group of distinguished faculty members who meet weekly with their medical students. Faculty are chosen because of their dedication to patients, teaching, and professionalism. Faculty mentors serve as role models as well as advisors. Weekly meetings are held throughout the first two years.

* Curriculum coordination. Topics assigned for weekly meetings with faculty mentors are coordinated with topics discussed concurrently in the basic science curriculum. Several clinical topics are discussed, including:

1. History taking. Gathering clinical data by speaking with the patient.

2. Physical examination. Gathering clinical data by observing and examining the patient. The emphasis is on bedside teaching and patient-centered care.

3. Diagnosis. The synthesis of the information gathered during the history and physical examination. This enables one to understand the cause of the patient's symptoms or signs.

4. Professionalism. Counseling, demonstrating, and modeling by faculty mentors of techniques for understanding and managing complex human behavior and ethical issues that are a daily part of the care of patients.

♢ All students accepted are randomly assigned to a College and to a mentor. Each College is assigned a College master and six or seven College mentors. The master oversees the mentoring activities of the College.

♢ The Web Curriculum was established in July 1999 and has been continuously enhanced. The resources, categorized by medical school class and course, generally include syllabus, lecture mp3s, lecture slides, self-assessments, and Q&As. More recently, video streaming of lectures has been added. Both fixed and dynamic content are supported. Usage statistics for the curriculum server for all courses (2007–2008) reveal Visits = 100,605 with 11,302 unique users, 5,749 visited more than once; Page views = 229,109; and 33 Downloads (PDFs) = 778,027. These data clearly demonstrate an electronic-resource-rich, robust environment for the education of medical students.

♢ Integrated MS2 year was implemented in 2004, and includes pharmacology, microbiology, general and systemic pathology, and an introduction to clinical medicine. These disciplines are now taught in the context of organ systems, rather than in a department based manner.

♢ Preclinical Electives: Since 2002 a number of preclinical electives have been available to students during the first two years of medical school. The Preclinical Electives Program is a student-driven program supervised by full-time faculty that includes topics such as Literature and Medicine; Gender, Race, and Medicine; Genetics and Medicine; Medical Law; Medical Spanish; Community Service Learning; and Global Health.

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Changes in Assessment

Clerkship OSCE. The UT Southwestern MS3/4 Curriculum Committee implemented a formal Clerkship OSCE program in the 2009–2010 academic year that includes at least one case with a clinical issue pertaining to each clerkship. This change in assessment allows the examination of components of competency beyond the realm of knowledge measured by single-answer multiple choice questions.

Clinical Passport. Each clerkship developed Clinical Skill passports to monitor student encounters with patients and to ensure that each student gains exposure to a rich diversity of patients and their clinical issues.

Reflective Essays. The Academic Colleges experience involves a reflective essay that is submitted after each clinical clerkship, allowing an assessment of the “hidden curriculum” that is enriching our understanding of and ability to improve the medical student learning environment.

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Clinical Experiences

♢ The medical school has substantial resources for the clinical instruction of its medical students, with a diverse mix and large numbers of patients in both inpatient and ambulatory settings.

♢ The primary clinical sites for student education are the county-supported Parkland Health and Hospital System (PHHS), the not-for-profit University Hospitals (Zale-Lipshy and St. Paul), the private not-for-profit Children's Medical Center, and the Veterans Affairs North Texas Health Care facility. All clinical sites are fully supported by EMR and PACS technologies.

♢ PHHS is the primary teaching hospital for UT Southwestern. PHHS provides ambulatory care, emergency services, and hospital care to indigent and needy persons residing in Dallas County. The patient population is diverse (52% Hispanic, 29% African American, 15% Caucasian), providing opportunities for greater cultural competence. The number of FTE house officers is about 600.

♢ Faculty members supervise medical students in all rotations. PHHS has acquired adjacent land and will build a new state-of-the-art facility including an 862-bed hospital and outpatient center.

♢ UT Southwestern University Hospitals are adult referral centers for medical school faculty. Long-range planning includes construction of a new state-of-the-art teaching hospital.

♢ Children's Medical Center is private and not-for-profit and is one of the largest pediatric health care providers in the nation. The patient mix is ethnically diverse (44% Hispanic, 27% Caucasian, 20% African American). Student supervisors include faculty attending physicians and private practice attending physicians. Private practice physicians on staff who participate in student teaching have volunteer faculty appointments.

♢ Ambulatory care sites include Children's Medical Center, PHHS, Presbyterian Hospital, University Hospital St. Paul, and the VA hospital, all with high-quality facilities. In addition, various private clinics are used for pediatrics and family medicine.

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Highlights of the Program/School

Academic Colleges—The creation of a learning community focused on the acculturation of medical students into the profession has positively impacted student and faculty members alike. The students enjoy the early clinical exposure and personal attention afforded by the rich relationship that develops between mentor and mentee. The faculty also enjoy the opportunity to teach and develop relationships with the future leaders of the profession.

Excellent Teaching Hospital Affiliates—The staff and facilities of the premiere teaching hospitals of PHHS and the Children's Medical Center have education soundly at the center of their missions. When combined with plentiful and diverse patient populations and pathology, this makes them ideal partners for a medical school. A new University Hospital is currently being built, and one prominent goal is to incorporate education soundly into its mission as well.

Foundation of Basic Science—Students learn their basic science from some of the greatest minds in these disciplines. The basic science faculty members who teach are widely recognized as experts and many are decorated with awards such as the Nobel Prize and membership in the National Academy of Sciences.

© 2010 Association of American Medical Colleges

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