Bridge, Patrick D. PhD; Frank, Robert R. MD
Curriculum Management and Governance Structure
♢ The executive vice dean is appointed by the dean with the authority over all educational programs at the School of Medicine, including undergraduate, graduate, continuing medical education, graduate education (master's and PhD), and all services that support the educational mission.
♢ The associate dean reports to the executive vice dean and is responsible for the Office of Academic and Student Programs (OASP), whose divisions support the medical education program.
♢ The divisions include education management, evaluation, and medical education research, admissions, diversity, records and registration, student affairs, curriculum, conjoint teaching services, clinical skills center, and all biomedical communication functions.
♢ The governance of the curriculum is more centralized, with increased authority for the curriculum placed in the hands of the associate dean.
♢ There is still considerable decentralized authority for delivery of the curriculum at the departmental level in the hands of course and clerkship directors reporting to department chairs.
♢ The curriculum is managed using a hybrid system to ensure that the curriculum topics are delivered appropriately.
♢ The various management methods include CurrMIT, curricular maps, organization and review through the basic science and clinical science course/clerkship directors committees, student reporting, education core group, and the education deans.
♢ Final approval of the Curriculum Committee and executive vice dean is required (see Figure 1).
FIGURE 1: Curriculum...Image Tools
♢ The Curriculum Committee members are appointed by the Faculty Senate and monitor the content of required courses and clerkships, identifying gaps and redundancies through the work and subsequent reporting of the Course and Clerkship Directors Committees.
♢ The assistant deans of basic sciences, clinical sciences, and evaluation and medical education research annually review the course and clerkship content with the executive vice dean to further identify gaps and redundancies.
♢ When changes occur, a “planned incremental change” strategy is used, which focuses on the gradual implementation of curricula. This type of strategy allows for careful implementation, monitoring, and assessment of curricular components.
Office of Education
♢ The Office of Academic and Student Programs (OASP) was established in 1992.
♢ Within OASP resides the division of education management, which consists of four full-time support staff, associate dean, assistant deans for basic sciences, clinical sciences, and evaluation and education research.
♢ The division of education management supports all undergraduate medical education (UME) curriculum activities for Years 1–4, including scheduling, evaluation of faculty and courses, testing services, grade reporting, academic support services, and co-curricular programs.
♢ In 2005, a division of evaluation and education research was developed as part of the division.
Financial Management of Educational Programs
♢ The Department of Academic and Student Programs manages the budget for undergraduate medical education.
♢ Undergraduate medical education is funded by the University in a variety of ways: state support, tuition, student fees, and revenue from external clients (users of clinical skills center and media services).
♢ In 2008, a teaching academy was developed under the OASP, division of education management to promote and improve faculty teaching for all the medical education programs.
♢ The university uses a teaching portfolio for all issues regarding promotion and tenure. This has provided an opportunity to highlight the importance of teaching and encourage the faculty to also carefully document teaching accomplishments.
♢ Approximately 10% of our full-time faculty (80–100 faculty) are honored each year with the university teaching award program ($1,000 stipend plus recognition).
♢ The students have teaching awards for full-time and voluntary faculty.
♢ All course and clerkship directors are given a stipend for their work on a yearly basis.
Curriculum Renewal Process
♢ Following a faculty retreat in 1995, the school adopted a five-year plan for curriculum renewal. It was referred to as “radical incrementalism” and identified a series of incremental steps, which faculty believe were necessary to effect a major curricular reform.
♢ In 2004, the Curriculum Committee conducted a review of the institutional learning objectives. The objectives were modified, and a set of competencies was developed to meet the educational needs of students.
♢ On-going changes in the curriculum can be proposed by faculty, administrators, or students. All requests must go through and be approved by the Curriculum Committee and executive vice dean.
♢ In 2010, the Curriculum Committee and associated subcommittees will undertake another extensive review of the learning objectives and competencies.
♢ In 2004, the institutional learning objectives were carefully reviewed and compared/contrasted to the objectives from the Medical School Objectives Project (MSOP). From this review, the learning objectives were modified.
♢ In 2004, a set of medical school competencies were designed to align with the ACGME core set of competencies when relevant to undergraduate medical education. These competencies include the following:
* integration of the basic sciences in medicine,
* integration of clinical knowledge and skills to patient care,
* interpersonal and communication skills,
* organization and systems-based approach to medicine, and
* life-long learning and self-improvement.
♢ The competencies and institutional learning objectives formalize the objectives of a WSU medical education, define what a graduating physician should know, and provide the measurement and evaluation mechanisms to ensure that objectives are being met. For further information go to http://www.med.wayne.edu/academic_student_programs/overview.asp.
New Topics in the Curriculum Since 2000
♢ Development of an ultrasound curriculum during Years 1–2.
♢ Development of a vertically integrated Clinical Medicine course to address a variety of public health and psychosocial topics. The Clinical Medicine course comprises a variety of longitudinal curricular themes.
♢ Year 1 Clinical Medicine
* Achievements and Challenges in Public Health
* The Aging Patient
* Clinical Preventive Medicine
* Cultural Competence
* Evidence-Based Medicine
* Exposure History
* Family History Exercises
* Human Sexuality
* Terminology in Clinical Medicine
♢ Year 2 Clinical Medicine
* Advanced Care Decisions
* Adverse Health Outcomes
* Behavioral Risk Factors
* Community Health Assessment
* End-of-Life Decision Making
* Ethnic and Racial Disparities
* Health Care Disparities
* Health Care Financing/Allocation of Resources
* Persons with Disabilities
* Quality Health Care Assessment
♢ There have been some changes in the Year 3 clerkship curriculum, including the following:
♢ Development and implementation of a six-month Continuity Clinic Clerkship in Year 3.
♢ Minor changes in the Year 3 Clerkships, including the following topic areas:
* Barriers and Incentives
* Characteristics of Medicare
* Clinical Quality Benchmarks
* Confidentiality: Health Care Literacy and Patient Education
* Disease Prevalence in a Community
* Impact of Health Care Disparities
* Managed Care and Other Health Plans
* Treatment Expectations, Outcomes
Changes in Pedagogy
♢ The enhanced use of small groups, computer assisted instruction, self-study, conferences, and panel discussions in place of large-group lectures.
♢ The integration of virtual microscopy in pathophysiology.
♢ Streaming video was introduced for all large-group lectures to meet the learning styles of our students.
♢ Increase in case studies in all preclinical courses.
♢ Increased use of standardized patients.
♢ Continuing efforts to empower students through committee work, community service, and student organizations.
♢ Integration of a clinical campus model for all Year 3 clinical rotations.
♢ Development of methods to identify students at-risk for failing Step 1.
♢ New programs to provide Step 1 support services during Year 1 and 2.
♢ Development of an education commons with state-of-the-art computers and smart classrooms, promoting life-long learning and self improvement.
♢ A state-of-the-art library in the new Richard J. Mazurek, MD, Medical Education Commons provides students electronic delivery of documents.
♢ Development of a clinical skills center, including standardized patients and patient simulation.
Changes in Assessment
♢ Standardized patients are used in the Clinical Medicine 1 and Clinical Medicine 2 courses.
♢ A web-based student encounter tracking system was developed for students in clinical clerkships.
♢ Students must pass Step 1 CK and take Step 1 CS before being promoted to Year 3.
♢ Numerous clerkships have introduced OSCEs at the end of their clerkship.
♢ The comprehensive basic science NBME exam is required at the end of Year 2 to develop a baseline of student deficiencies.
♢ Faculty observations in small group settings are used to assess student knowledge and clinical skills in the Clinical Medicine 1 and 2 Course.
♢ All student evaluation of faculty and courses are conducted through a web-based interface.
♢ Currently piloting computer-based testing.
♢ In 2008, a clinical campus model was developed for students' Year 3 clerkship rotations. Under this model, students conduct a majority of their Year 3 course work at one partner affiliated hospital rather than rotating among our eight affiliated hospital sites.
♢ Students go to physicians' offices in the Year 1 Clinical Medicine Course.
♢ Students interact with patients in the hospital setting during the Year 2 Clinical Medicine Course.
♢ During Year 3, students are in physicians' offices for the continuity clinic clerkship, as well as an ambulatory block rotation in the fourth year.
♢ Co-curricular programs in Years 1–2 offer students experiences in nursing homes, hospice, as well as other community health organizations.
Highlights of the Program/School
♢ The new Richard J. Mazurek, MD, Medical Education Commons provides students with state-of-the-art classrooms and computer laboratories and new opportunities in the latest patient simulation technology.
♢ A unique co-curricular program that recognizes students who have dedicated themselves to building partnerships with surrounding communities through a variety of sponsored outreach and volunteer activities.
♢ Students acquire a greater understanding of human needs, concerns, interests, and values through their participation in these programs, learning to interact with area residents by providing services in their communities.
♢ A diverse student body with a focus on student-centered learning.