Curriculum Management and Governance Structure
♢ The University of Pittsburgh School of Medicine (UPSOM) has a centrally governed curriculum that features active learning, a problem-based approach, an early introduction to the patient and the community, and the integration of a rigorous foundation in basic and clinical biomedical sciences with the social and behavioral aspects of medicine.
♢ The UPSOM curriculum is the outgrowth of five years (in the late 1980s and early 1990s) of self-study and planning, involving five major task forces and over 200 faculty and students.
♢ The Curriculum Committee (CC) was organized in 1991 as a standing committee of the faculty with student representation and was given responsibility and authority for all four years of medical student education. As the new committee began to prepare for its role as a centrally governing body, it became apparent that to govern effectively, an “effector arm” of the committee was needed to manage centrally the curriculum. The Office of Medical Education was founded as a component of the dean's office and was charged with implementation and management responsibilities.
♢ The curriculum was “phased in” one year at a time beginning in the fall of 1992.
♢ The central governance structure [described by Reynolds et al. in Academic Medicine, August 1995] facilitates the planning of curricular innovations and the implementation of new initiatives since the CC has the authority, including budgetary control, to complement its responsibilities.
Office of Education
♢ The Office of Medical Education (OMEd) was founded in May 1992 to implement the new hybrid problem-based learning curriculum for medical students.
♢ OMEd has grown with the curriculum and now includes academic counseling, course and clerkship evaluation services, testing services, information technology support, facilities management, advanced administrative support for special projects (e.g., community-based courses and clerkships), and instructional support.
Budget to Support Educational Programs
♢ The CC has a Resource Subcommittee that oversees the funding for all first- and second-year courses and selected third- and fourth-year activities.
♢ The Resource Subcommittee considers budget proposals and makes recommendations to the senior associate dean and dean about funding.
♢ The source of the education budget has been a combination of hard money funds from the dean's budget, new funds, and selected resources previously allocated to departments.
♢ Generally, the sponsoring department funds discipline-based third- and fourth-year clerkships and electives.
♢ Faculty leaders for the educational program are recommended for appointment to the dean/senior associate dean by the CC's Executive Subcommittee.
♢ Faculty leaders frequently identify themselves by participating in an exemplary manner in an existing course or clerkship, by assuming administrative responsibility for a segment of a course or clerkship, by chairing an ad-hoc curriculum task force, or by designing an outstanding elective experience.
♢ Faculty leaders receive titles that describe their duties (e.g., course director, block coordinator).
♢ Faculty may be recognized by students (e.g., Golden Apple Awards, Excellence in Teaching Awards) or by the dean with advice from the CC (e.g., the Kenneth Schuitt, MD, PhD Award).
♢ Documentation of teaching excellence is required for promotion in non-tenure and tenure streams.
♢ Individuals whose accomplishments are exceptional at both individual and programmatic levels may be promoted primarily on the basis of teaching contributions.
CURRICULUM RENEWAL PROCESS
♢ As part of the process to reorganize years three and four the Goals and Integration Task Force identified knowledge, skills, and values essential for attainment of the MD degree at this institution.
♢ The learning outcomes were reviewed and approved by the school's CC and by the Executive Committee, the dean, and ultimately the faculty.
Changes in Pedagogy
♢ Features of the new curriculum include: active learning; an emphasis on problem solving; an early introduction to the patient and the community; and the integration of a rigorous foundation in basic and clinical biomedical sciences with the social and behavioral aspects of medicine. Each senior student takes an innovative, integrated course in advanced biomedical science.
♢ Scheduled instructional time in the first two years of the new curriculum is apportioned approximately as one third lecture; one third small-group learning (much of which is problem-based learning; the remainder includes demonstrations, faculty-directed problem-solving exercises, skill-practice sessions, and other activities); and one third other (which includes observation of and limited participation in patient care, community site visits, experience with standardized patients, laboratory exercises, and other activities). This represents an increase in active learning and small-group learning compared with the traditional curriculum.
♢ The use of standardized patients for teaching and assessment is increasing. Simulated patients have been used for several years in the first-year Patient Interviewing Course to teach students how to obtain a history and how to communicate effectively with patients under a variety of circumstances.
Application of Computer Technology
♢ OMEd is responsible for facilitating and supporting the application and integration of information technology in the educational program. OMEd has a full-time information technology position. Duties of the individual who fill this position are application programming, instructional design consultation, equipment maintenance, and system administration, among others.
♢ The information technologist is supported by a 0.3 full-time equivalent position by contract with university computing services and by a campus-wide “expert partners” program.
♢ Each of 32 small-group rooms used for first- and second-year medical students is equipped with an Internet port and an X-terminal with servers maintained by the Office of Medical Education.
♢ Students have access to a host of resources such as images that have been specially digitized for viewing in support of scheduled courses (e.g., pathology specimens, EKG tracings, radiographs) and to resources available through Falk Library of the Health Sciences and World Wide Web resources.
♢ OMEd maintains Pitt-Med Curriculum Online, a Web-based application with domain-specific courseware to support student achievement of course objectives.
♢ Most courses in the first two years have digitized images, schedules, practice quizzes, and/or other material associated with specific instructional units. Some material is designed for reference and review, while other material is developed for in-class use (e.g., radiology images and procedure reports for use during a problem-based learning session).
♢ Web-based resources provide a history and review of a local community that first-year students visit as part of our Introduction to Being a Physician course.
♢ A third-year clerkship has a Web-based “patient and procedure log,” material to support evidence-based information on selected topics, and other relevant readings, assignments, and schedules.
♢ Relevant links provide a faculty perspective on other valuable information resources for learners.
♢ A component of our on-line curriculum is the computer-based patient-care simulation that supports the Integrated Case Studies course. This course, the last taken by students in their second year, has as its objective the application of information learned during the first two years to case-based problems, further developing independent active learning and data-acquisition skills. The course functions as a bridge to the supervised patient responsibilities of the final two years of medical school. The format is exclusively problem-based learning, and all case materials and related case exhibits (e.g., radiographs, laboratory test results, procedure results) are available to students solely on-line [described by Schor et al. in Academic Medicine, September 1995].
♢ OMEd also maintains tools to support the administration of the educational program
♢ The development of the new UPSOM curriculum led to a productive collaboration with the health sciences library. The director and personnel of Falk Library for the Health Sciences are significantly involved in support and instruction for information seeking, retrieval, and management.In a program initiated in the fall of 1992, incoming first-year medical students attend an orientation to library resources, including instruction in searching Medline and other databases. Subsequently, students have a more in-depth exposure to library and information resources in the problem-based learning segment of the Introduction to Being a Physician course (librarians participate in course development).
♢ A student-organized and student-run Computers in Medicine committee serves to promote the use of computer-based resources within the medical school community. In the early 1990s, the group initiated the automatic creation of computer accounts for incoming medical students, a system of e-mail lists, and an on-line medical student directory synchronized with the medical school registrar's database. Several years ago, the group developed a World Wide Web page designed to help incoming medical students find housing in the Pittsburgh area, which has evolved into a comprehensive set of Web-based resources for applicants and new students.
Changes in Assessment
♢ Performance-based assessment (using real patients) is used during the third-year internal medicine clerkship, in which each student is observed performing a complete history and physical exam by a senior faculty member. An OSCE that includes standardized patients for some stations and comprises a significant portion of the final grade is used to assess students' history, physical exam, and diagnostic skills at the end of the required 12-week community/ambulatory medicine clerkship. A comprehensive, CC-monitored, performance-based assessment is being implemented at the beginning of the fourth year.
♢ Computer-based applications have been used intermittently for assessment (e.g., in a portion of a dermatology final exam, neuroscience quizzes, digitized “movie clips” of clinical procedures).
♢ Students begin their clinical experience by observing a faculty physician interview a patient on the first day of medical school.
♢ After observing several experts interview patients during the first few weeks of the curriculum, the students practice interviewing simulated patients during the Patient Interviewing course.
♢ In the second half of the first year each student sees patients (approximately one half-day every other week) with a primary care practitioner in the Western Pennsylvania region as part of our Ambulatory Care course. This course continues through the first half of the second year, in which each student participates in a service learning experience associated with our Program for Healthcare to the Underserved.
♢ Various voluntary activities provide supplementary clinical experiences during the first two years, including: Bridging the Gaps (a seven-week summer internship in a community clinic); Area Health Education Center (AHEC)-supported initiatives; work in shelters for the homeless and for victims of domestic violence; and others.
♢ Most students participate in one or more voluntary clinical experiences.
♢ The third and fourth years are primarily grounded in appropriately supervised clinical experiences.
Curriculum Review Process
♢ The CC is charged with ongoing review of the medical student curriculum, which is conducted through evaluation of individual courses and clerkships, analysis of external and internal data, examination of special issues with ad-hoc task forces, and appraisal of the curriculum as a whole at an annual colloquium attended by over 100 invited faculty and students.
♢ During the next five years, key issues to be addressed by the CC will include:
* options for training clinician—scientists, including a research experiment for all medical students
* the effectiveness of the problem-based learning initiative
* the quality of current community/ambulatory education methods and sites
* the integration of education in palliative and end-of-life care issues, medical informatics, and evidence-based medicine, and complementary and alternative medicine