Learning communities, also called colleges or academic societies, are an emerging trend in medical education, but they are not a new educational concept. By the 13th century, Oxford University’s first colleges, with community residence halls and endowed houses overseen by faculty masters, had been established.1 More than 300 years ago, Harvard graduate Cotton Mather2 described the “collegiate way of living,” which attempted to bridge traditional classroom education with the informal learning that happens among students. In the United States, Harvard and Yale introduced undergraduate residential colleges in the early 1930s.3 It was not until the 1970s, however, that learning communities began to be created within U.S. medical schools; they first appeared at the University of Missouri–Kansas City and had progressed to 18 U.S. and Canadian medical schools by 2006.4 In this article, we describe the evolution of Vanderbilt University School of Medicine’s (Vanderbilt’s) colleges from organizations focused solely on wellness and career planning to learning communities that also explore the medical humanities and help medical students develop as leaders.
Medical School Learning Communities
The Learning Communities Institute, a national organization of medical educators who support the presence of learning communities in medical schools, broadly defines learning communities as intentionally developed longitudinal groups of faculty and students that aim to enhance students’ medical school experience and maximize learning.5 Many medical school learning communities focus on specific aspects of the curriculum (e.g., professionalism, leadership development, service learning, medical humanities, clinical skills, cultural competency). They also encourage students to think critically and become more active, engaged, and self-motivated learners. Their activities may include social functions, career advising, and wellness promotion.4 Importantly, through learning communities, students establish longitudinal relationships with faculty who not only teach but also model professionalism and ethical behavior.
Increasingly, educational leaders are calling for medical education reform, especially in regard to individualized learning, professional identity, and knowledge integration.6 Learning communities offer a potential foundation to meet the suggested need for reform in these areas.
The Vanderbilt Learning Community Experience
In 2005, the associate dean for medical student affairs (S.R.) worked with groups of interested medical students to establish two organizations on campus—the Student Wellness Committee (SWC) and Vanderbilt Careers in Medicine (VCiM). The new organizations created their own mission statements, elected student leaders, and independently developed programming that spanned the entire four years of medical school. In 2006, Vanderbilt embarked on an ambitious restructuring of its medical student advising and created the Advisory Colleges Program (ACP). This change shifted responsibility from a multitude of randomly assigned, one-on-one faculty advisors to a group of eight designated core advisory college directors (ACDs; two for each of the four advisory colleges).7 The SWC and VCiM, with teams of student leaders in place, played a major role in establishing the foundation for the ACP. Promotion of student well-being and career planning were the guiding forces of the ACP from its inception, and a symbiotic relationship between the student-led organizations and the faculty-led advisory colleges formed quite naturally. Due largely to the ACP’s initial focus on wellness and career planning—topics of significant interest to students—student buy-in occurred early in the process. Subsequent collaborative programming has had a substantial, positive impact on Vanderbilt medical students, reflected in a statistically significant improvement in student satisfaction with the overall advising system.7 The structures of the Wellness Program/SWC8 and VCiM,9 as well as the campus wellness initiatives,8,10 have been described previously.
Transition to learning communities with faculty mentors
Following our successes with the ACP, the SWC, and VCiM, Vanderbilt’s administrative leaders recognized that there were opportunities to significantly improve the teaching of the medical humanities and the development of students as future leaders, researchers, and service providers. At the beginning of the 2011–2012 academic year, a subtle, yet important, transition occurred in the roles and responsibilities of the advisory colleges. A new educational component—the College Colloquium, a course taught by faculty advisors—was introduced, leading to the renaming of the advisory colleges as simply “the colleges” and their subsequent branding as learning communities. Previously, the wellness and career planning programs were separate entities with some overlap in their use of the advisory colleges to reach students (Figure 1). After the transition to learning communities (Figure 2), the colleges became the overarching environment for advising, community involvement, and intellectual growth.
To select faculty to serve as the “college mentors” (CMs), the new title given to the ACDs, a chaired selection committee was convened in spring 2011. The university-wide selection process considered existing ACDs as well as new applicants. The call for applications indicated that the position required the following traits: “creativity, enthusiasm, accountability, good judgment, and a positive mindset” in addition to “a background in teaching and advising at the undergraduate medical education level.” The application was extensive (curriculum vitae, educator’s portfolio, teaching philosophy, and letters of support). In recognition of the CM’s role as an integral component of education and advising in the medical school, the dean’s office provided 0.3 full-time equivalent salary support for each CM, which increased the desirability of the position. The committee chose a diverse group of eight CMs on the basis of their dedication to medical student education, advising, and professional development.
In fall 2011, with their time protected for teaching and advising, the CMs began to teach the medical humanities within their colleges through the new College Colloquium course. They also started to provide enhanced career advising to students in their colleges across all years of training. For example, in addition to participating in regular VCiM programming9 (e.g., specialty fairs, mock interviews, backstage pass elective to explore career options), they meet with rising senior medical students to review curricula vitae, personal statements, and residency application strategies to help them prepare for their medical student performance evaluation meetings with the associate dean for medical student affairs. They also participate in a range of wellness initiatives and serve in important leadership roles within the specialty interest groups.
The College Colloquium course
The College Colloquium course, designed as a four-year learning experience, takes a novel approach to teaching the medical humanities: It stresses that the sciences and humanities are not siloed disciplines, teaches meta-cognition as a foundation for professionalism and empathy, and situates the humanities within the environ of Vanderbilt’s learning communities. Beginning with meta/neurocognition, topics include thinking, learning, narrative medicine, perception, complexity, change, uncertainty, and making mistakes. The realization of human differences in cognition lays the groundwork for tolerance, empathy, and professionalism and prepares students for ensuing discussions on medical ethics and health care policy.
Students prepare for sessions via exploration of assigned readings that are designed to challenge their knowledge, assumptions, and beliefs (for sample readings, see List 1). Each session begins with a meeting of the entire class for a 30-minute talk delivered by a content expert to help students understand the readings within the larger scope and context of medicine. Following the talk, students break into groups by colleges (25–28 students each) for a 1.5-hour discussion. The CMs promote active discussion and encourage debate, with the goal of helping students gain a respectful tolerance of perspectives and beliefs discordant with their own as a foundation for professionalism and future professional discourse with colleagues and patients. Additionally, students complete a series of written, critical reflections each semester; these are designed to guide them in the process of analyzing and applying course topics to various scenarios and to inculcate the deliberate practice of self-reflection. The course is graded on a pass/fail system, based on attendance, participation, satisfactory written reflections, and an end-of-course written examination. A course director, who is not a CM, grades the examinations and assigns the final course grades, keeping the mentoring and summative evaluation faculty roles separate.
In fall 2012, the College Colloquium curriculum was supplemented with additional educational components. Its academic focus expanded to include teaching in additional areas of importance for professional development, specifically leadership, research, and service-learning (List 2). The new sessions follow the same structure as the others and, at times, engage additional university faculty with special expertise (e.g., physician–scientists, ethicists).
The expansion of the college’s academic and curricular focus has allowed the colleges to become all-encompassing, multitiered learning communities that incorporate wellness, professional advising, and education into one cohesive unit.
Reflections on the Vanderbilt Colleges Program
Reflecting on the development of the ACP and the evolution of the colleges into learning communities (Table 1), we identified five critical lessons related to factors important in our program’s success. First, the ACP was initially built on two fundamental themes, career counseling and personal wellness, both of which are vitally important to medical students.8 This emphasis and collaboration with the SWC and VCiM produced immediate student buy-in; the colleges were quickly viewed as a welcome addition to the Vanderbilt learning environment. Several of Vanderbilt’s most popular events—the College Cup, wellness retreats, career fairs, and specialty speed dating8–10—are rooted in the early days of collaboration between the faculty-led colleges and the two student-led organizations.
Second, early successes with wellness and career planning provided the momentum necessary to expand the scope of the colleges. In this context, our administrative leaders realized the potential to enhance students’ educational experience by weaving an academic component within the colleges. The addition of the College Colloquium course has greatly aided the colleges’ evolution into true learning communities.
Third, selecting superb faculty leaders with the necessary attitudes and skill sets for mentoring and teaching is critical. Our CMs have developed excellent rapport with students, which has strengthened students’ connection to their colleges. CMs are recognized on campus, and students have become quite comfortable engaging with them in clinically oriented discussions of various medical humanities topics. As a result, students and CMs are rigorously discussing topics from metacognition to health policy in a way heretofore unseen at Vanderbilt.
Fourth, acceptance and support by the medical school leadership is paramount. The dean’s office has funded the development of the colleges as well as the Wellness Program/SWC and VCiM (Table 2). The provision of funding for protected academic time allows the CMs to invest in the lives of students. Additionally, the Vanderbilt academic leadership has strongly supported the colleges through dedicating time within the curriculum for the College Colloquium course.
Finally, it is important to keep advisory and evaluative roles distinct. We initially intended to incorporate longitudinal personalized learning plans (PLPs) into the college structure for the CMs’ use in mentoring students in their professional development. To help students contemplate career and professional goals and to set learning objectives for the next six months, PLPs require students to assess themselves on the six Accreditation Council for Graduate Medical Education competencies plus three additional competencies (leadership, scholarship, and wellness). We quickly found that the scale of the project was greater than the CMs could handle given their other duties. Additionally, Vanderbilt’s administrative leaders wanted the CMs to remain free of any task involving summative assessment to ensure that students would not feel awkward when approaching their CMs with personal and career-related questions. Therefore, Vanderbilt recently created new faculty “portfolio advisors” positions. The portfolio advisors—10 assigned to each incoming class beginning in summer 2013—will operate outside the colleges program, tracking their assigned students’ progress through all years of training and mentoring them in the PLP process. This division between CMs and portfolio advisors maintains an important separation between personal/career advising and academic assessment and will help ensure the success of both the college and PLP programs.
Since initial implementation of the colleges program, student satisfaction has improved. A comparison of 2004 (pre-colleges) and 2012 (colleges fully implemented) Vanderbilt data from the Association of American Medical Colleges Medical School Graduation Questionnaire (GQ) shows a high degree of student satisfaction across several core metrics associated with the key philosophies of the colleges.11,12 Satisfaction with personal counseling remains consistently high, with 87.5% of responding students either satisfied or extremely satisfied in 2012. GQ data show increases in student satisfaction with both faculty mentoring (from 75.6% in 2004 to 87.5% in 2012; P = .81) and career planning (from 67.5% in 2004 to 82.9% in 2012; P = .037) following full implementation (P values calculated using the Fisher exact test based on a 2 × 2 contingency table). It should be noted, however, that these data are preliminary as the class of 2015 will be the first to experience all aspects of the colleges described in this article.
Additionally, 2012 Vanderbilt student affairs survey data show a high degree of student satisfaction with the colleges and CMs. Over 91% of the 245 responding first- through fourth-year students indicated that the colleges contributed meaningfully or somewhat meaningfully to their Vanderbilt experience. Respondents described CMs as approachable (92%), accessible (91%), and responsive (93%), and almost all (97%) reported being satisfied with the quality of CM advising.
Vanderbilt’s colleges have been successful, and our strategic plan for the future builds on this momentum. When students first enter medical school, their initial acceptance of the colleges is easy; the colleges’ sense of community, belonging, and camaraderie facilitates students’ transition into the learning community. However, busy curricular loads and extracurricular activities can reduce the time that students devote to their colleges and may lead some to withdraw from consistent participation. It is essential, therefore, to develop strategies to maintain each student’s college involvement across all years of medical school. Continued critical analysis and reflection are necessary to ensure that the colleges adapt to the educational needs of an ever-changing student body.
In a challenging economic environment, financial resources continue to prove difficult for medical schools and health care institutions. The colleges have been fortunate to continue to receive financial support from the medical school leadership. This support is an essential component of the forward progress generated by these learning communities. It may be important to consider seeking additional avenues of financial support, including philanthropy and fundraising, in the future. Further, the creation and use of physical space dedicated to learning community activities can improve the student experience. Although current medical school classrooms are allocated for the College Colloquium sessions, dedicated space will be imperative for the continued development of community and camaraderie within the colleges. Vanderbilt is exploring avenues to acquire such space for the colleges.
Sharing innovations and achievements is also essential. At a national level, ongoing discussions, exchanges of best practices, and scholarly research regarding learning community development and implementation will increase understanding of the benefits of learning communities and offer support to medical schools planning to start similar programs. At the local level, we intend to evaluate the outcomes of our program in the areas of medical student well-being, satisfaction with career counseling, and the overall effectiveness of our approach to teaching the medical humanities.
In conclusion, we believe Vanderbilt’s implementation of learning communities has been a successful first step along this new frontier of medical education. We feel the colleges will continue to be an integral component of Vanderbilt’s approach to medical education, professional development, career counseling, and wellness.
Acknowledgments: The authors would like to thank the administration at Vanderbilt University School of Medicine for their continuing support of the colleges. Association of American Medical Colleges Medical Student Graduation Questionnaire data are used with permission.
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