Medical Education Program Highlights
Our medical education program is characterized by effective and ongoing collaborations between basic scientists and clinicians and between students and faculty. Unique features of our program include the following:
We have strong central oversight of the curriculum by clinical and basic science faculty members in the Office of Undergraduate Medical Education (UME), who participate in the development and implementation of class sessions across all courses.
Each systems course in the preclerkship curriculum is codirected by a clinician and basic scientist.
We have a robust mechanism to provide feedback through the Aesculapian Society, a student-run organization that fosters ongoing communication between students and faculty. Students meet frequently with course directors to give feedback on individual course sessions and provide formal reports on courses and clerkships. Changes that are made in response to feedback are made public to students.
Clinical and basic science faculty lead our student learning communities (houses). The houses are integral to both curriculum delivery (small-group seminars) and extracurricular development (mentorship and reinforcement of professional values).
We enjoy strong support of the educational program from the dean. Resources to enable student learning include a new state-of-the-art team-based learning (TBL) classroom and an AV faculty training suite, in addition to materials for students to use in their courses and in USMLE Step 1 examination preparation. The dean also provides educational stipends for house faculty and has expanded faculty positions and administrative support in the Office of UME.
Curriculum
Curriculum description
The School of Medicine curriculum begins in August with a 1-week Introduction to the Profession course, followed by 3 courses: Gross Anatomy, Biochemistry, and Clinical Skills Integration, an introductory clinical skills course, in the fall. The spring semester includes cell biology and anatomy, physiology, medical genetics, medical immunology, foundations of population medicine and health systems, and human behavior and development, as well as continuation of Clinical Skills Integration.
The second year is made up of the Foundations of Disease and Therapy course, followed by 8 systems courses: Diseases and Therapy of the Neuropsychiatric, Musculoskeletal/Dermatology, Hematologic, Pulmonary, Cardiovascular, Renal, Endocrine/Reproductive, and Gastrointestinal Systems. A longitudinal Clinical Skills Integration course that focuses on literature evaluation and patient counseling runs throughout the year. Second-year students have opportunities to take a variety of elective courses and to shadow clinicians from a wide variety of specialties. The year ends with a synthesis experience that consists of case-based questions and review. Students take USMLE Step 1 after a period of study time, which is a requirement before they begin their clerkships.
Students begin their third year with a 1-week Clerkship Preparation course. They then rotate through 7 clerkships and an elective:
Internal medicine: 10 weeks
Surgery: 9 weeks
Pediatrics: 8 weeks
Obstetrics–gynecology: 6 weeks
Psychiatry: 6 weeks
Family medicine: 4 weeks
Neurology: 3 weeks
Career planning elective: 2 weeks
The fourth year includes 2 acting internships and a Critical Concepts course, which focuses on emergency and intensive care and simulation. Four electives are required, and 3 blocks are reserved for interviews and other activities. The fourth year ends with a 1-week Special Topics course, which includes sessions on internship, financial planning, and opioid prescribing.
Curriculum changes since 2010
In 2012, we underwent a significant change in the preclerkship curriculum from a completely departmentally based structure to the one described above, which is a hybrid of departmentally based courses and organ system–based courses. Additional changes included enhancement of the curriculum on cultural competency, literature evaluation, health systems, and clinical reasoning. One of the major improvements of the new curriculum was increased integration, both between various basic science disciplines and between basic science and clinical medicine. Another improvement was the expansion of opportunities to take electives in the second, third, and fourth years and the creation of greater scheduling flexibility for senior students.
Planned changes for the future include restructuring some courses to increase active learning opportunities and minor changes in sequencing of some courses. Our core basic science and clinical teaching faculty engage in frequent discussions to continuously improve individual teaching sessions and the curriculum as a whole.
Assessment
The 28 medical education program objectives were revised as part of our recent curriculum change and are based on the ACGME competencies of patient care, medical knowledge, practice-based learning and improvement, systems-based practice, professional behavior, interpersonal relationships and communication, interprofessional collaboration, and personal and professional development. Changes in assessment since 2010 include customized NBME examinations in the first and second years, addition of TBL exercises that include individualized and group readiness assessment tests, and development of new graded written exercises.
See Supplemental Digital Appendix 1—Program Objectives and Assessment Methods—at https://links.lww.com/ACADMED/A866
Parallel curriculum or tracks
The Rural Scholars Track trains physicians to practice medicine in rural settings. The preclerkship curriculum for students in this track is identical to the other students’ curriculum but with the addition of specific didactic activities relevant to rural medicine. Students in this track complete their third and fourth years at our regional campus at University Medical Center in Lafayette, Louisiana, and spend 1 day per week with a primary care preceptor.
The Primary Care Track trains physicians interested in primary care. The preclerkship curriculum for students is in this is identical to the other students’ curriculum but with the addition of specific didactic activities relevant to primary care. Students spend 1 half day per week with a primary care preceptor during their third and fourth years.
The MD–PhD Track trains physician–scientists. Students in this track complete the preclerkship curriculum, take USMLE Step 1, and then pursue their PhD. After successfully receiving their PhD, they reenter the clerkships and complete their third and fourth years with other students.
The MD–MPH Track is either a 4- or 5-year track. Students in the 4-year track begin MPH coursework in the summer before matriculation, and they attend MPH classes during the preclerkship phase of the curriculum. They complete a capstone project in their fourth year. Students in the 5-year track complete their MPH degree between the preclerkship and clerkship phases of the curriculum.
Pedagogy
We use a variety of pedagogical approaches to achieve our medical education program objectives. We use recorded and live lectures and readings to deliver content. We have implemented approaches to reduce lecture time since 2010, including TBL, use of audience-response systems, and addition of active learning sessions. We use laboratory sessions and simulations for students to apply their knowledge to clinical situations. We use role play for students to practice clinical skills of history taking, clinical reasoning, and communication.
Clinical experiences
Our students see a very diverse patient population. We place students in ambulatory and inpatient settings in a 1-week preceptorship after their first semester. Second-year students are required to participate in a longitudinal clinical elective and provide a written reflection of their experience. Students complete their clinical clerkships in ambulatory clinics and inpatient units at partner hospitals across the state, including regional campuses in Baton Rouge and Lafayette. Our primary partner hospitals in New Orleans are part of the Louisiana Children’s Medical Center corporation and include University Medical Center, Children’s Hospital, and Touro Infirmary. Our students also complete rotations at our Veterans Administration medical center.
Curricular Governance
Three curriculum committees have various roles in the administration of our curriculum. All committees have representation from the general faculty and students. Their main responsibilities are described below.
Curriculum Steering Committee:
Oversees curriculum changes and approves recommendations from the Curriculum Renewal Committee
Develops and revises program objectives
Monitors all educational program outcomes
Reviews major findings from the Course Evaluation Committee
Curriculum Renewal Committee:
Develops and revises curriculum structure and content
Oversees preclerkship and clerkship director committees
Ensures that course objectives are linked to educational program objectives
Ensures that pedagogical methods are appropriate to meet course and program objectives
Approves changes in pedagogy, objectives, and course hours
Engages in continuous quality improvement of the curriculum
Course Evaluation Committee:
Reviews all course and clerkship evaluations that are prepared by the Aesculapian Society
Establishes ad hoc committees to perform in-depth evaluations of courses and clerkships
Education Staff
All preclerkship courses are centrally administered by the Office of UME, with oversight by the assistant dean for UME and 2 basic science curriculum codirectors. The Office of UME has 3 full-time coordinators who provide administrative support to curriculum management and who assist course directors. Clerkships are administered by departments with central oversight by the assistant dean for UME, the Clerkship Directors’ Subcommittee, and 3 clinical curriculum codirectors.
Content directors in the disciplines of pathology, pharmacology, and microbiology work with faculty in the Office of UME and systems-based course directors to ensure adequate content coverage across courses. Faculty members in the Office of UME also work closely with basic science and clinical faculty in the development of teaching sessions across all courses to optimize integration of basic science with clinical medicine.
Areas outside of educational programming, such as student affairs, are handled by a separate office.
See Figure 1 —Organizational chart.
Figure 1: Organizational chart.
Faculty Development and Support in Education
We provide professional development for our faculty through internal and external faculty development sessions, including sessions on TBL and innovative teaching techniques. In addition, invited speakers educate our faculty on issues such as resilience and wellness. Teaching contributes significantly to the promotion and tenure process, especially for those on the tenure and full clinical tracks. Educator portfolios are used in the process. There is currently no independent educator track, but discussions regarding this are ongoing.
In an ongoing effort to improve the overall quality of the educational environment for our students, we initiated a pilot program to provide peer–peer feedback for lecturers. The aim was to provide constructive feedback to improve all lecturers’ teaching skills. While the pilot program is still in progress, a feedback survey sent to year 1 reviewees resulted in a positive response to a feedback survey questioning confidentiality, bias, and constructiveness of critiques.
Regional Medical Campuses
See Table 1 —Regional Medical Campuses.
Table 1: Regional Medical Campuses
The educational experiences are consistent across sites. Site directors for all clerkships are members of our Clerkship Directors’ Subcommittee, and they collaborate and communicate with clerkship directors at our main campus in New Orleans. The assistant dean for UME travels to both sites regularly to meet with site directors and provide support as needed.
