University of South Carolina School of Medicine Greenville

Medical Education Program Highlights

Through a synergistic partnership between the state’s largest public university and the state’s largest public hospital, the University of South Carolina School of Medicine (UofSC SOM) Greenville welcomed its charter class in the fall of 2012. Focused on expanding the physician workforce in South Carolina, the curriculum was developed to create a new type of graduate and a different kind of doctor: one responsive to society’s medical needs and acquainted with the foundations of the quadruple aim, structured communication, professionalism, and awareness of the socio-economic environment.

• Vision: “Cultivate a culture of curiosity and commitment to others to transform the health and wellness of communities.”
• Emergency medical technician (EMT) training¹ provides students an opportunity to better understand their patients’ life circumstances and the community in which they live, acute and subacute care delivery, and the importance of working as part of an interprofessional team.
• The Lifestyle Medicine Curriculum is a pedagogic shift to a need-based curricular approach focused on disease prevention and lifestyle-related noncommunicable chronic diseases currently affecting population health. This curricular thread is developed around the 6 pillars of lifestyle medicine—exercise, nutrition, substance avoidance, sleep, stress management, and relationships²—and creates graduates prepared to influence patient outcomes and lower costs related to chronic disease management. UofSC SOM Greenville is considered a pioneer in designing and implementing a Lifestyle medicine curriculum.³
• The fourth-year curriculum includes specialty tracks for students to assure a solid general training and preparation for their chosen specialty. Through a menu of selectives and electives, students are guided through a variety of clinical experiences to prepare for their future career. The fourth year culminates in a 2-week intensification to assure adequate knowledge and skill in core areas through small-group learning and simulation, followed by 2 weeks of intensification in their matched specialty to ensure mastery of entry-level intern skills. Several of these specialty intensifications are based on national boot camp programs.^4,5

Curriculum

Curriculum description

The curriculum is an integration of interactive experiences from classroom to clinical to community, designed to foster and enhance the acquisition and application of essential knowledge and skills including communication, diagnostic reasoning and problem-solving, critical thinking, and quality patient care.

Curricular themes:

• Integration of biomedical science and core clinical skills
• Early introduction of core clinical skills (EMT and integrated practice of medicine)
• Lifestyle medicine
• Behavioral, social, and population health
• Professionalism

The Integrated Practice of Medicine module (IPM) is a 4-year longitudinal course focused on clinical skills, behavior/social/population health, and clinical reasoning.

See Supplemental Digital Appendix 1—Curriculum Overview—at https://links.lww.com/ACADMED/A911.

Curriculum changes since 2010

• Implementation of substance use disorder curriculum (2019): Based on recommendations from vertical integration mapping of behavioral health content and in response to the local and national opioid epidemic, substance use disorder content was further integrated and medication-assisted treatment waiver training (https://www.samhsa.gov/medication-assisted-treatment) was added to the fourth-year intensification, to provide students with additional knowledge of addiction and recovery processes. Faculty partner with one of our community agencies FAVOR (Faces and Voice of Recovery) Greenville, to deliver additional curricular content.
• Delivery and assessment of biostatistics and epidemiology: The NBME Step 1 report following the 2016–2017 academic year revealed student performance below the national mean in the area of 1-PBLI: Evidence-Based Medicine. This was hypothesized to be a consequence of disjointed content delivery within the first and second years of the curriculum and the absence of summative assessments. In response to these findings, the content and distribution of evidence-based medicine/epidemiology/biostatistics material was revised. Specifically, content was adjusted to shift from the delivery of broad concepts and foundational knowledge in the first-year IPM module into more specific, granular content that was delivered and assessed in the second year. During the second year, this material was integrated into biomedical science modules where it is was assessed via summative written examinations. This approach helped improve students’ performance (NBME) and student satisfaction (AAMC Graduation Questionnaire).

Assessment

The school’s educational program objectives were initially based on core competency domains described by the ACGME and specific program objectives suggested by the AAMC’s Medical School Objectives Project. In 2019, the Curriculum Committee aligned its educational program objectives with the Physician Competency Reference Set,⁶ maintaining some of the original medical knowledge objectives to better reflect the biomedical science module objectives. In addition, a set of lifestyle medicine objectives reflect our unique curriculum and align with the Agency for Healthcare Research and Quality’s quadruple aim⁷ to improve health care through modalities outside of or adjunctive with the traditional medical model that focuses on curing diseases.

See Supplemental Digital Appendix 2—Program Objectives and Assessment Methods—at https://links.lww.com/ACADMED/A911.

These educational program objectives are the backbone for curriculum planning. As faculty develop module/clerkship content, session-level objectives are mapped to the module/clerkship-level objectives, which in turn are mapped to the educational program objectives.

Pedagogy

Our curriculum focuses on student-centered learning to support lifelong learning skills using different approaches to engage learners, reflecting the diversity of instructional methods used in the preclinical years in a recent curriculum inventory report (2018–2019), including:

• Problem-based, team-based, and self-directed learning: During first- and second-year IPM, weekly clinical reasoning cases provide a basic patient presentation and students individually review the information provided, develop a hypothesis regarding the case, and identify knowledge gaps and resources needed to follow up on their hypothesis, reinforcing the skills of lifelong learning. Small-group and case-based discussions during years 3 and 4 emphasize problem-solving skills in patient care.
• Blended learning: Our blended learning approach offers individualized and small-group computer-based, self-directed experience supported by direct interaction with faculty in a classroom setting.
• Real, standardized/simulated/virtual patients: Throughout the curriculum, students have ample opportunities for patient encounters including real and standardized patients, simulation, and online virtual patients. Practice and application of medical problem-solving skills is integrated into standardized patient encounters and simulation scenarios in the Clinical Skills and Simulation Center across all 4 years. During the clinical years, students apply their medical knowledge and clinical skills (i.e., development of a differential diagnosis, diagnostic testing, interpreting results, analysis of information, and incorporating patient concerns) through daily interactions with patients, morning reports, and rounds.

See Table 1—Preclerkship Phase Instructional Formats.

Table 1: Preclerkship Phase Instructional Formats^a

Changes in pedagogy since 2010

The instructional goal of the curriculum is to limit use of the traditional lecture-based didactic methods and encourage active learning and student-centered learning. Selection of the instructional methods is guided by the session-level objectives. Thus, various teaching methods are planned to deliver different elements of the curriculum. For example:

• Medical knowledge: Instructional delivery includes lecture, case-based instruction, small-group, large-group discussion, laboratory, and self-directed learning.
• Clinical skills: Case-based instruction, small-group, problem-based learning, laboratory, real/standardized/virtual patients, and simulation.

Clinical experiences

• During third- and fourth-year clerkships, selectives, and electives, students have a broad exposure to the clinical environment including a Level 1 trauma center, intensive care units, and inpatient wards, along with hospital-based clinics and community practices. This variety contributes to students’ understanding of all aspects contributing to the comprehensive care of the patient and resources available in various locations. The need for ancillary services is also emphasized. In addition, students have exposure to nursing home and long-term care facilities to better aid in the understanding of transitions of care. Students may elect extramural rotations during their fourth year, including global health electives.
• The distribution of clinical experiences reflects a balance that a physician would encounter in the various core specialties, while considering the overall exposure of students to inpatient and ambulatory settings in their third year.
• Medical students begin their clinical learning in the EMT program, subsequently participating in ambulance shifts and gaining an understanding of prehospital medicine as they follow patients into the clinical setting. In addition, students have sessions in the hospital and clinics as part of IPM during the first and second years.
• As part of the core clinical curriculum, all students have community-based weeks during their family medicine, internal medicine, obstetrics–gynecology, and pediatrics rotations. In addition, there are outpatient experiences in psychiatry and outpatient surgery and neurology practices; the emergency medicine clerkship places students in more rural emergency settings as well. In addition, there are elective opportunities specifically in rural family medicine and community practices.
• Many students asked for additional hospital experiences, specifically in internal medicine, so we made a deliberate shift to additional time managing acute patients, while maintaining a balance with outpatient family medicine to help students recognize illness and understand the importance of preventive care and lifestyle medicine. One of our biggest challenges has been the desire of students to see patients in the Children’s Hospital as well as labor and delivery in the affiliated tertiary care hospital, where student numbers are limited to ensure a robust learning experience. We have been fortunate to engage community physicians with the support of the clinical departments.

See Table 2—Ambulatory and Inpatient Experiences During Clerkships.

Table 2: Ambulatory and Inpatient Experiences During Clerkships^a

Curricular Governance

The faculty committee with primary responsibility for the oversight and management of the curriculum is the Curriculum Committee. The curriculum is centralized, with support provided to the various departments through administrative staff from the SOM and a transfer of dollars to cover clinical teaching and administrative roles.

See Figure 1—Curricular governance committees.

Figure 1: Curricular governance committees.

Educational Staff

The Office of Academic Affairs is responsible for the planning, implementation, evaluation, and oversight of the curriculum and for the development and maintenance of the tools to support curriculum delivery, monitoring, and management. The associate dean for curriculum is supported by 2 curriculum managers, 1 focused on preclinical and the other on clinical. Curriculum coordinators provide support for all 4 years. The senior associate dean oversees the Department of Academic Affairs, including the faculty director for assessment, manager of assessment, and assessment coordinator.

The organizational structure includes the dean as the lead for the school and the chief academic officer for the health system. The senior associate dean for academic affairs serves under the dean as the chief operations officer. Other associate deans include curriculum, GME, student affairs, faculty affairs, institutional culture and inclusivity, research, and a director for business operations and finance. The senior associate dean for academic affairs oversees student affairs and supports the educational program across the continuum.

Faculty Development and Support in Education

The Office for Faculty Affairs and Professional Development supervises the broad set of responsibilities related to faculty development with a full-time associate dean and a full-time director focused entirely on faculty development. In addition, the Office for Academic Affairs employs a director of instructional design who provides faculty development through programs and individual consultation on instructional issues, technologies, and learning theory.

Faculty also have access to professionals in the University’s Center for Teaching Excellence. These full-time staff are available for consultation regarding instructional design and general educational questions and concerns (https://www.sc.edu/about/offices_and_divisions/cte/consultations/index.php).

Role of teaching in promotion and tenure

The University of South Carolina is a Carnegie Research institution, and as such subscribes to a model where faculty must demonstrate a national or international reputation to progress to the rank of professor. This must be accompanied by tangible evidence of excellence in both scholarship and teaching. Research and scholarship including medical educational research are essential and highly valued elements in the life of the faculty member. In preparation for annual reviews, faculty compile documentation of the evidence of their accomplishments, which are included in their supplementary file for promotion.

Initiatives in Progress

• The school is currently in the process of developing the Academy for Educators, which will be open to biomedical and clinical science faculty who demonstrate excellence and a promise of growth in field of medical education.
• The Curricular Refresh team will convene in April 2020 to review vertical integration documents and Curriculum Committee recommendations in an effort to integrate value-based care and additional health system science initiatives, while enhancing commitment to the community.