Year: 2020
Type: article
Abstract: Medical Education Program Highlights The Brody School of Medicine (BSOM) fulfills the threefold mission of increasing the supply of primary care physicians serving the state, enhancing the access of minority and disadvantaged students to a medical education, and improving the health status of citizens in eastern North Carolina. Our commitment to service and mission are highly valued by the BSOM community. BSOM is in the top 10% of U.S. medical schools for graduating physicians who practice primary care, practice in the state, and practice in rural and underserved areas. During the past 30 years, BSOM has contributed to improvement in health outcomes and narrowed health care disparities for residents in eastern North Carolina. BSOM is in the top 10% of U.S. medical schools graduating physicians who identify as Black/African American or American Indian/Alaskan Native. Curriculum Curriculum description The BSOM curriculum offers early immersion in a variety of clinical settings while laying the foundation of knowledge for the practice of medicine. Education is delivered in a spiral architecture with planned, spaced repetition that ensures students return to key concepts with increasing complexity. The 20-month foundational phase begins in August and consists of traditional basic sciences content embedded within courses that begin to develop clinical skills, critical thinking, and understanding of social and systemic forces in health systems. This phase provides immersion in clinical care experiences, including a longitudinal primary and community care preceptorship. Activities focused on professional identity formation, wellness, lifelong learning skills, and reflection are woven throughout the reenvisioned Foundations of Doctoring course. The Molecular Basis of Medicine course integrates cellular and biochemical function with its expression in genetic conditions. Newly designed organ-systems courses integrate pathophysiology, pharmacology, and clinical applications. The 12-month clinical phase, beginning in April, includes 6 core clerkships and 4 weeks of electives. Electives provide additional time for career exploration and the residency selection process. The radiology clerkship is a longitudinal experience integrated and aligned with each of the core clerkships. The 13-month differentiation phase begins in April and is the final phase of the curriculum. It includes the required advanced core clerkships and ample elective time for exploration of career interests and individualization of learning experiences. The Transition to Year 4 course prepares students through interprofessional simulation activities, standardized patient encounters, and other advanced workshops. Neurology and physical medicine & rehabilitation is a new 4-week clerkship focused on both acute and chronic presentations of neurological and musculoskeletal conditions. A newly designed Transition to Residency course with specialty specific integration of foundational sciences refocuses students on foundational concepts needed for success in residency training. The innovative health systems science (HSS) curriculum is longitudinally interwoven throughout the 4-year curriculum to prepare students to care for patients, families, and communities in a rapidly changing health care environment. See Supplemental Digital Appendix 1—Curriculum Schematic—at https://links.lww.com/ACADMED/A888. Curriculum changes since 2010 The BSOM curriculum was revised in 2016 to prepare students to work in the health systems of tomorrow by integrating basic sciences and clinical skills, providing early immersion in patient care experiences, and incorporating HSS as the third pillar of medical education. Key curricular changes include: Longitudinal HSS curriculum Increase in problem-based learning, simulation, and self-directed learning Expansion of interprofessional education Reorganization of the foundational science curriculum Integrated neurology and physical medicine and rehabilitation clerkship In addition to the formal curriculum, 4 longitudinal cocurricular distinction tracks (research, medical education and teaching, health care transformation and leadership, service learning) allow students to pursue in-depth professional development based on individual interests. The matriculating class size increased from 82 to 86 in 2017. Assessment In 2012, BSOM developed new institutional learning objectives through an iterative process anchored on the mission of the school. The ACGME competency domains were selected as an organizing framework. In 2016, the ACGME milestones and the AAMC Core Entrustable Professional Activities were used to identify emerging competencies (HSS and interprofessional education) needed to bridge the continuum from undergraduate medical education to graduate medical education. Curricular design focused on assessment models that incorporated spaced repetition and retrieval. Practice questions provide formative feedback and evidence to drive self-directed learning. Comprehensive, blended computer assessments are administered for all quizzes and exams. Formative progress testing using the NBME Comprehensive Basic Science Examination occurs in the foundational phase. OSCEs have been expanded throughout the curriculum, and cases have been reformulated to address emerging issues that affect health and society. See Supplemental Digital Appendix 2—Program Objectives and Assessment Methods—at https://links.lww.com/ACADMED/A888. Pedagogy We use a variety of pedagogical approaches based on institutional learning objectives: Case-based learning and discussion, audience response, and problem-solving activities are integrated into lectures to increase student engagement. Our longitudinal Foundations of Doctoring course uses small groups, problem-based learning, role play, standardized patients, simulation, preceptorships, and clinical experiences to promote critical thinking and clinical skills. Laboratory sessions are used throughout the foundational phase to facilitate active learning. Clinical experiences are balanced in the ambulatory and inpatient settings. Other techniques include workshops, flipped classroom, case analysis, peer teaching, research presentations, and educational gaming. Since 2010, learner-centered, experiential, and active learning strategies have been increasingly emphasized. Included are earlier clinical experiences, increased formative feedback, problem-based learning, and flipped classrooms. Increased emphasis has been placed on incorporation of simulation, especially in the foundational phase of the curriculum. Clinical experiences Clinical experiences in the foundational phase occur in community primary care practices that reinforce the patient-centered medical home model of care. The majority of required clinical training in the clerkship and differentiation phases of the curriculum is provided on our health science campus and through our teaching hospital, Vidant Medical Center. Longitudinal experiences include: Foundations of Doctoring course where students participate in a 20-month longitudinal small-group curriculum focused on critical thinking and clinical skills. Students complete a longitudinal primary care preceptorship. Radiology clerkship extends over 12 months and is integrated with the core clerkships to emphasize relevant imaging modalities. HSS is longitudinally interwoven throughout the entire curriculum. Student immersion in clinical settings begin the first week of medical school with shadowing and interprofessional experiences. Simulation and clinical skills sessions prepare students for clinical immersions that begin early in the first year. Outpatient community-based rotations throughout the state are components for 4 weeks of the family medicine clerkship and 2 weeks of the pediatrics clerkship. On the psychiatry clerkship, students have the opportunity to rotate at a variety of sites including a state psychiatric facility, inpatient and outpatient community sites, substance treatment facilities, and an outpatient Veterans Administration facility. Students have a required ambulatory primary care fourth-year clerkship experience that may be community based. Affiliations with community clinical partners have become increasingly challenging as medical schools have expanded. Perceived time constraints and financial impacts, including preceptor payments, are challenges for both institutional and community-based clinical faculty. Appropriate housing for community rotations is a challenge for all our health sciences schools. As we moved to a shortened foundational phase, preserving time for clinical experiences in the foundational phase of the curriculum requires careful attention. Curriculum Governance The Executive Curriculum Committee (ECC) is responsible for institutional oversight and designs, monitors, and evaluates the curriculum. Recommendations for content and structural changes are informed by annual retreats and supported by year curriculum and other committees. The Office of Medical Education (OME) along with the Office of Data Analysis and Strategy offer support through data generation and report creation needed to monitor and evaluate the curriculum. Resource members representing the East Carolina University Health Sciences Library, information technology, faculty development, and diversity affairs ensure appropriate resources for curriculum delivery. The budget distribution for teaching uses a shared governance model. State teaching dollars are distributed by the Division of Academic Affairs to individual departments based on an educational RVU system to support faculty teaching. Course and clerkship director recommendations are made jointly by the OME, senior associate dean for academic affairs, and department chairs before review and approval by the ECC. The foundational science courses and faculty are supported centrally through curriculum coordinators in the OME. The clinical departments employ clerkship coordinators to manage and coordinate medical student activities. See Figure 1—Curriculum management and governance structure.Figure 1: Curriculum management and governance structure.Education Staff The OME enhances the undergraduate medical education mission through supporting the process of accreditation, leadership in curriculum development, programmatic evaluation, and student assessment. The office is led by the associate dean for curricular innovation in medical education and includes an associate dean for medical education (accreditation), an assistant dean of medical education outcomes and assessment, and a staff of 8 who support the educational program. Administrative support for the foundational science courses and curriculum committees is provided to ensure planning, implementation, evaluation, and oversight of the curriculum. Administration of a systematic course review system—including annual course/clerkship reviews and 3-year course reviews; curriculum mapping; tracking of required clinical experiences and procedures; testing administration; and evaluations of students, faculty, and course/clerkships—is provided through the office. The distinction tracks, longitudinal HSS curriculum, and Teachers of Quality Academy (TQA) are administered through the OME. The OME is an office in the Division of Academic Affairs and collaborates with the offices of Clinical Simulation, Faculty Development, Student Affairs, Clinical Skills, Diversity Affairs, and Student Development and Academic Counseling to effectively deliver the curriculum and support learners. Faculty Development and Support in Education All faculty receive support from the Office for Faculty Excellence (OFE) that includes education and support for research and teaching methods across the university. Our BSOM Office for Faculty Development (OFD) partners with the OFE to bring programming to the Brody campus. The OFD provides programming tailored to our curricular and faculty needs, a mentoring program for junior faculty, and individual consultations to all faculty. Through the Academic Skills for Medical School Faculty Workshop Series, faculty members can develop and enhance their skills as teachers, clinicians, researchers, and educational leaders. Every year, the OME hosts Medical Education Day, a day we celebrate innovation and scholarship and advance best practices in education. We also hold a course and clerkship directors bootcamp that supports the growth and development of educational leaders at BSOM. Additionally, we have partnered with East Carolina University’s College of Education to offer a graduate-level certificate program, Education in the Health Care Professions, that can be applied to a Master of Arts in Adult Education. The Division of Academic Affairs supports external faculty development for educators and educational coordinators. Teaching is evaluated and valued, along with service, research, and creative activity, in the promotion and tenure process. Documentation of teaching quality, including peer observation of teaching, is a requirement of the promotion and tenure process for all faculty. Educational grants and manuscripts may be used to fulfill the expectations for scholarly productivity. We are fortunate to have a cadre of master educators recognized and nominated by their peers and learners. The Master Educator Program recognizes excellence in education in any of the following areas: educational leadership and administration, outstanding teaching or mentorship contribution, educational innovation and curriculum development, educational evaluation and research, faculty development in education, and outstanding educational contribution by a community physician. This program offers a wealth of experience to assist faculty in their teaching roles. The TQA is a professional development program for health care leaders designed to fundamentally change care delivery through a curriculum focused on building knowledge and skills in HSS. Interprofessional participants engage in advanced learning, apply these skills in projects across the health system, teach others in their environment, and evaluate the outcomes of improvement interventions. Leading by example, TQA participants promote a culture of quality and safety across our enterprise and serve as experts for curricula development for HSS educational experiences.
Source: Academic Medicine
Authors: Luan Lawson, David Gilbert, Robert G. Carroll, Stephen Charles, Kendall M. Campbell
Language: English
Field: Medicine
Domain: Health Sciences
SDG: Quality education
Open Access status: bronze
OpenAlex ID: W4233049255