Transcript Indiana University School of Medicine School Expansion

Achieving the Vision
of the IUSM
Competency Curriculum
Curriculum Reform: 5 Top Excuses
1. What’s wrong with the old curriculum?
2. If it isn’t broken, why fix it?
3. Why do we have to transform? Can’t we just
fine tune?
4. What is the evidence that the new curriculum
will be better than the old?
5. We aren’t ready. We need more time.
Courtesy of David Irby, PhD. UCSF School of Medicine
1.
What’s wrong with the old curriculum?
- It produced me and I’m terrific
LCME site visit: … our curriculum is at least 40 years
old, and is antiquated…
* New developments in Medical Education
- Clinically relevant learning focus
* New research in Adult Learning
- Variety of effective methodologies
yield beneficial outcomes
2. If it isn’t broken, why fix it?
- LCME feedback
- New integrated “Gateway Exam”
- Performance of IU students on CS/CK
- Macy Conference, 2009: “medical students too
often graduate without all of the knowledge and skills
that 21st century physicians need….”
2. If it isn’t broken, why fix it?
- 2004 Institute for Improving Medical Education Report:
“Roughly half of all deaths in the United States are linked to
behavioral and social factors.” Recommended that “medical
students [should] be provided with an integrated
behavioral and social science curriculum that extends
throughout the four years of medical school.”
- Joint Commission Report, July 2008:
“Rude language and hostile behavior among health care
professionals …poses a serious threat to patient safety and
quality of care.”
3. Why do we have to transform ? Can’t we just fine tune?
 Dean Brater’s explicit charge: “…avoid nibbling around the
edges…” and to “…create a new curriculum…”.
(March 27 2009 CCSC meeting)
 Competency Team reports: need for substantial curricular
change to fully realize the competency curriculum.
 IUSM 2008 Education Strategic Plan: faculty recommended
significant changes for IUSM medical education.
 CCSC motion re-affirms IUSM create a curriculum that will
achieve the 9 IUSM competency goals.
4. What is the evidence that the new curriculum will be better
than the old?
 New curricular structure will be intentionally
developed to align with IUSM’s nine competency
educational goals.
 Variety of medical schools have gone to an
“Integrated Curriculum” with improved CS/CK
performance.
5. We aren’t ready. We need more time.
We may not have much time
 USLME  developing an integrated “Gateway Exam”  assess
student knowledge of basic science within a clinical context.
 Peter Scoles of the NBME: “It is not too early to explore curriculum
models that encourage the interaction of basic scientists and clinicians
throughout the undergraduate curriculum and, indeed, into graduate
medical education.”
Comprehensive review of the USMLE; Peter V. Scoles; Assessment
Programs National Board of Medical Examiners, Philadelphia,
Pennsylvania; Adv Physiol Educ 32: 109–110, 2008;
Where are we now?
4 Phases of Curricular Development
Phase I:
 Environmental
Assessment
Create Guiding
Principles
Phase II:
 Create
overarching
curricular
structure
based on
principles
Phase III:
Phase IV:
Develop
Implement
specific
Assess
curricular
Continue
components to improve
Phase I: Research and Guiding Principles
Phase I
Phase II
Phase III
Phase IV
January, 2009  MECA initiated the research process.
 Reviewed local, state and national recommendations for
medical education
 Reviewed curriculum change at 20 other schools (based on
nominations from educational committees, faculty and MECA):
Boston, Brown, Colorado, Flinders, Florida State, Harvard,
Michigan State, McMaster, Missouri-Columbia, New Mexico,
North Dakota, Pittsburgh, Rochester, Stanford, Southern Illinois,
UCLA, UCSF, UCD and Vanderbilt
 Identified themes in curricular organization, content, structure,
assessment, and process
Results of MECA Research
Phase I
Phase II
Phase III
Phase IV
Key themes :
 Courses often not based in departments: integrated basic,
clinical and behavioral science. (blocks, themes or organ
systems)
 Some schools focused on self directed learning, small groups
and active learning (reduction in formal lectures)
 Early clinical experiences beginning in 1st year 
“longitudinal patient” experiences and/or weekly outpatient
clinical experiences”
 Basic science content integrated in the clinical years
2009 IUSM Guiding Principles
for Curricular Development
1.
Culture: Create and support a collaborative statewide culture
where behavioral, basic, and clinical science faculty along with,
interprofessional and education faculty work together toward the
goal of producing competent and compassionate physicians to meet
the needs of Indiana and the nation.
2.
Curricular Goals: Comprehensively teach and assess student
mastery of all nine IUSM competencies throughout all years.
3.
Curricular Structure: Organize curricular content around integrated
competency learning goals rather than disciplines and departments.
Begin clinical experiences in the first week of medical school. Extend
basic science learning experiences into all years.
IUSM Guiding Principles
for Curricular Development
4.
Educational Methods: Use paper, simulated, standardized and real
patient’s cases as the core teaching methods and increase self
directed, active and small group learning.
5.
Assessment: Identify pivotal points in the curriculum and dedicate
blocks of time for comprehensive class-wide assessment, feedback,
and development of learning plans to guide next steps.
6.
Teaching Excellence: Provide the programs and resources needed
for faculty to be outstanding teachers in an integrated, case/patientbased, interprofessional curriculum.
Next Step: Phase II
Based on the guiding principles, straw curricular
structure models will be created and shared with
key education committees and IUSM faculty for
review and input.
Phase I:
Environmental
Assessment
Create Guiding
Principles
Phase II:
Phase III:
Create
Develop
overarching
specific
curricular
curricular
structure based
components
on principles
Phase IV:
Implement
Assess
Continue to
improve
Take home Message
1. No model has been decided on or adopted.
2. Step 1 & 2 will be replaced with the Gateway Exam within 4 years
3. Integration has many degrees & moving parts
4. Input/feedback regarding the process is welcome from all quarters.
Each CCSC meeting has designated time for such interaction. Faculty
participation throughout the process is essential for success.
5. What is success?
- preservation of a strong basic science foundation
- improved CS/CK
- student satisfaction and understanding of the relevance of all
training as it relates to their chosen profession
You are invited
Please share your thoughts and ideas
throughout the process. The more
faculty input that is received, the
better the final product will be.
3. Why do we have to transform ? Can’t we just fine tune?
Dean Brater, CCSC Meeting, March 27,
2009:
“I have a philosophical bias about this, wherein,
I’m not inclined to want to think about the
curriculum and change as ‘nibbling around the
edges’ and being incremental…but look at it is as
though you parachuted here from Mars, and were
asked to design a medical education experience
for the current generation of physicians at large.
Don’t be limited by the current structures and
how we do it now.”
Why do we have to transform? Can’t we just fine tune?
Competency Team Report Recommendations: Jan. 2009
 Create sufficient protected time in the curriculum to teach and assess
the competencies
 Chart student competency progress, including reflections and peer
assessment, over time
 Increase early clinical exposure and develop targeted basic science
review during clinical rotations
 Reduce lectures in favor of small group and self-directed learning
 Use patient cases structured around key learning issues as the core
curricular methodology
 Implement annual year-end summative assessments
Why do we have to transform? Can’t we just fine tune?
2008 IUSM Education Strategic Plan
Goal 2: Re-structure the undergraduate education program so
that it fully achieves the 9 competency curricular objectives.
 Objective 3: Integration of behavioral, clinical and basic sciences
throughout the IUSM curriculum and integration and communication
across all curricular components and years to ensure comprehensive
coverage and reduce unplanned redundancy
 Objective 4: Develop early and ongoing clinical experiences,
including longitudinal and outpatient experiences
 Objective 5: Promote student-driven learning in the new curriculum
 Objective 6: Expand multidisciplinary teaching to improve patientcentered care and promote collegiality and professionalism
Curriculum Council Steering Committee
December 8, 2008
CCSC motion was made to restructure the
IUSM curriculum on the foundation of the nine
curricular objectives that IUSM has already
defined for itself  the 9 Competencies.
Motion was unanimously passed.
Many internal and external lines of evidence
point to the need to transform our curriculum
to better accomplish our 9 competency
curricular goals and to prepare our students
for the practice of medicine.
Where are we now?
IUSM 9 Competencies
I. Effective Communication
II. Basic Clinical Skills
III. Using Science to Guide Diagnosis, Management,
Therapeutics, and Prevention
IV. Lifelong Learning
V. Self-Awareness, Self-Care and Personal Growth
VI. The Social and Community Contexts of Health
Care
VII. Moral Reasoning and Ethical Judgment
VIII. Problem Solving
IX. Professionalism and Role Recognition
5.
Assessment: Identify pivotal points in the curriculum and
dedicate blocks of time for comprehensive class-wide
assessment, feedback, and development of learning plans
to guide next steps.
6. Teaching Excellence: Provide the programs and resources
needed for faculty to be outstanding teachers in an
integrated, case/patient-based, interprofessional
curriculum.
The End
Background slides:
Use as you need them
Many internal and external lines of evidence
point to the need to update our curriculum to
better prepare our students for the practice of
medicine.
Gateway Implications for
Medical Education
“Whatever forms the exam may take, there will likely be
fundamental medical science materials in all components.
It is not too early to explore curriculum models that
encourage the interaction of basic scientists and
clinicians throughout the undergraduate curriculum and,
indeed, into graduate medical education.”
Comprehensive review of the USMLE; Peter V. Scoles;
Assessment Programs National Board of Medical Examiners,
Philadelphia, Pennsylvania; Adv Physiol Educ 32: 109–110, 2008;
External Drivers:
Macy Conference, 2009
“… medical education has not kept pace with the growing public
expectations of physicians or with the novel demands of an
increasingly complex healthcare system. As a consequence,
medical students too often graduate without all of the
knowledge and skills that 21st century physicians need….”
Chairman’s Summary of the Conference on Revisiting the Medical School
Educational Mission at a Time of Expansion
Published by the Josiah Macy, Jr. Foundation, 2009
External Drivers:
Joint Commission 2008 News Release
External Drivers:
Institute for Improving Medical Education
2004 Report
“Roughly half of all deaths in the
United States are linked to behavioral
and social factors. The leading causes
of preventable death and disease in the
United States are smoking, sedentary
lifestyle, along with poor dietary habits,
and alcohol consumption.”
The IIME Recommendation?
“medical students [should]
be provided with an
integrated behavioral and
social science curriculum that
extends throughout the four
years of medical school.”
Key national reports and
studies point to a need
for improving medical
education
External Drivers:
USMLE New Gateway Exam
The USMLE is developing a Gateway exam that will
integrate basic science knowledge within a clinical
context, to better reflect medical practice.
IUSM students need to be prepared.
Committee to Evaluate the USMLE Program
Summary of Final Report and Recommendations
June, 2008
Recommendation #3
Committee to Evaluate the USMLE Program recommends
that USMLE emphasize the importance of the scientific
foundations of medicine in all components of the
assessment process. The assessment of these
foundations should occur within a clinical context
or framework, to the greatest extent possible.
First Steps: IUSM Guiding Principles
for Curricular Development
1. Culture
Create a collaborative statewide culture where behavioral, basic,
and clinical science faculty along with, interprofessional and
education faculty work together toward the goal of producing
competent and compassionate physicians to meet the needs of
Indiana and the nation.
Develop an institutional culture that supports and expects ongoing
curricular innovation and improvement
2. Curricular Goals
The nine IUSM competencies are the IUSM core curricular goals.
Comprehensively teach and assess student mastery of all nine
IUSM competencies throughout all years.
Graduate only those students who have demonstrated achievement
in all of the competencies.
IUSM Guiding Principles for Curricular
Development, continued
3. Curricular Structure
Organize curricular content around integrated competency learning goals
rather than disciplines and departments.
Begin clinical experiences in the first week of medical school and student
immersion in outpatient or similar patient care venues beginning early in the
first semester and continuing through all years.
Extend basic science learning experiences into all years.
Expand behavioral science learning experiences in all years
Ensure curricular time for students to customize their education through
elective opportunities. Students will apply to enter thematic tracks immediately
or declare a focus of interest by the end of the first semester of the first year.
4. Educational
Methods
Develop integrated teams of basic, behavioral, clinical science,
interprofessional and education faculty to develop, lead and assess curricular
learning experiences.
Use paper, simulated, standardized and real patient’s cases as the core
teaching methods.
Increase self directed, active and small group learning as well as decrease &
cap lecture time.
Increase interprofessional learning experiences.
IUSM Guiding Principles for Curricular
Development, continued
5. Assessment
Build in ongoing curricular time for formative assessment and
feedback to students.
Identify pivotal points in the curriculum and dedicate blocks of time
for comprehensive class-wide assessment, feedback, and development
of learning plans to guide next steps.
Document and track results of formative and summative assessments
in an e-portfolio
6. Teaching Excellence
Provide the programs and resources needed for faculty to be
outstanding teachers in an integrated, case/patient-based,
interprofessional curriculum.
Support and reward the scholarly work of faculty leaders designing
and implementing the new curriculum
Align faculty financial reporting and reimbursement structures,
based on both quantity and quality teaching measures, as well as
incentives and rewards for quality educational efforts with the goals of
the new curriculum.
Small Groups/Active Learning
School A
d
School C
d
d
School B
Small Groups/Active Learning
School A
Small Groups/Active Learning
School B
Small Groups/Active Learning
School C
d
d
d
School A
Early Clinical Experiences
School B
Early Clinical Experiences
School A
Early Clinical Experiences
School B
Integration
(Basic, Clinical and Social Science)
Integration
(Basic, Clinical and Social Science)
Integration
(Basic, Clinical and Social Science)
Integration
(Basic Science in Clinical Years)