Transcript Bridge to 21st Century Medicine

Joseph Chen, Eve Clark, Hans House, Janna Lawrence, Frances Meyer,
Jeff Pettit, Peter Rubenstein, Kate Thoma, Teri Thomsen, Kristen Gerjevic,
Manish Aggarwal, Jill Bowman, Brandon Alleman, Nancy Rosenthal
Charge
• Design an educational structure
– Increased flexibility
– Increased integration
– Earlier clinical experience
– Enable individualized progress through the
curriculum
– Ability to incorporate other goals
• Patient and societal needs
• Maintaining competencies
• Promoting student centered education and use of
educational technologies
First 2 weeks
• Intro to medical school – basic orientation and
practical skills for success
– Intro to searching the literature
– Ethics, professionalism
• “Cornerstone” Mega-Case
– “That which all other stones are compared”
– Start to think like a doctor caring for a specific patient
– Case starts with simple anatomy, physiology, but then
becomes more complicated as learners understand more
– Can also address some psychosocial issues related to
medicine – coping with chronic disease, death, dying, etc.
– Case can be re-addressed throughout the 1st or 2nd year
First 12 weeks
• Focus on basic principles of biochemistry,
genetics, cell biology and embryology that must
be understood before specific organ system
curriculum starts.
• Combination of lectures and small group
discussion sessions.
• Basic concepts of pathology such as
inflammation, neoplasia, cellular injury, etc.
• Basic concepts of pharmacokinetics that are not
easily fit into the organ-based blocks.
Organ System-Based Curriculum*(40 weeks)
Micro/ID/Immunology
Cardiovascular
Respiratory
Renal
Hematology / Oncology
Gastrointestinal / Nutrition
Reproductive / Endocrine
Neurology / Psychiatry
Musculoskeletal/CT/Derm
6 weeks
4 weeks
4 weeks
4 weeks
4 weeks
4 weeks
4 weeks
6 weeks
4 weeks
* Courses Co-Directed by a combination of basic scientists and clinicians
Continuity / Introduction to
Clinical Medicine half-day
• Introduction to obtaining history
• Comprehensive physical examination
• Continuity of care experience
– To start in January of 1st year
– Seeing physicians interact with patients in
clinics or wards
– Aim it to integrate with organ systems
– Practical exposure to professionalism, ethics
Transition to Clinics
• 12 week course, similar to current FCP-4
and Ethics courses
• Structure can be determined
– Chief complaints?
– Organ system based?
Board review/
USMLE
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4 week block
Optional review sessions
Take the boards any time in the month
Time for remediation of courses not passed,
if needed
Required 4 week Clerkships
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Medicine – outpatient /primary care
Medicine – inpatient
Surgery – inpatient
Pediatrics
Family medicine
Obstetrics and gynecology
Psychiatry
Neurology
Critical care or Emergency Medicine
Required Electives (2 weeks)
• Surgical specialties (3)
□ Orthopedics
□ ENT,
□ Urology,
□ Opthalmology,
□ Cardiothoracic Surgery,
□ Vascular Surgery
□ Neurosurgery
□ Interventional Radiology
• Med/Peds Specialties (2)
□ EKG, Cardiology
□ Nephrology,
□ Pulmonary,
□ Rheumatology
• Chronic Disease/Disability (1)
□ Rehabilitation medicine
□ Geriatrics
□ Hospice/Palliative care
□ Chronic care (4 weeks)
• Hospital-based Specialties (2)
□ Pathology
□ Lab medicine
□ Radiology
□ Anesthesia
□ Dermatology
Keystone =
Subinternship
• Keystone: “That stone which if not present,
would not be able to form an arch”
• Must be a 4 week rotation
• Any specialty with inpatient unit
• Goal is to function as an intern
• Culmination of progressive increase in
responsibilities
Senior Seminars
• Near Match Day (before or after)
• Revisit basic sciences for specific
medical conditions pertinent to their
future career
• Taught by basic scientist, clinician, and
an allied health professional
• Improves vertical integration of basic
sciences with clinical sciences
• Week-long sessions
• Required to take two
• Examples:
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Obesity/Metabolic syndrome
Diabetes
Aspects of Medical Nutrition
Personalized medicine, etc.
• Foundation for lifetime learning
Capstone =
Highest, ultimate
stone
– Focus on necessary skills to be a successful as a house officer
– Intensive course of patient simulation for common high-yield procedures
as a house officer
– ACLS, PALS
– Reflective Writing
– Review of ethics and professionalism
– Evidence-based Medicine
– Interdisciplinary Teams
Assessment of
Competencies
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Touchstone = “that which is used to compare with all others”
– USMLE Step I and II
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Intermixed throughout curriculum
– End of 1st year,
– Before Step II,
– After core clerkships,
– After all clerkships
Related to competencies to be developed by COM
Global assessment using:
– OSCEs, Direct observations, Simulations
Increased integration
• Integration of basic science curriculum into an organ-based
format which is less departmentally-based.
• Each unit co-directed by a basic scientist and a clinician
• Early clinical exposure allows exploration before deciding
specialty career focus (middle instead of end of 2nd year)
• Transitions to clinic course that could be focused on
common chief complaints
• Interdisciplinary education with new electives in chronic
disease management, geriatrics, rehabilitation, and pain
control
• Return to basic sciences with Senior Seminars before or
after Match Day
• Capstone at the end of 4th year that emphasizes practical
house officer skills as well as reflective writing, evidenced
based medicine, and working in interdisciplinary teams
Increased flexibility in curriculum
• Earlier clinical experiences give more time to see
progressive change in roles in medicine
• 4 weeks for board review and USMLE Step 1
• Decrease in the required clerkships allows more
flexibility in student-centered learning
• Electives among variety of disciplines ensures broad
exposure to many areas and strengths of UI CCOM
• Departments will want to make clerkship experiences
positive to compete for students.
• Increased time to work on Distinction Tracks
• Increased elective time makes it easier to complete
independent scholarly activities
• Time for reflective writing and expertise of the writing
program
What we didn’t address
• Specifics of how courses should be taught
– Combination of lectures (minimized) and
small groups
• Inter-departmental priorities and ability to
collaborate on teaching similar medical
conditions
Joseph Chen, Eve Clark, Hans House, Janna Lawrence, Frances Meyer,
Jeff Pettit, Peter Rubenstein, Kate Thoma, Teri Thomsen, Kristen Gerjevic,
Manish Aggarwal, Jill Bowman, Brandon Alleman, Nancy Rosenthal