Transcript Curriculum Renewal at the Iowa Carver College of Medicine

RECIPROCAL INTEGRATION:
Medical Curriculum Model
University of Iowa
Carver College of Medicine
Curriculum Renewal Modeling Committee
Report
September 27, 2010
Team Members
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Anderson, Jason
Axelson, Rick D
Brown, Donald
Christine, Paul J
England, Sarah K
Fox, Daniel K
Haugsdal, Michael L
Hoffmann, Darren S
Khaja, Sobia
Lenoch, Susan
Liu, Vincent
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Longley, Thomas W
Murray, Jeff
Rahhal, Amal
Rowat, Jane
Smith, Mark C
Sugg, Sonia
Takacs, Elizabeth B
Wickham, Gerald P
Willemsen-Dunlap, Ann
Zeitler, William A
Overview
• I. Strategy
• II. Permeating Themes
• III. Pedagogical Considerations
• IV. Reciprocal Integration Model
• V. Model Analysis
• VI. Conclusions
Overview
• I. Strategy
• II. Permeating Themes
• III. Pedagogical Considerations
• IV. Reciprocal Integration Model
• V. Model Analysis
• VI. Conclusions
Strategy
• Charge
• Approach
Charge
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Provide flexibility to accommodate new knowledge
Improve integration of basic, clinical, social sciences
Address patient & societal needs
Provide earlier clinical experience
Encompass competencies
Promote student-centered learning
Maximize use of educational & informational
technologies
Enable individualized progress
Approach
• Create ideal Iowa medical graduate
• Propose original curricular elements
• Review literature
• Draft original curricula
• Consider curricula at other medical schools
• Integrate into one model
Overview
• I. Strategy
• II. Permeating Themes
• III. Pedagogical Considerations
• IV. Reciprocal Integration Model
• V. Model Analysis
• VI. Conclusions
Permeating Themes
• Integrate basic and clinical sciences, both
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vertically and horizontally
Optimize opportunity for career exploration
Ensure exposure to spectrum of conditions
encountered in primary care
Optimize pedagogical aspects of curriculum
Provide “core” and “dynamic” components to
curriculum to accommodate changing medical
knowledge and to accommodate different
learning styles
Attend to personal as well as professional needs
of students
Overview
• I. Strategy
• II. Permeating Themes
• III. Pedagogical Considerations
• IV. Reciprocal Integration Model
• V. Model Analysis
• VI. Conclusions
Pedagogical Considerations
• Curricular oversight critical=> Curriculum
Oversight Committee
• Evaluation of process and goals of student
evaluations
• Eclectic combination of various curricular
models
– Organ-based
– Case-based
– Presenting-complaint based
Overview
• I. Strategy
• II. Permeating Themes
• III. Pedagogical Considerations
• IV. Reciprocal Integration Model
• V. Model Analysis
• VI. Conclusions
RECIPROCAL INTEGRATION CURRICULAR MODEL
Basic Sciences Boot camp
1st Year
Dec
Foundations of Clinical Practice
PPD
Re-evaluation of pedagogical techniques (e.g.
Communication
small groups)
Mentoring
Learning Communities Connection
Small Group Component
Re-evaluation of assessment, value, resources,
Attaching EMR to H&P
and time
Jan
Feb
March
Systems and Disease
April
Human Organ Systems
Physiology
Histology
Immunology
May
June
Pharmacology
Pathology
Microbiology
** Integrated Small Group **
Foundations of Clinical Practice***
Physical Exam Skills
Introduction to Presenting Complaint Learning (PCL)
Evidence based medicine
Break
Oct
Nov
Foundations of Basic Sciences
Anatomy, Neuroanatomy, Embryology
Biochemistry
Genetics
Cell biology
(Intro/Basic) histology*
Intersession
Sept
Break
Aug
Intersession
July
Continuity of Care Clerkship
Jan
Feb
March
April
** Integrated Small Group **
Foundations of Clinical Practice***
Physical Exam Skills
Introduction to Presenting Complaint Learning (PCL)
Evidence based medicine
Intersession
Pharmacology
Pathology
Microbiology
Foundations of Clinical Practice
May
June
Internal Medicine Block (Composed of
Inpatient and Outpatient)
Intersession
Dec
Break
Break
Human Organ Systems
Physiology
Histology
Immunology
Nov
Complete Step 1
Oct
Clinical Beginnings
Sept
Systems and Disease
Boards Preparation
Aug
Intersession
July
2nd Year
**Must be taken during the M3 Year**
Continuity of Care Clerkship
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
March
April
May
June
3rd Year
Family Medicine and Cognitive Behavioral Sciences
(Encompassing Family Medicine, Community Based Primary
Care, Dermatology, Psychiatry, and Neurology)
**Student must take either FM/CBS block or OB/GYN Pediatric
block during the M3 year. One could be moved to a different
position allowing 3 more electives in the M3 year**
**Must be taken during the M3 Year**
Elective
Elective
OB/GYN and Pediatrics Block
Intersession
Intersession
Intersession
Surgical Block (Encompassing General Surgery, Ophthalmology,
Orthopedic, Otolaryngology, and Urology)
**Student must take either FM/CBS block or OB/GYN Pediatric
block during the M3 year. One could be moved to a different
position allowing 3 more electives in the M3 year**
Continuity of Care Clerkship
Jan
Feb
March
April
Intersession
Critical Care Block (Encompassing Emergency Medicine,
Critical Care, Anesthesia, EKG, and Radiology)
**Must be taken in the M4 Year**
Continuity of Care Clerkship
May
Commencement
Dec
Elective
Sub-Internship
Elective
Elective
Elective
Nov
Elective
Oct
Complete Step 2
Sept
Elective
Aug
**Pre-requisites of Medicine, Surgical, and
either FM/CGS or OBG/Peds Block
required**
July
4th Year
June
Residency
“Reciprocal Integration”
• Mutual integration
– Interweaving of basic and clinical sciences throughout
the four years of medical school
– Collaboration across medical specialties/fields as well
as across the health care team
• Goal: to prepare a versatile, complete physician
who is equipped to act in the best interest of the
patient and society through teamwork and an
ability to stay current with medical knowledge
1st year (M1)—
Feb
March
April
May
Systems and Disease
Human Organ Systems
Pharmacology
Physiology
Pathology
Histology
Microbiology
Immunology
** Integrated Small Group **
Foundations of Clinical Practice***
Physical Exam Skills
Introduction to Presenting Complaint Learning (PCL)
Evidence based medicine
Continuity of Care Clerkship
June
Break
Foundations of Clinical Practice
PPD
Re-evaluation of pedagogical
techniques (e.g. small groups)
Communication
Learning Communities
Mentoring
Connection
Small Group Component
Re-evaluation of assessment,
value, resources, and time
Attaching EMR to H&P
Jan
Intersession
Dec
Break
Sept
Oct
Nov
Foundations of Basic Sciences
Anatomy, Neuroanatomy, Embryology
Biochemistry
Genetics
Cell biology
(Intro/Basic) histology*
Intersession
Basic Sciences Boot camp
Aug
Basic Science Primer
• Description: Course providing fundamental basic science
• Duration: 2 weeks
• Goal: Ensure all students of diverse backgrounds
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equipped with tools for successful mastery of basic
science
Components
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Molecular/cell biology
Biochemistry
Immunology
Biostatistics
Introduction to evidence-based medicine
Introduction to ethics
Personal Wellness Exploration
• Description: Longitudinal care experience utilizing one’s own
personal health and wellness as a venue for learning the
application of basic science to clinical care
• Duration: over 4 years
• Goal: To expose students to the principles of public health,
wellness (including nutrition, diet, exercise, and other
identifiable environmental components, as well as genetic
predisposition) at the personal level.
• Components
– A series of short lectures
– Coupled to small groups
– Incorporate wellness aspects such as nutrition, exercise, public health,
and genetics
– Opportunity for self-reflection
Continuity of Care Clerkship
• Description: Longitudinal care experience
• Duration: 4 years x ½ day/week
• Goal: To progressively develop clinical skills in a
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closely monitored fashion, thereby offering early
clinical exposure, mentorship, and development
of independence.
Components
– Pairing with a “Master Clinician” mentor
– Weekly 1/2-day clinical sessions
– May utilize rotating schedule of 2-3 mentors
Foundations of Basic Science
• Description: Course on core basic sciences that serve as
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the basis for clinical practice
Duration: 16 weeks
Lectures and complementary small group interaction
Goal: Provides the tools required for learning in an
organ-based approach.
Components
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Biochemistry
Cell biology
Anatomy/neuroanatomy/embryology/histology
Genetics
Human Organ Systems & Disease
• Description: Organ-systems approach to the
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normal and abnormal human condition
Duration: 38 weeks
Goal: Provides understanding of how disease
states represent disturbances of the normal
human condition on a molecular, cellular, and
organ level
Components
– Encompasses current HOS curriculum
– Plus integration of microbiology and immunology
Foundations of Basic Science:
Biochemistry
Cell biology
Anatomy/neuroanatomy/embryology/histology
Genetics
Systems and Disease:
HOS (normal): physiology, histology, anatomy
Path (abnormal): pathology, pharmacology
Cellular:
Histology, Immunology, Microbiology
Integration: Small groups, Continuity of Care clerkship etc…
1st year (M1)—
Feb
March
April
May
Systems and Disease
Human Organ Systems
Pharmacology
Physiology
Pathology
Histology
Microbiology
Immunology
** Integrated Small Group **
Foundations of Clinical Practice***
Physical Exam Skills
Introduction to Presenting Complaint Learning (PCL)
Evidence based medicine
Continuity of Care Clerkship
June
Break
Foundations of Clinical Practice
PPD
Re-evaluation of pedagogical
techniques (e.g. small groups)
Communication
Learning Communities
Mentoring
Connection
Small Group Component
Re-evaluation of assessment,
value, resources, and time
Attaching EMR to H&P
Jan
Intersession
Dec
Break
Sept
Oct
Nov
Foundations of Basic Sciences
Anatomy, Neuroanatomy, Embryology
Biochemistry
Genetics
Cell biology
(Intro/Basic) histology*
Intersession
Basic Sciences Boot camp
Aug
Foundations of Clinical Practice
• Description: Course providing the practical skills
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and knowledge for the practice of clinical
medicine
Duration: 66 weeks
Goal: To train medical students to think and act
like physicians, with emphasis on basic science
application
Components
– Expansion of current FCP curriculum
– Specific adoption of presenting complaints learning
paradigm
Integrated Small Group Bridge
• Description: Course bridging Human Organ Systems & Disease
with Foundations of Clinical Practice
• Duration: 38 weeks
• Goal: Provides explicit platform for integration of clinical
context to basic science instruction
• Components
– “Patient-centered Vertical Vignette”
– hypothetical patient cases that serve as curricular vehicles that move
with the students as they progress through the chronological curriculum
sequence
– serve as educational strands that unify the curriculum longitudinally
– e.g. autoimmunity topic addressed in HOS-D is illustrated in hypothetical
patient with lupus erythematosus, whose clinical findings are mastered
in FCP, and re-addressed later in discussion of renal pathophysiology,
etc.
– Case-presentation and presenting complaint-based series of cases
2nd year (M2)—
** Integrated Small Group **
Foundations of Clinical Practice***
Physical Exam Skills
Introduction to Presenting Complaint Learning (PCL)
Evidence based medicine
Dec
Jan
Feb
March
Foundations of Clinical Practice
Continuity of Care Clerkship
April
Intersession
Boards Preparation
Complete Step 1
Clinical Beginnings
Intersession
Sept
Oct
Nov
Systems and Disease
Human Organ Systems
Pharmacology
Physiology
Pathology
Histology
Microbiology
Immunology
Break
Aug
Intersession
Break
July
May
June
Internal Medicine Block
(Composed of Inpatient and
Outpatient)
**Must be taken during the
M3 Year**
Intersessions
• Description: Periodic week-long intervening sessions at the
start of each clinical clerkship and between basic science
courses
• Duration: 1 week
• Goal: To provide dedicated time to basic science integration
into the clinical years, and for explicit incorporation of other
health-related issues (e.g. ethics, safety/quality, etc) into the
basic science years
• Components
– Basic science review and application during clinical clerkships to provide
the basic science groundings for the subsequent clinical experience
– Allied health issues incorporated into basic science years
– Potential time for addressing remediation issues
– Dynamic curriculum
3rd year (M3)—
**Must be taken during the M3 Year**
Dec
Jan
Family Medicine and Cognitive
Behavioral Sciences (Encompassing
Family Medicine, Community Based
Primary Care, Dermatology,
Psychiatry, and Neurology)
**Student must take either FM/CBS
block or OB/GYN Pediatric block during
the M3 year. One could be moved to a
different position allowing 3 more
electives in the M3 year**
Feb
March
April
May
June
OB/GYN and Pediatrics Block
Continuity of Care Clerkship
**Student must take either FM/CBS
block or OB/GYN Pediatric block during
the M3 year. One could be moved to a
different position allowing 3 more
electives in the M3 year**
Elective
Surgical Block (Encompassing General
Surgery, Ophthalmology, Orthopedic,
Otolaryngology, and Urology)
Nov
Elective
Oct
Intersession
Sept
Intersession
Aug
Intersession
July
Required Clinical Blocks/Clerkships
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Description: Core clinical experiences deemed necessary for all medical
graduates
Duration: 5 blocks x 12 weeks/block = 60 weeks
Goal: To provide spectrum of clinical experiences required of primary care
and to offer career exploration
Components:
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Cerkships grouped into integrated blocks to facilitate interdisciplinary
integration
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Internal medicine (inpatient + outpatient)
Surgery (general surgery + surgical subspecialties)
Family medicine + Cognitive/behavioral medicine (neurology + psychiatry)
OB/Gyn + Pediatrics
Critical care (emergency medicine + critical care unit + anesthesia + radiology) (M4)
M3: IM + Surg + either FM/CBM or Ob/Gyn/Peds
Within the integrated block, different sequences/tracks of experiences may be
offered
Sub-internship (4 weeks)
4th year (M4)—
March
April
Critical Care Block (Encompassing
Emergency Medicine, Critical Care,
Anesthesia, EKG, and Radiology)
**Must be taken in the M4 Year**
Continuity of Care Clerkship
May
Commencement
Feb
Intersession
Jan
Elective
Elective
Dec
Complete Step 2
Nov
Elective
**Pre-requisites of Medicine,
Surgical, and either FM/CGS or
OBG/Peds Block required**
Oct
Sub-Internship
Sept
Elective
Aug
Elective
Elective
July
June
Residency
Clinical Electives
• Description: Non-required, multidisciplinary,
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clinical experiences
Duration: 32 weeks
Goal: To offer a breadth and depth of clinical
experiences to enable students to make
informed career decisions and to enhance their
clinical knowledge and skills
Components
– Emphasis on multidisciplinary approach
– e.g. cutaneous oncology=onc, derm, surg, etc.
Overview
• I. Strategy
• II. Permeating Themes
• III. Pedagogical Considerations
• IV. Reciprocal Integration Model
• V. Model Analysis
• VI. Conclusions
Model Analysis
• Charge
• Resource implications
Charge
•
•
•
•
•
•
•
•
Provide flexibility to accommodate new knowledge
Improve integration of basic, clinical, social sciences
Address patient & societal needs
Provide earlier clinical experience
Encompass competencies
Promote student-centered learning
Maximize use of educational & informational
technologies
Enable individualized progress
Charge
• Provide flexibility to accommodate new knowledge
•
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•
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“Core-dynamic” concept- intersessions
Clinical experience blocks
Attention to pedagogy
Curriculum Oversight Committee
Increased and earlier elective time
Improve integration of basic, clinical, social sciences
Address patient & societal needs
Provide earlier clinical experience
Encompass competencies
Promote student-centered learning
Maximize use of educational & informational technologies
Enable individualized progress
Charge
• Provide flexibility to accommodate new knowledge
• Improve integration of basic, clinical, social sciences
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•
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Intersessions
Curriculum Oversight Committee
Personal Wellness Exploration
Integrated Small Group
Clinical experience blocks
Multidisciplinary electives
Address patient & societal needs
Provide earlier clinical experience
Encompass competencies
Promote student-centered learning
Maximize use of educational & informational technologies
Enable individualized progress
Charge
• Provide flexibility to accommodate new knowledge
• Improve integration of basic, clinical, social sciences
• Address patient & societal needs
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Intersessions
Focus on primary care issues in curricular design
Personal wellness exploration
Preservation of service distinction tracts
Preservation of learning commuities
Provide earlier clinical experience
Encompass competencies
Promote student-centered learning
Maximize use of educational & informational technologies
Enable individualized progress
Charge
•
•
•
•
Provide flexibility to accommodate new knowledge
Improve integration of basic, clinical, social sciences
Address patient & societal needs
Provide earlier clinical experience
– Continuity of Care clerkship
– Earlier formal entrance to clinical clerkships (April, 2nd year)
• Encompass competencies
• Promote student-centered learning
• Maximize use of educational & informational
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technologies
Enable individualized progress
Charge
•
•
•
•
•
Provide flexibility to accommodate new knowledge
Improve integration of basic, clinical, social sciences
Address patient & societal needs
Provide earlier clinical experience
Encompass competencies
– Call to re-evaluate evaluation methods
– Curricular Oversight Committee
• Promote student-centered learning
• Maximize use of educational & informational
•
technologies
Enable individualized progress
Charge
•
•
•
•
•
•
Provide flexibility to accommodate new knowledge
Improve integration of basic, clinical, social sciences
Address patient & societal needs
Provide earlier clinical experience
Encompass competencies
Promote student-centered learning
–
–
–
–
Personal wellness exploration
Continuity of care clerkship (mentorship)
Greater schedule flexibility
Call to re-evaluate evaluation methods
• Maximize use of educational & informational technologies
• Enable individualized progress
Charge
•
•
•
•
•
•
•
Provide flexibility to accommodate new knowledge
Improve integration of basic, clinical, social sciences
Address patient & societal needs
Provide earlier clinical experience
Encompass competencies
Promote student-centered learning
Maximize use of educational & informational technologies
– Personal Wellness exploration
– Attention to safety and quality (explicitly during intersessions)
• Enable individualized progress
Charge
•
•
•
•
•
•
•
•
Provide flexibility to accommodate new knowledge
Improve integration of basic, clinical, social sciences
Address patient & societal needs
Provide earlier clinical experience
Encompass competencies
Promote student-centered learning
Maximize use of educational & informational technologies
Enable individualized progress
– Greater flexibility in scheduling
– Continuity of care clerkship for longitudinal evaluation
– Intersessions
Resource Implications
• Creation of Curriculum Oversight Committee
• Continuity of Care clerkship
• Intersessions scheduling requirements
Overview
• I. Strategy
• II. Permeating Themes
• III. Pedagogical Considerations
• IV. Reciprocal Integration Model
• V. Model Analysis
• VI. Conclusions
Conclusions: Key Features of
“Reciprocal Integration” Model
• Earlier clinical exposure (e.g. through Continuity of Care clerkship, earlier
entrance into the formal clinical clerkships [by April of 2nd year], etc.)
emphasizing relevance of basic science to clinical medicine and allowing for
achievement of more advanced clinical skill level by graduation
• Conscious attention to integration of basic and clinical sciences (e.g. through
Intersessions, Personal wellness course, etc) and to pedagogy (through
curricular oversight, etc) fosters conceptual connections to be made by the
student and facilitates broader and deeper learning (‘spiral model’)
• Increased (8 months) and earlier (as soon as April of second year) elective
time opportunities that allow for individualized learning and greater
opportunities for exploration of career goals
• Provision of longitudinal mentorship opportunities (e.g. through Continuity
of Care clerkship, etc.) to cultivate personal and professional development