Clinically Centered Education, with Reinforced Foundations

1. Clinically Centered Education, with Reinforced Foundations Members: Marc Pizzimenti, Charles Clark, Jeff Emrich, Jill Endres, Paul Leonard, Marygrace Elson, Erwin Shibata, Jack Stapleton, Michael Takacs, Kelly Thormodson, Jerry Weiss, Jaci Haugsdal, Mara Determan, Joshua Fischer, Eric Kaiser Steering Committee Liaisons: Kristi Ferguson, Mark C Wilson, Tim Thomsen

2. Primary Idea • Move students from discipline overviews/concepts to experiencing the multifacets of medicine (and back) throughout the curriculum •  Reliance on lecture (traditionally defined) • Independent/group learning fostered • Distribution of foundational and clinical sciences across the continuum of curriculum • Experiences are content relevant and demonstrate integration across disciplines

3.  Lecture Use • CCOM has large percentage of lecture use • CCOM also effectively uses small group exercises • Expand activites • Module learning • Online learning • Large Lecture “Discussions” Barzansky, 2009; CCOM database, AAMC database

4. CCOM Curriculum Renewal Year I, Sem. 1 Macro Medicine (Anatomy (with lab), Embryology, Imaging) Clinical links in the curriculum Cellular and Molecular Medicine (Biochem, Genetics, Cell Bio) Clinical Continuity Experience FCP I: CBL and PPD The ‘Well Patient Visit’ - Interviewing, history, and comprehensive PE Restructure the Foundational Sciences:  independent/group learning,  lecture ,  discussion oriented small/large group meetings

5. Well-Patient Visit • Year I Semester 1 • Focus on Interviewing and basic skills • Clinical Observation • Simulated Patient • Interview, Hx • PE • Year I Semester 2 • Focus on comprehensive PE • Participate in clinical visits • Practice • Limitations • Available visits • Student travel • Scheduling

6. Clinical Links in the Curriculum • Self/Group directed learning modules • simulation, cases, interactive on-line, procedural observation and reflection, etc.) • Faculty guidance, debriefing • Promote understanding of basic science concepts and illustrate clinical relevance • Example: Chest-Tube Insertion

7. CCOM Curriculum Renewal Year I, Sem. 2 HOS Clinical links in the curriculum Mind, Brain, Behavior Clinical Continuity Experience FCP II: CBL and PPD The ‘Well Patient Visit’ - Interviewing, history, and comprehensive PE • Allows for participation and integration of other student teams • PT, Dentistry, Graduate Students

8. CCOM Curriculum Renewal Year 1 SummerTrack Distinctions Mentored Independent Scholarly Project Global Health Project Teaching and Learning Project Community Service Project 10-week project that contributes to successful completion of a distinction track • Large % of student currently participate • Formal part of the curriculum? • Limitations • Opportunities for all • Funding issues • Assessment • Portfolio - ifolio

9. CCOM Curriculum Renewal Year II, Sem.1 Common Core Problem Visits - Unit visits to observe and practice focused Hx and PE components Pathobiology - pathology focused with elements of Anatomy, Immunology, PID, and Pharmacology Intersession Integrated blocks based upon common clinical presentations: Carcinogenesis, Headache, Diabetes, Hypertension, Smoking, Obesity, Geriatrics, Pain, Orthopaedic Issues, Respiratory infection, etc. Track Distinctions Clinical Skills Workshops • Provides opportunity for PA program students to participate

10. Intersession • Modeling of Year structure • Case studies, simulations focus on disease process and mechanisms • Review skills, foundational concepts • Interdisciplinary approaches • Ethics • Patient safety, human Factors • Communication

11. Integrated Blocks and Core Problem Visits • Disease process, clinical presentation focus • Focal shift of FCP III-IV • Carcinogenesis • Chest Pain • Diabetes • Permits review of foundational material in conjunction with parallel studies in pathobiology • Demonstrate variety of clinical settings • Introduction to specific issues of team function, patient safety, human factors, ethics

12. Carcinogenesis Block • Foundations • Genetics > inheritance, counseling • Pathology> presentation, mechanisms, biochem • Pharmacology> neoplastic drugs • Anatomy > lymphatics, circulatory • PID> opportunistic infections • Immunology > mounted responses, drug pathways • FCP > bad news, screening, economics, social, legal • Health policy • Clinical Areas • Dermatology • OB/GYN • Urology • Surgery > GI, Breast • ENT > Head & Neck • FM & IM > Screening, Dx • HemOnc • Psychiatry > mental health • Ortho • Anesthesia > pain management • Radiology >

13. CCOM Curriculum Renewal Year II, Sem. 2 Common Core Problem Visits - Unit visits to observe and practice focused Hx and PE components Pathobiology - pathology focused with elements of Anatomy, Immunology, PID, and Pharmacology Intersession Integrated blocks based upon common clinical presentations: Carcinogenesis, Headache, Diabetes, Hypertension, Smoking, Obesity, Geriatrics, Pain, Orthopaedic Issues, Respiratory infection, etc. Track Distinctions Clinical Skills Workshops USMLE preparation and vacation time

14. CCOM Curriculum Renewal Year III (Starts July 1) Intersession: Clinical Beginnings Theme (2) Intern. Med (6 IP + 4 OP) • Surgical Selectives (examples) • Orthopaedics (2) • Ophthalmology (2) • Urology (2) • Anesthesia (2) • Radiology (2) • Dermatology (2) • Otolaryngology (2) Surgery (6 + 2 +2 ) OB/GYN (3 + 3) Foundation Modules Peds (3 IP + 3 OP) Fam. Pract., CBPC (6) Adv. Electives (12) If two-site delivery model is maintained programs must be consistent. Required rotations reflect areas of needed competency for graduation. These areas must demonstrate programs that reflect foundations content, clinical case exposure, clinical skills opportunities to fulfill competencies.

15. Foundation Modules • Integration of foundational material across and in light of clinical experiences • Foundational sciences/concepts • Focal exposure to issues of interdisciplinary team work, patient safety, human factors, ethics • Skills (re)assessment • Delivery • Distance education • Online, CAI modules • Simulation • Case presentation • Large/Small group discussion

16. Electives • ‘New’ Clinical experiences that provide multi or cross discipline exposure • Orthopedics • Working with Peds, Family Medicine, Emerg. Med., PM&R • Opportunities to evaluate and treat common MSK injuries • Develop rehab. plans • Women’s Health • Working in an Adolescent clinic (Peds or OBG), Family Medicine, Geriatrics • Other ideas: Perioperative Medicine, Infectious Disease, Research, Foundational Science, Health Law/Policy

17. CCOM Curriculum Renewal Year IV (Starts July 1) Neurology (4) Capstone (4) Psychiatry (4) M4 Sub-I (4) Foundation Modules Emerg. Med or CCM (4) Adv. Electives (12) If two-site delivery model is maintained programs must be consistent. Required rotations reflect areas of needed competency for graduation. These areas must demonstrate programs that reflect basic science content, clinical case exposure, clinical skills opportunities to fulfill competencies.

18. Scholarly Project • Opportunities to participate and develop a longitudinal plan of study • M1 Summer experience • Year II • Advanced Elective

19. Capstone • 4(2?) weeks • Organized similar to scientific meeting • Plenary sessions, focus groups/ themes • Skills workshops • Foundational science reviews in light of clinical experience • Research presentations • Residency prep topics • Ethics issues • Systems medicine, patient safety and human factors • ACLS certification and Neonatal resuscitation • Social activities (Community challenges, ‘olympics’, etc.)

20. Charge • Provide curricular flexibility for integration and change • Address patient and societal needs • Provide earlier clinical experience and appropriate skill development to support that experience • Encompass existing collegiate educational competencies for students • Promote student-centered education, student well-being, engagement, and active learning • Maximize use of education and information technologies • Enable individualized progress through the curriculum as appropriate

21. Questions