RECIPROCAL INTEGRATION : Medical Curriculum Model

1. RECIPROCAL INTEGRATION:Medical Curriculum Model University of Iowa Carver College of Medicine Curriculum Renewal Modeling Committee Report September 27, 2010

2. 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 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 Team Members

3. Overview • I. Strategy • II. Permeating Themes • III. Pedagogical Considerations • IV. Reciprocal Integration Model • V. Model Analysis • VI. Conclusions

4. Overview • I. Strategy • II. Permeating Themes • III. Pedagogical Considerations • IV. Reciprocal Integration Model • V. Model Analysis • VI. Conclusions

5. Strategy • Charge • Approach

6. 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

7. 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

8. Overview • I. Strategy • II. Permeating Themes • III. Pedagogical Considerations • IV. Reciprocal Integration Model • V. Model Analysis • VI. Conclusions

9. Permeating Themes • Integrate basic and clinical sciences, both 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

10. Overview • I. Strategy • II. Permeating Themes • III. Pedagogical Considerations • IV. Reciprocal Integration Model • V. Model Analysis • VI. Conclusions

11. 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

12. Overview • I. Strategy • II. Permeating Themes • III. Pedagogical Considerations • IV. Reciprocal Integration Model • V. Model Analysis • VI. Conclusions

14. “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

15. 1st year (M1)—

16. Basic Science Primer • Description: Course providing fundamental basic science • Duration: 2 weeks • Goal: Ensure all students of diverse backgrounds equipped with tools for successful mastery of basic science • Components • Molecular/cell biology • Biochemistry • Immunology • Biostatistics • Introduction to evidence-based medicine • Introduction to ethics

17. 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

18. Continuity of Care Clerkship • Description: Longitudinal care experience • Duration: 4 years x ½ day/week • Goal: To progressively develop clinical skills in a 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

19. Foundations of Basic Science • Description: Course on core basic sciences that serve as 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 • Biochemistry • Cell biology • Anatomy/neuroanatomy/embryology/histology • Genetics

20. Human Organ Systems & Disease • Description: Organ-systems approach to the 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

21. 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…

22. 1st year (M1)—

23. Foundations of Clinical Practice • Description: Course providing the practical skills 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

24. 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

25. 2nd year (M2)—

26. 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

27. 3rd year (M3)—

28. Required Clinical Blocks/Clerkships • 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: • Cerkships grouped into integrated blocks to facilitate interdisciplinary integration • 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)

29. 4th year (M4)—

30. Clinical Electives • Description: Non-required, multidisciplinary, 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.

31. Overview • I. Strategy • II. Permeating Themes • III. Pedagogical Considerations • IV. Reciprocal Integration Model • V. Model Analysis • VI. Conclusions

32. Model Analysis • Charge • Resource implications

33. 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

34. Charge • Provide flexibility to accommodate new knowledge • “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

35. Charge • Provide flexibility to accommodate new knowledge • Improve integration of basic, clinical, social sciences • 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

36. Charge • Provide flexibility to accommodate new knowledge • Improve integration of basic, clinical, social sciences • Address patient & societal needs • 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

37. 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 technologies • Enable individualized progress

38. 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

39. 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

40. 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

41. 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

42. Resource Implications • Creation of Curriculum Oversight Committee • Continuity of Care clerkship • Intersessions scheduling requirements

43. Overview • I. Strategy • II. Permeating Themes • III. Pedagogical Considerations • IV. Reciprocal Integration Model • V. Model Analysis • VI. Conclusions

45. 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