Challenges & Needs in Starting a New Medical School: Medicine's Macy Perspectives

1. MRRN September 14, 2011

2. CMU College of Medicine • Starting a new medical school • Accreditation – LCME • Strategic Planning • Educational Program design and development • Fund raising • Organizational change – the university • Getting the community on board • Managing politics – competing health systems, etc. • Recruiting faculty • And, lots more…

3. Medicine’s Challenges (Macy) • Accelerating pace of scientific discovery • Calls for more public accountability • The economy • Rising cost of health care • Shortfalls in health care quality • Racial/ethnic disparities • Rising burden of chronic illness/disability • Aging population

4. Challenges/needs • Re-define foundation sciences of medicine • Psychology, social science, quality improvement, decision science, epidemiology, EBM, CQI… • Facilitate problem solving and self-directed learning skills • Certification and maintenance of certification • Assure students experience continuity of care • Students need skills in continuous improvement and safety

5. Challenges/needs • Increase emphasis on community-based education rather than the hospital • Prepare students to work as team members (inter-professional teams) • Increase knowledge of public health and non-biological determinants of health and disease • Foster long-term relationships between students and faculty • Develop teaching and mentoring skills of faculty

6. Needs Assessment - CMED • LCME • USMLE • AHRQ, HHS, CMS,IHI, IOM, etc. – care quality, safety, patient experience, control costs, etc. • Other curricula (content, models, organization) • AAMC – HHMI- competencies • AAMC Training Physicians white papers • ACGME/ABMS – competencies, MOC, etc. • Local disease/health data • Literature of medical education

7. IHI Goal: Crossing the Quality Chasm • Care that is: • Safe, Effective, Patient-Centered, Timely, Efficient, Equitable • Evidence-Based • Personal • Holistic, and CARING

8. Competencies – ACGME-plus • Patient care Consider procedural skills as a competency? • Medical knowledge • Communication & interviewing • Professionalism • Practice-based learning & improvement • Systems-based practice • Community and population health

9. Future Practice of Medicine • Patient-centered care • Patients as individuals and member of population to be cared for supporting health assessment, patient outreach, illness prevention strategies • Systematic assessment and improvement of quality indicators for physicians, hospitals, systems, patient populations • Coordinates and delivers care through organized systems • Places value on cost-effective care • Helps address constraints on health care resources Helps to define physician skill set for future

10. Local needs/challenges • Physician shortage current – perhaps 1,000 • By 2020 – 6,000 • Closing the gap and the ongoing loss of physicians to their communities through retirement, etc. • Distributional issue • Recruiting to rural environment • Retaining physicians in rural environment • Who will come, who will stay? • Pipelines-AHEC • Specialty distributional issue

11. Complexity of undertaking…

12. What is unique about CMED? • Location • Mission, vision • Curriculum

13. Mission • Prepare exceptional physicians • Improving access to individualized, essential care (health care delivery) • Focus in rural and medically underserved regions of Michigan • Rural/small community focus • Differentiated skill set • Generalist focus: (FM,IM, Peds, Gen Surg, Ob/Gyn, Psych, EM, PM&R)

14. Vision • Excellence in instruction/active learning • Team-based learning experiences • Early patient contact • Student-centered environment/program • Patient-Centered care • Residencies (new, distributed) • Community-based, 11 affiliations thus far

15. Develop Objectives Develop Assessments Feedback & Revise Evaluate Instruction (Summative) Design Instruction Assess Needs Manage Instruction Develop Instruction Iterative Process Implement Instruction Pilot Instruction Evaluate Instruction (Formative) Revise Instruction

16. LMCE: Integrated MD Curriculum Year I Year II Year III Year IV

17. Course Structure

18. Curriculum • College culture: respect, compassion, inclusiveness, social responsibility, excellence, innovation, curiosity • Integration of foundation and clinical science • Anatomy, biochemistry, physiology, pharmacology… • Psychology, decision science, continuous improvement… • Early clinical experience • Continuing foundation science education • Schemata and Patient Presentation model, simulated patients and families (relevancy) • Team-based learning (learning communities, in practices, in the hospital, friendly competition-game theory) • Inter professional (PA, PT, et al.) • Self directed learning/cognitive science

19. Knowledge Scheme for Anemia Classification Mechanism Causation/ Cases

20. Flow Diagram of the Learning Process 1. Provision of schemata and assigned readings 2. Students prepare for instruction of coming week 3. Socratic session discussion of basic science principles 4. Large group discussion of clinical skills 5. Discussion of “Patient Presentations” for the week 6. Review of relevant anatomy and practice physical examination 7. Socratic discussion of diagnostic process 8. Socratic discussion of treatment, focus on pharmacology 10. Discussion of patient management & adherence challenges – Society/Community 9. Small group/ team work to identify and solve problems from PPs 14. Small group discussion of problems/solutions clinical experience 11. Discussion of ethical & professionalism issues 13. Journal club/EBM session relevant to PP-diagnosis/ treatment 15. Formative assessments/ Discussion 12. Open question & answer sessions Orange: large group information sharing and discussion sessions Blue: small group sessions Gray: clinical experience Yellow: large group Socratic sessions (questions based upon PPs) Green: student self-study sessions

21. Typical Student Schedule for a Week of Instruction for Years 1 & 2

22. Example Student Schedule for a Week of Instruction for Year 3 Longitudinal Integrated Clerkship

23. Curriculum • Longitudinal clinical skills curriculum – integrated with anatomy, imaging, physical examination, interviewing • Longitudinal courses: Art of Medicine, Society & Community Health • Clinical and health services/delivery research • Lean, process and quality improvement – including as research, at the practice and system levels • Population health, epidemiology, community health • Evidence-based medicine (proven practice) • Health system, care delivery, business of medicine, financing… • Assessments: to facilitate success for individual and team (simulations, mannequins, simulated patients, actual patients)

24. Curriculum • Longitudinal, integrated clerkship • Gradual transitions as skills/knowledge develop • Focus on self assessment, lifelong learning, practice-based learning and improvement… • Rural/small community emphasis • Clinical experience based there • Community faculty as preceptors and facilitators • GME in the rural/small community setting • Patient Centered Medical Home

26. CMU College of Medicine Office of the Dean 208 Rowe Hall Phone: (989) 774-7547 Web site: www.cmich.edu/med 26