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Curriculum renewal

FSM will mentor and educate students to become exceptional, compassionate and innovative physicians , educators, and researchers We expect our students to be inquiry-driven team leaders who will serve patients , society and the profession. Curriculum renewal. March 2011 Update.

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Curriculum renewal

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  1. FSM will mentor and educate students to become exceptional, compassionate and innovative physicians, educators, and researchers We expect our students to be inquiry-driven team leaders who will serve patients, society and the profession Curriculum renewal March 2011 Update

  2. March 2011 Update 100 faculty 15students 200faculty 25students Sept 2009 Retreat Oct 2010 Kick-Off Sept 2011 Phase 1 Plan Completed Aug 2012 Phase 1 Implementation ~April 2013 Phase 2 Implementation ~April 2014 Phase 3 Implementation Curriculum Development organization, content Curriculum renewal Instructional Design to deliver content Faculty Development to facilitate content delivery Assessment Design to evaluate student learning outcomes 113faculty 25students Curriculum Evaluation and Continuous Quality Improvement

  3. Collaborative Multidisciplinary & Inter-professional Teams, Societies, Colleges Collaborative Colleges Competency-Based Evidence-Based Learning PBL, TBL, Simulation, Virtual Reality Active Learning PBL Science in Medicine Content AOC, Competency, PPS , MDM Content PPS , MDM Structure Function Health & Society Scientific Basis of Medicine Integrated Personal - Adaptive Learner-Centered Inquiry-Driven Clinical Medicine Professional Development

  4. 4 Curricular Elements content threads • Clinical Medicine • Prevention, Diagnosis, Treatment, Rehabilitation, Palliation • (Prevention includes nutrition, lifestyle medicine, behavioral change, wellness • (Diagnosis includes Hx & PE, laboratory medicine, imaging) • (Treatment includes therapeutics and technical skills) (Rehab includes transitions of care) (Palliation includes end of life care) • Medical Decision-Making & Clinical Reasoning • (MDM includes Info Acquisition & Management, EBM, Cost- Effectiveness) • Communication (oral, written, counseling, teaching) • Professional Development • Area of Scholarly Concentration, “Pathways”, Professional Goals • Personal Awareness and Self-Care • Professional Behavior and Moral Reasoning • Teamwork & Leadership • Curricular Model • Health & Society • Biopsychosocial determinants of Health and Disease (Healthy People 2020) • Health Disparities, Equity and Advocacy • Health Economics and Health Systems • Global, Community and Public Health Perspectives • Patient Safety and Quality Improvement • Science in Medicine • Foundational Sciences (cellular processes, genetics, metabolism • inflammation and infection) • Normal Structure and Function • Mechanisms of Disease, Diagnosis, Therapeutic Interventions, • Disease Prevention • Organ-based, lifecycle / developmental framework

  5. March 2011 Update Curriculum renewal Continuity Organizing principles

  6. Year 2 Year 1 Year 3 Current Curriculum Year 4 SF SBM Clinical Medicine Normal Abnormal Patient, Physician, Society Proposed Curriculum Phase 1 Phase 2 Phase 3 Science in Medicine Clinical Medicine Health & Society Professional Development

  7. March 2011 Update Curriculum renewal

  8. March 2011 Update Curriculum renewal

  9. Phase 1 I II III IV V VI VII VIII IX X XI XII XIII XIV Psychiatry/Behavioral Science Head & Neck, Ophthalmology Break Reproductive/Urogenital Area of Concentration Gastrointestinal Musculoskeletal Summer Break Holiday Break Holiday Break Spring Break Spring Break Dermatology Pulmonary Neurology Hematology Endocrine Oncology Renal Prologue CV CV Integration & Synthesis Module Integration & Synthesis Modules Integration & Synthesis Module SiM CM H&S PD Competency-Based, Gateway Assessments with Portfolio Reviews 3

  10. March 2011 Update Sept 2009 Retreat Oct 2010 Kick-Off Sept 2011 Phase 1 Plan Completed Aug 2012 Phase 1 Implementation ~April 2013 Phase 2 Implementation ~April 2014 Phase 3 Implementation Curriculum Development organization, content Curriculum renewal Instructional Design to deliver content Faculty Development to facilitate content delivery Assessment Design to evaluate student learning outcomes Curriculum Evaluation and Continuous Quality Improvement

  11. March 2011 Update Science in medicine Phase 1 Phase 2 Phase 3 Curriculum renewal Science in Medicine Clinical Medicine Health & Society Professional Development

  12. Phase 1 Sequence - Science in Medicine Modules I II III IV V VI VII VIII IX X XI XII XIII XIV Psychiatry/Behavioral Science Head & Neck, Ophthalmology Break Reproductive/Urogenital Area of Concentration Gastrointestinal Musculoskeletal Summer Break Holiday Break Holiday Break Spring Break Spring Break Dermatology Pulmonary Neurology Hematology Endocrine Oncology Renal Prologue CV CV Integration & Synthesis Module Integration & Synthesis Modules Integration & Synthesis Module CM H&S PD Competency-Based, Gateway Assessments with Portfolio Reviews 3

  13. Prologue - Sequence of Science in Medicine (Weeks) Fall 2012 September October November CELLS, RECEPTORS, MEMBRANES PHARMACOLOGY MICROBIOLOGY IMMUNOLOGY HUMAN BODY CELL INJURY GENETICS EXAM & PORTFOLIO ASSESSMENT

  14. September 2012 Calendar November 2012 Calendar Prologue Sequence of SiM - Weekly Calendar Mon Tue Wed Thu Fri Mon Tue Wed Thu Fri 3 5 1 2 6 7 4 INTRO, THEMES, THREADS PHARMACOLOGY: KINETICS INTRO MICROBIOLOGY LABOR DAY CELLS, ORGANELLES, MACROMOLECULES CELLS, RECEPTORS, MEMBRANES 10 12 5 6 7 8 9 13 14 11 MICROBIOLOGY INTRO IMMUNOLOGY RECEPTORS, G PROTEINS, MEMBRANE TRANSPORT, CHANNELS CELLS, CONT. RNA & DNA VIRUSES, BACTERIA, FUNGI, PARASITES, THERAPEUTICS 17 19 12 13 14 15 16 20 21 18 IMMUNOLOGY CHROMOSOMES, CELL CYCLE, STEM CELLS, MUTATION, INHERITANCE ANTIBODIES, T CELLS, EFFECTOR FUNCTIONS, AUTOIMMUNITY, TRANSPLANTS GENETICS 24 26 19 20 21 22 23 27 28 25 IMMUNOPATHOLOGY, INFLAMMATION GENETIC VARIATION, PEDIGREE, AUTOSOMAL & CHROMOSOMAL DISORDERS THANKSGIVING 26 27 28 29 30 EXAM PROLOGUE EXAM CARDIOVASCULAR MODULE October 2012 Calendar December 2012 Calendar Mon Tue Wed Thu Fri Mon Tue Wed Thu Fri 1 2 3 4 5 3 5 6 7 4 GENETICS CARDIOVASCULAR MODULE GENETIC DISORDER DIAGNOSIS, SCREENING & THERAPEUTICS, SPECIFIC DISEASES CARDIOVASCULAR MODULE 8 9 10 11 12 10 12 13 14 11 METABOLISM, PATHWAYS, MITOCHONDRIA CARDIOVASCULAR MODULE HUMAN BODY: EPITHELIUM, CONNECTIVE TISSUE HUMAN BODY 15 16 17 18 19 17 19 20 21 18 AUTONOMIC, SOMATIC NERVOUS SYS. EMBRYO- GENESIS BLOOD, CIRCULATION HUMAN BODY: BONE, MUSCLE CARDIOVASCULAR MODULE 22 23 24 25 26 24 26 27 28 25 PHARMACOLOGY: ABSORPTION, TRANSPORT CELL INJURY <===============HOLIDAY BREAK===============> CELL ADAPTATION & INJURY, APOPTOSIS, TUMORS, CANCER CHRISTMAS 31 29 30 31 PHARMACOLOGY <===============HOLIDAY BREAK===============> PHARM: DISTRIBUTION, EXCRETION, METABOL., KINETICS

  15. December 2012 Calendar November 2012 Calendar October 2012 Calendar September 2012 Calendar Prologue Sequence of SiM - Weekly Topics Mon Tue Wed Thu Fri Mon Mon Mon Tue Tue Tue Wed Wed Wed Thu Thu Thu Fri Fri Fri 3 3 5 5 1 2 3 4 5 1 2 6 6 7 7 4 4 INTRO, THEMES, THREADS PHARMACOLOGY: KINETICS INTRO MICROBIOLOGY LABOR DAY CELLS, ORGANELLES, MACROMOLECULES CARDIOVASCULAR MODULE GENETIC DISORDER DIAGNOSIS, SCREENING & THERAPEUTICS, SPECIFIC DISEASES 10 10 12 12 8 9 10 11 12 5 6 7 8 9 13 13 14 14 11 11 METABOLISM, PATHWAYS, MITOCHONDRIA INTRO IMMUNOLOGY RECEPTORS, G PROTEINS, MEMBRANE TRANSPORT, CHANNELS RNA & DNA VIRUSES, BACTERIA, FUNGI, PARASITES, THERAPEUTICS CELLS, CONT. CARDIOVASCULAR MODULE HUMAN BODY: EPITHELIUM, CONNECTIVE TISSUE 17 17 19 19 15 12 13 16 17 14 18 15 19 16 20 20 21 21 18 18 AUTONOMIC, SOMATIC NERVOUS SYS. EMBRYO- GENESIS BLOOD, CIRCULATION HUMAN BODY: BONE, MUSCLE CARDIOVASCULAR MODULE ANTIBODIES, T CELLS, EFFECTOR FUNCTIONS, AUTOIMMUNITY, TRANSPLANTS CHROMOSOMES, CELL CYCLE, STEM CELLS, MUTATION, INHERITANCE 24 24 26 26 19 22 20 23 24 21 25 22 26 23 27 27 28 28 25 25 PHARMACOLOGY: ABSORPTION, TRANSPORT <===============HOLIDAY BREAK===============> IMMUNOPATHOLOGY, INFLAMMATION GENETIC VARIATION, PEDIGREE, AUTOSOMAL & CHROMOSOMAL DISORDERS CHRISTMAS THANKSGIVING CELL ADAPTATION & INJURY, APOPTOSIS, TUMORS, CANCER 31 29 30 31 26 27 28 29 30 <===============HOLIDAY BREAK===============> PROLOGUE EXAM PHARM: DISTRIBUTION, EXCRETION, METABOL., KINETICS CARDIOVASCULAR MODULE

  16. Example: Prologue SiM Week 5, Hourly Topics Fall 2012 Monday October 1 Tuesday October 2 Wednesday October 3 Thursday October 4 Friday October 5 Approaches to genetics disorders Development, pattern formation, homeobox genes Contiguous gene deletions, uniparentaldisomy Genetic screening, prenatal, cancer risk X chromosome: inactivation, pseudoautosomal regions, Turner syndrome Treatment of genetic disorders Prenatal diagnosis Mitochondrial genetics & diseases Behavioral genetics Neurofibromatosis Marfan syndrome, hemiglobinopathy, PKU • Tasks ahead: • Improve coordination and communication across SiM topics • Integrate the daily and weekly schedule with other curricular elements - clinical medicine, health and society, professional development • Develop stimulating, interactive learning experiences that engage students in large and small groups

  17. March 2011 Update Clinical medicine Phase 1 Phase 2 Phase 3 Curriculum renewal Science in Medicine Clinical Medicine Professional Development

  18. Tuesday 5pm : Clinical Med Steering Committee • Ben Singer • Julia Corcoran • John Butter • Warren Tourtelotte • Rama Gourenini • Jen Trainor • Stephanie Kerns • Nicholas Volpe • Donna Woods • Margaret Duggan • Kristine Gleason • Bob Tanz • John Vozenelik • Jay Thomas • Michael Fleming • Alex Korutz • Daniel Katz • Joseph Brown • Kate Kinner • Kelly Walker • Aarati Didwania • Amanda Zick

  19. Tuesday 12noon : Clinical Med subComittee #1 • Eric Terman • Arv Vanagunas • Lori Goodhartz • Cristine Park • Toshi Uchida • Boye Ogunseitan • Stevie Mazyck • Gary MacVicar • Marie Crandall • Jen Bierman • Todd Davis • Karen Mangold • Alexander Sandu • Sharon Unti • Mike Moore • Susan Santacaterina • Nicole Wysolcki • Cherina Cyborski • Donald-Lloyd Jones

  20. Thursday 8am : Clinical Med subCommitee #2 • Bob Brannigan • Tania Saroli • Michael Angarone • Rick Lee • Amer Aldeen • Jyothy Puthumana • Edgar Black • Darius Loghmanee • Danielle Smith • Julie Stamos • Tina Tan • Melissa Brown • Natasha Wheaton • Allison Hammer • Stephanie Miller • Jay Sarthy • Jared Mendelson

  21. Clinical medicine element group: • Tuesday 12noon subcommittee: • Task: organize the clinical medicine curriculum horizontally almost done mapping broad goals, assessment methods, & learning strategies • Thursday 8am subcommittee: • Task: integrate clinical medicine vertically into the CV unit Focused Clinical Experience (FCE) initiative • Tuesday 5pm steering committee: • Task: think tank for “big picture” & reactor panel developing a longitudinal student/patient experience

  22. Year 2 Year 1 Year 3 Current Curriculum Year 4 SF SBM Clinical Medicine Normal Abnormal Patient, Physician, Society FCE Proposed Curriculum Phase 1 Phase 2 Phase 3 Science in Medicine Clinical Medicine Health & Society Professional Development

  23. single dosesof early clinical medicine…

  24. The FCE Concept: • Find a lecture • https://fsmweb02.northwestern.edu/emerg/ • Pick 2-3 objectives • Find real-world examples where the lecture content is applicable • Embed students in a clinical area. Aims: provide context, apply & synthesize knowledge and inspire

  25. Provide the “why” & inspire inquiry

  26. Could it work? First FCE pilot Dr. Puthumana’s echo lab experience… • “Experience was wonderful” • “the lecture material really came together” • “Cardiac echo, E/A & E’ definitely seemed more relevant after the exercise” • “It was certainly inspiring and I would definitely do it again- for other units” What’s up next: • NMH valve surgery (R. Lee) • CMH heart biopsy (T.Saroli) • Heart transplant (E.Black) • Cardiac cath lab (J.Flaherty) • CCU pharmacist (K. Gleason) • ED ecg’s (Aldeen, Wheaton) • CCU nurse shadow (M.Duggan) • Cardiac MRI imaging (A.Korutz) • Stress test lab (J.Puthumana) • Cardiac autopsy (J.Lomasney) • Any volunteers?

  27. A maintenance dose of clinical medicine… Because understanding the social/environmental determinants of disease & the chronic care model requires… more than 4 weeks!

  28. Continuity

  29. So we need to create an educational experience where: • A team of health professionals, coordinated by a longitudinal physician, working collaboratively to provide high levels of care, access and communication, care coordination and integration, and working to improve care quality and safety. • This is the AAFP, ACP, AAP, AOA 2007 consensus definition of a Patient-Centered Medical Home

  30. SIMPLE & ELEGANTAll residents & attendings can understand a continuity clinic concept

  31. Recruit vulnerable patients with one or more of 20 core conditions such as: heart disease, cancer, stroke, COPD, obesity, trauma/SCI, dementia, DM, ESRD, mood disorders, asthma, HIV, SLE, cirrhosis, CHF, high-risk OB, cystic fibrosis, sickle cell, chronic pain, and OA Continuity Panel of 100 patients with Q4 mth visits would be ~6 patients/wk, +add 1-2 acute slots as needed

  32. Simple design, infinite flexibility • All students have a clinic (simple concept) • But within their clinic- many chances for “layered individualization” & adaptability: • Panel of 100 patients allows students to focus (“own”) the patients with conditions they find most interesting • Multiple visits with 1 patient over 4 years allows for “deep learning” rather than just superficial initial encounters • Multiple levels of learners allows students to operate at exactly their “true” level. M1’s who are ahead of the curve can start doing more DDx and M3’s who are struggling can work more on PEx skills or Hx • M3 students could recruit the inpatients that inspire them

  33. New resources since 1993: • Ability to track patient progress when not physically at the clinic • And increasing ease of data-mining to assess quality across sites

  34. Other schools can measure their curricular reform efforts with student satisfaction surveys Our educational outcomes could be: 97% of student CAD patients on B-Blkrs & Aspirin Average Hgb A1c dropped1.0% compared to entry 80% patients up to date with cancer screening metrics No racial disparities detectable in screening rates Mean BMI of patient panel dropped over 4 years

  35. Rhinoceros– why were you so inspiring? • Students owned the project • Students worked as a team and had a goal • The project was simple but yet integrated everything they had been learning in class (reading, writing, math, art, weather, geography, biology, health/nutrition) • The project inspired inquiry & deep learning • Professionalism, responsibility were required • Can’t we aspire to compete with 1st graders??

  36. Year 2 Year 1 Year 3 Current Curriculum Year 4 SF SBM Clinical Medicine Normal Abnormal Patient, Physician, Society PCMH FCE Proposed Curriculum Phase 1 Phase 2 Phase 3 Science in Medicine Clinical Medicine Health & Society Professional Development

  37. Imagine working with these 4 FSM students over 4 years and seeing what they could do with a panel of their OWN patients • Imagine the PR campaign & recruitment impact… • Improving Medical Education by Improving Chicago’s Health

  38. March 2011 Update Health & Society Phase 1 Phase 2 Phase 3 Curriculum renewal Science in Medicine Clinical Medicine Health & Society Professional Development

  39. Health & Society CEG Healthy People 2020 www.healthypeople.gov

  40. Prologue:Students learn about themselves • Health Risk Appraisal (HRA) • Lifestyle factors and readiness to change • Biometric and laboratory results • Compliance with recommended preventive screenings • Existing chronic conditions • Future disease risk factor • Personal environment • Personal and group results • Behavior Change Plan (BCP) • Reanalysis of HRA results • Personal and group results

  41. Prologue:Students learn about others • Textbook Chicago • Chicago bus tour of 6 communities to assess the 4 determinants of health (social environment, physical environmental, health services, individual behavior) • SES • Racial/ethnic demographics • Built environment • Health care access & delivery • Prevalence of selected health conditions • Presentations and discussion of health outcome disparities regarding determinants of health

  42. Overarching themes • Determinants of health • Disparities in health outcomes • Public health • Community and global health • Health service delivery • Physician roles • Professional well-being • Advocacy • Communication / motivational interviewing/ behavior change • Interdisciplinary learning • Lifestyle Medicine Thread

  43. March 2011 Update Professional development Phase 1 Phase 2 Phase 3 Curriculum renewal Science in Medicine Clinical Medicine Health & Society Professional Development

  44. Professional Development Curriculum Renewal Update March 2011

  45. Overview A curricular element that encompasses: • An Area of Scholarly Concentration (AOSC) • Professional Behavior and Moral Reasoning/Medical Ethics (PBMR) • Personal Awareness and Self-Care (PASC) • Teamwork and Leadership (TL)

  46. Accomplishments: November 2010 • Area of Scholarly Concentration task force: Report on activities of other schools and recommendations for FSM • Professional Behavior and Moral Reasoning Competency Committee: Education and assessment blueprint • Personal Awareness and Self-Care Competency Committee: Education and assessment blueprint

  47. Progress: November 2010-March 2011 1. Convened sub-committees for four areas of Professional Development. 2. Agreement on goals, teaching activities and assessment strategies for Prologue/Phase 1. 3. Development of Pilot projects for Fall, 2011.

  48. Broad Goals for Prologue/Phase 1... • DISCUSS basic theories of teamwork and leadership (TL). • ANALYZE team structure and roles for a team that they are currently on (TL). • UNDERSTAND basic research designs in biomedical research (AOSC). • DEVELOP a 4 year plan for an area of scholarly concentration in research, education or community service (AOSC) • IDENTIFY, ANALYZE and JUSTIFY appropriate ethical and legal choices in the care of patients and their families (PBMR)

  49. …Broad Goals for Prologue/Phase I • IDENTIFY, ANALYZE, and JUSTIFY ethical choices in the healthcare systems in which they work, including issues of access to care and conflicts of interest (PBMR) • BEHAVE with honesty, integrity, respect, and compassion toward all patients, families, students, faculty, and other healthcare professionals (PBMR) • CREATE a 4 year plan for personal awareness and self-care(PASC)

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