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Year 3-4 taskforce report. Faculty Members: Jennifer Cox, Shelly Holmstrom, Laura Haubner, Drew Keister (LVHN), Barbara Lubrano, Dawn Schocken, Jamie Shutter , Frazier Stevenson, Kira Zwygert Student Members: Alicia Billington, John Emerson, Byron Moran, Nishit Patel OEA staff:

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year 3 4 taskforce report

Year 3-4 taskforce report

  • Faculty Members:
  • Jennifer Cox, Shelly Holmstrom, Laura Haubner, Drew Keister (LVHN), Barbara Lubrano, Dawn Schocken, Jamie Shutter, Frazier Stevenson, KiraZwygert
  • Student Members:
  • Alicia Billington, John Emerson, Byron Moran, Nishit Patel
  • OEA staff:
  • Tanisha Battle, Patti Parisian

March 24, 2010

  • Reviewed history of current requirements
  • Reviewed national, grad questionnaire, and course data
  • Received written or verbal input from required clerkship directors
  • Rec’d written and verbal input from MS3 and MS4 students
  • Rec’d Written or verbal input from chairs (IM, Psych, Peds, Anat-Path, Pharm/Phys, Mol Bio, Neurology)
  • Formed recommendations to Curriculum Committee
lcme standards
LCME standards

ED-13. Clinical instruction must cover all organ systems, and include the important aspects of preventive, acute, chronic, continuing, rehabilitative, and end-of-life care.

ED-14. Clinical experience in primary care must be included as part of the curriculum.

ED-15. The curriculum should include clinical experiences in family medicine, internal medicine, obstetrics and gynecology, pediatrics, psychiatry, and surgery.

  • Schools that do not require clinical experience in one or another of these disciplines must ensure that their students possess the knowledge and clinical abilities to enter any field of graduate medical education.

ED-16. Students' clinical experiences must utilize both outpatient and inpatient settings.

health professions education a bridge to quality 2003
Health Professions Education: A Bridge to Quality (2003)
  • Students must learn to provide patient-centered care in inter-disciplinary teams.
  • Refocus the clinical experiences
      • Patient centered
      • Student centered
      • Not department-centered!
  • Use multiple venues
      • Emergently ill
      • Acutely ill
      • Chronically ill
      • Healthy
the aamc project on the clinical education of medical students
The AAMC Project on the Clinical Education of Medical Students

Improve integration of learning exercises related to contemporary issues in medicine

    • End of life care
    • Breaking bad news
    • Nutrition, health promotion
    • Ethics and professionalism
    • Genetics
  • Competency based curriculum and assessment
  • Integration of basic and clinical science
the clinical education of medical students report on the millennium conferences i and ii 2003
The Clinical Education of Medical Students:Report on the Millennium Conferences I and II (2003)

Improve coherence in the design of year 4

  • Courses should have objectives and thoughtfully produced curricula, not just “tag along”
  • Innovative advanced experiences need to be created that:
    • build on the scientific and clinical foundations begun in the earlier years of medical school;
    • integrate interdisciplinary topics, especially orphan topics; and
    • provide guided elective experiences of particular value for the individual student based on his/her future goals and career plans.
  • Quality faculty guidance is key, so students do not take multiple, and essentially repetitive, “audition electives” in the same discipline.
macy foundation report 2009
Macy Foundation Report 2009

Adopt pedagogy to:

  • Underscore relevance of basic science to clinical situations
  • Emphasize inter-professional team-based care
  • Use community and hospital based experiences
  • Use simulation
  • Use E-learning to model lifelong learning
macy foundation report 20091
Macy Foundation Report 2009

Ensure student familiarity with:

  • Health care quality and safety
  • Public health and prevention
  • Non-biologic determinants of illness
  • Health implications of cultural diversity
  • Organization of health care system
  • Governmental health policy
carnegie foundation report 2009
Carnegie Foundation Report 2009
  • Build learner identity formation
    • Professionalism, values, community, role models, mentoring
  • Enhance individualization of learning
    • Build on learners’ prior experience and expertise
    • Increase curricular/educational flexibility
rationales for change 2003
Rationales for Change, 2003

Ongoing challenges

Unplanned redundancy between clerkships

Sense that students were unable to care for undifferentiated patients

Poor communication between departments/ clerkships

Lack of mid-clerkship feedback for students

Assessment of students only involved written examinations; lack of assessment of clinical skills in many clerkships

usf 3 rd 4 th year curriculum prior to 2003 4 changes
USF 3rd/4th Year Curriculum Prior to 2003-4 Changes

Third Year: Six 8-week rotations

Internal Medicine, Psychiatry, Surgery, Family Medicine, Pediatrics, OB/Gyn

Fourth Year: Two required rotations

Neurology (4 weeks)

Critical Care (8 weeks)

iom vision for education
IOM Vision for Education

“All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.”

IOM’s Committee on Health Professions Education

general results from feedback
General results from feedback

Positives: year 3

  • The integrated clerkships are, in general, delivering excellent learning experiences
  • Consistent clerkship student evals in 3.7-3.9 range on GQ
  • USMLE 2CK scores steady (overall and disciplines), whether or not shelf exams are given in discipline
general results from feedback1
General results from feedback

Challenges: year 3

  • There is variable integration within these “integrated” clerkships
  • Clerkships with multiple USMLE shelf exams, esp. in close proximity, reduce student clinical time and diminish clinical experience.
  • Discipline-based shelf exams do not reflect interdisciplinary clerkships and may detract from clerkship integration
  • Travel logistics are sometimes difficult to match with interdepartmental clerkships
themes for improvement 2010 year 3
Themes for improvement 2010: year 3

How can we:

  • Enhance interdisciplinary learning?
  • Improve assessment?
  • Improve clerkship logistical barriers?
  • Return to mechanistic “basic” science?
  • Improve curriculum for LCME focus areas:
    • CAM
    • Law and medicine
    • Public health
    • Occupational, environmental health
    • Public health policy
recommendations assessment

Recommendations: Assessment

Students assessment should focus on material actually covered in the clerkship

Make use of NBME custom exams when available

Assessment should not detract from the clinical experience (exam fatigue)

CPX and other CACL exams should reflect actual clerkship objectives and, if possible, simulate USMLE 2CS conditions and grading.

recommendations basic science
Recommendations: Basic Science
  • An organized plan to reinforce pathophysiology in years 3-4 should be developed
  • Current anatomy elective is highly popular and is a model
  • Basic science should be tailored to student needs and career goals, esp in year 4
  • Clinical faculty need development to ensure mechanistic teaching is integrated into clinical education
recommendations lcme focus topics
Recommendations: LCME focus topics
  • Work with the Doctoring faculty to develop year 3 objectives and specific pedagogy to deliver these
  • Models:
    • Within clerkships? Has been difficult to accomplish
    • Create a separate year 3 Doctoring longitudinal parallel curriculum?
    • Current model of assigning topics as lectures to Intro to Clerkships not effective
feedback year 4 requirements
Feedback: Year 4 Requirements
  • Current requirements well run but variably received, often not perceived relevant to career needs
    • Critical Care, Skin/Bones, Interdisc. Oncology
  • Year 4 requirements are challenging to administer—interviews, externships, specialty interest, USMLE exams, etc.
feedback year 4 ai acting internship selectives
Feedback, year 4 AI (acting internship) selectives
  • Required acting internships are of variable intensity and are not evaluated centrally
  • Goal was for an intense patient care experience for all students—not always delivered
  • Assessment of these courses has not occurred
year 4 aamc currmit data
Year 4 AAMC/CurrMIT data
  • Avg months of year 4 requirements: 2.0
  • Avg months of year 4 selectives: 0.8
  • USF months yr 4 requirements: 3
  • USF months yr 4 selectives: 1
themes for usf in 2010 year 4
Themes for USF in 2010: year 4
  • Are current requirements appropriate?
  • How can we build mentored learner individualization within an appropriate core curriculum?
principles of a better year 4
Principles of a better year 4

Recommended Goals for Students

  • Individuation of learning
  • Mentorship by expert faculty who are oriented appropriately
  • All students select electives with clear purpose:
    • to prepare for specific residency programs
    • to cap longitudinal experience (Scholarly Concentrations, LVHN SELECT program)
    • to correct gaps in knowledge or skill
    • to broaden experience in a clearly targeted way
possible year 4 tracks
Possible Year 4 Tracks
  • Students all do a “mini major”
  • 3-4 months of targeted requirements
    • All include a clinically intense AI
    • All include targeted basic science
    • Developed by each department based on entry skills needed for interns in their discipline
  • Acknowledged in MSPE (Deans Letter)

Possible Flavors:

    • Career-directed (i.e. ENT, Psychiatry)
    • Scholarly Concentration capstone
suggested plan for 2011 12
Suggested Plan for 2011-12
  • Taskforce to develop plan for selective tracks, working with departments
  • OEA develops plans for robust evaluation of all year 4 courses, esp. AIs
  • AIs all need to meet time and intensity guidelines
  • Current year 4 required courses to be re-evaluated in context of time requirements for new curricular tracks
specific year 4 feedback interdisciplinary oncology
Specific year 4 feedback: Interdisciplinary Oncology
  • Well run, with selective options for students
  • Several well done core activities, i.e. Giving Bad News
  • Difficult to administer, limited sites, difficult to tailor to student desires for all 120 students
  • Oncology is required by no other medical schools
  • Current course directors are supportive of elective status for course
interdisciplinary oncology
Interdisciplinary Oncology

Recommendation: (for June, 2010)

  • Convert to elective status
  • Offer enough sections in 2010-11 to accommodate all students who want it
  • Add 2 week Oncology selective option for Med-Peds in 2011-12
  • Incorporate interactiveBad News session into Med-Peds seminar series
interdisciplinary oncology1
Interdisciplinary Oncology

Rationale for recommendations

  • Well done course, but not truly core to all students
  • Very challenging administratively; highly intricate scheduling and tailoring to student needs would be more feasible as elective course
  • No other school has similar specialty requirements for all students