Proposed New Curriculum Structure

PROPOSED NEW CURRICULUM STRUCTURE

University of Washington School of Medicine

March 9, 2014

Recommendations of the Foundations Committee, Patient Care Committee, Intersessions, Transitions Scholarship Committee, Evaluation Committee, and Governance Committee

Curriculum theme: Lifting the Burden of Disease

Phases ofthe Curriculum

Foundations

Patient Care

Explore and Focus

Foundations phase: 3 terms (July of year 1 through December of year 2): completed at regional campuses

Pedagogical Approaches and Course Management:

Focus curriculum on the theme oflifting the burden of disease— locally, regionally, nationally, globally, using resources and data from Institute for Health Metrics & Evaluation’s work on Global Burden of Disease
Focus on active learning and integration
Maximum 4 hours of classroom time per day
Maximum 1 hour of lecture per day
Vertical and horizontal organization
Vertical organization (i.e., teaching scientific principles in clinical context), including block leaders (2-4), with expertise in basic science and clinical medicine
Horizontal integration of subjects (i.e., teaching subjects that naturally function together in health and disease), including important themes taught in context (ethics, diversity, scientific discovery, population health, etc.)
Course planning to include experts incore disciplinesthat run longitudinally throughout all blocks (e.g., pharmacology, anatomy, imaging, pathology)
Integrated course/block development with inclusion of block/course leaders across regional WWAMI sites
Block content follows USMLE guidelines for minimal content, with enrichment
Areas that are core to all integrated blocks will be longitudinal for maximum integration and benefit, including anatomy/imaging, pathology and pharmacology, as well asclinical skills training andthemes.
Top 40 diseases integrated with each block and driving selection of case-based clinical correlates as anchors for each block
Each block begins with a patient presentation relevant to course content
USMLE Step 1 Examination is taken at the completion of the Foundations Phase prior to the Patient Care Phase

Foundations Phase Curriculum:

Initial four-week clinical immersion

Students will learn an initial finite set of clinical skills
Additional focus on professionalism, culture of medicine, self-care, service learning, other topics
Location (Seattle, regional site, combination) to be determined

Seven integrated scientific blocks across 18 months (blocks vary from 4-10 weeks)

Integrated throughout all blocks: pathology, pharmacology, anatomy and imagining

Two-week intersessions between blocks for remediation, vacation, enrichment

Enrichment: required (core) and elective offerings, including:
Critical thinking and clinical decision making
Scientific methods
Cultural competence and health literacy
Health policy, advocacy, and public health
Wellness and self-care
Global health
Health of special populations
Leadership skills, culture of change

Clinical, social, population health and lifelong learning skill development integrated throughout:

Introduction to Clinical Medicine (including Colleges-based clinical training): progressive complexity, incorporating simulation, interprofessional activities
Frontiers of Medicine course: integrated special topic seminar, including evidence-based medicine, critical reading and Medical Information for Decision-Making.
Population health content: intentional delivery and integration of population and
, medicine and society, health equity, cultural competence, diversity
Inclusion of themes identified as key during curriculum renewal process: diversity, lifelong learning, health equity, quality and safety, ethics and professionalism, communication and inter-professionalism, primary care, and scientific discovery.

Longitudinal clinical experience integrated throughout: weekly full-day clinical experience (organ systemsseen in clinical settings matched with scientific block where possible)

Primary care focus working with a preceptor every other week
Alternate weeks: Other clinical preceptor experiences, including topics from the chronic care clerkship (rehabilitation medicine, geriatrics, palliative care, and pain management),specialty clinics, interprofessional education, and other special topics
Complementary to College clinical skills training

8-10 week summer experience(June-August of summer between years 1 and 2) (students would register for at least one 4-week term)
Optional Rural/Underserved Opportunities Program
Research/scholarship opportunities such as MSRTP
Vacation

Final 12 weeks of Foundations Phase (January through March of Year 2): Transitions (times to be determined)
Board preparation: 6 weeks
Scholarship: 4 weeks
Transition to clerkships: 1 week
Vacation: 1 week

Core Patient Care Phase and Exploreand Focus Phase

Principles:

Clinical experiences will be competency-based.
Required clerkships will meet defined competency goals and objectives relevant to all medical students regardless of specialty.
Sufficient flexibility to allow students to meet these competencies within a clinical setting that is most relevant to career goals
Active, guided learning rather than shadowing will be the approach to student involvement in required clinical clerkships.
Students will have the option of completing their core patient care clerkships either in four 12-week blocks as outlined below or in a longitudinal integrated clerkship format (LIC) similar to the current WRITE model.
Students will have sufficient time forcareerexploration and scholarlypursuits prior to residencyapplication.
Opportunities will be provided for specialty-directed clerkships and targeted clinical and career exploration.
Clinical clerkships will be offered and available throughout the WWAMI region.
Every student will be expected to complete at least one 12 week block in Seattle
Every student will be expected to complete at least one 12 week block away from Seattle
Students must complete clerkships covering USMLE Step 2 (required core patient care clerkships) by fall of fourth year
Opportunities for dual degrees, such as M.D./M.P.H. will be options within the curriculum

Core Patient Care Phase Curriculum

Four required 12-week blocks consisting of core patient care with one-week vacations or intersessions between blocks:

Medical Care of the Hospitalized Patient (12 weeks)

Care of the Hospitalized Adult (8 weeks)
Care of the Hospitalized Child and Adolescent (4 weeks)
Competencies addressed: provide care to acutely ill patient, conduct and present a thorough history and physical examination, work as part of an interprofessional team in an inpatient setting

Care of the Surgical, Perioperative, and Peripartum Patient (12 weeks)

Care of the Surgical and Perioperative Patient (8 weeks)
Care of the Gynecologic Surgical andPeripartum Patient (4 weeks)
Competencies addressed: Provide care to patients who have problems amenable to surgical therapy, provide care to women requiring gynecologic surgical treatment, provide peripartum care in the inpatient/surgical setting, work in an interdisciplinary and interprofessional team, and gain other knowledge and experience in perioperative care, including:
Obtaining informed consent
Surgical indications, risks, and alternatives
Pre- and post-operative care
Surgical treatment
Anesthesia delivery and monitoring

Care of the Patient with Disorders of the Mind, Brain, and Nerves, plus elective (12 weeks)

Care of the Patient with Disorders of the Mind and Behavior (4 weeks)
Care of the Patient with Disorders of the Brain and Nerves (4 weeks)
Elective (4 weeks)
Competencies addressed: gain knowledge and experience in the care of patients with primary psychiatric and neurological disorders, enhance skills in the mental status and neurological examination, enhance skill in communicating with and assessing patients who have psychiatric disorders, and earn knowledge of other clinical and/or academic opportunities (elective block)

Integrated Primary and Family Care: longitudinal care of patients and families in ambulatory settings (12 weeks)

Competencies addressed: care for patients in the ambulatory setting, perform a problem-focused history and physical exam, diagnose and manage common disease processes, apply preventative care measures, appreciate the integrated nature of primary care (including primary psychiatric and obstetric care), care for families and communities, apply the biopsychosocial model of disease, and care for a group of patients in a longitudinal fashion.
Each student will spend dedicated time each week in family medicine, internal medicine, pediatric, obstetrics/gynecology, and psychiatric outpatient clinical settings (based on availability of participating specialties.)

Explore and Focus Phase Curriculum

Three 4-week required senior-level advanced care clerkships:

Advanced Care of the Undiagnosed and Acutely Ill Patient (4 weeks)

Competencies addressed: evaluate and treat the undiagnosed patient in the role of initial evaluator, prioritize the evaluation and treatment of the patient requiring urgent care, evaluate and manage multiple patients simultaneously, safely perform clinical hand-offs, and work with an interprofessional team in an adult or pediatric emergency room or in a high-acuity urgent care setting

Advanced Inpatient Care (i.e., sub-internship) (4 weeks)

Competencies addressed: take on a greater role in the care of inpatients, including providing documentation, writing orders, and serving as primary contact; function at the level of a first-year resident in a patient care team, develop and refine fundamental clinical skills, gain deeper experience in an area relevant to the student’s career goals, and work closely with faculty within a student’s career pathway

Advanced Outpatient Care (4 weeks)

Competencies addressed: take on a greater role in the care of outpatients, including providing the initial evaluation and the primary documentation; develop and refine fundamental clinical skills; develop efficiency in the evaluation and management of clinic patients; develop skill in telephone (and email) management of patient problems; gain deeper experience in an area relevant to the student’s career goals; and provide the opportunity to work closely with faculty within a student’s career pathway

Selectives (6 months)

Six 4-week blocks of required selectives, at least 4 blocks of which must be clinical
Organizational model: “Trails”: specialty focus areas to help students structure their career exploration
Medical Specialties Trail (dermatology, family medicine, internal medicine, neurology, pediatrics, physical medicine and rehabilitation, psychiatry)
Surgical Specialties Trail (general surgery, neurological surgery, obstetrics and gynecology, ophthalmology, orthopedic surgery, otolaryngology-head and neck surgery, plastic surgery, urology)
Hospital-based Specialties Trail (anesthesiology, diagnostic radiology, emergency medicine, pathology, radiation oncology)
Option for students to design a Trail that best fits their interests and planned career trajectory

Additional time for research, board preparation, residency interviews (4 months)

Capstone prior to Hooding (4 weeks)

Preparation for residency training
Customized to the different Trails

Research/Scholarship Requirement

All students willdevelop a core understanding of human subjectsresearch and will complete a scholarly project.

Students will be exposed to all forms of scholarship (e.g., discovery, synthesis) and then given the opportunity to pursue their interests, such as in laboratory, clinical, educational, community or health services research
All students will complete an Introduction to Human Subjects Research course during the final 12 week Transition block of Foundations Phase or during the summer between first and second year
Time during the intersession after Blood and Cancer block will be devoted to planning scholarly project
Time will be offered during the Transitions (final 12 weeks of Foundations Phase) block for scholarship

Important components of scholarship project include:

Adequate mentorship
Flexibility in scheduling and project content
Emphasis on working in team, especially interprofessional teams
Specific project milestones/timelines, with completion expected by graduation
Infrastructure and funding necessary for students’ success
Culminating “Day of Scholarship” at which student research is presented and celebrated

Evaluation of Student Performance and the Curriculum:

Core factors

Robust educator development
Implementation of regional education and assessment centers
Adoption of overall residency readiness goals, such as the milestones and /or entrustable professional activities
Design, implementation and ongoing support of a dashboard and portfolio system for performance tracking, monitoring and reporting

Principles and approaches:

The curriculum committee will develop and assign general objectives and competencies to multiple components of the curriculum.
AAMC Physician Competencies Reference Set and the USMLE Unified Content Outline will be adopted as frameworks for objectives and competencies.
An Assessment and Evaluation Committee will develop policy, assist curriculum leaders in development of assessment techniques, and provide evaluations of curricular units as well as the curriculum as a whole
Developmental milestones for each competency will be established for each phase of the curriculum that lead to the achievement and documentation of the knowledge, skills, behaviors, and attitudes expected of our graduates.
All assessment results will be recorded in a student longitudinal portfolio with a dashboard interface to allow review of progress in achieving objectives and competencies.
Performance within a unit will determine if a student passes the unit and will contribute to assessment of performance in the phase.
Each element in an assessment will be related to one or more competency, objective, theme, or milestone and will be recorded and available to determine success on those units within and across phases.
Postgraduate assessment and program evaluation will continue to support continuous improvement of the curriculum and meet the needs across the region.

Evaluation in Foundations Phase - Traditional assessment methods will be utilized with increasing reliance on simulations, structured observations, reflections, and other written methods:

Frequent summative assessments with feedback will be utilized in block courses to allow students with marginal or poor performance to remediate performance gaps during the block.
An extensive summative OSCE will be conducted at the end of the phase, focusing on the appropriate milestones.

Evaluation in Patient Care Phase–Patient Care Phase leaders will determine the methods for assessment of objectives, milestones, and competencies within the phase. Specific assessment within clerkships will determine successful completion of that unit. Review of performance across all measures in the phase will determine success for the phase.

Milestones and objectives assigned to this phase will be assessed in block clerkships and Longitudinal Integrated Clerkships (LICs). A predetermined number of assessments in LICs will be conducted by educators external to the site.
An extensive summative OSCE will be conducted at end of the phase, focusing on the advanced milestones assigned to the phase.

Evaluation in Exploreand Focus Phase – Assessment will be based on the specific objectives and competencies assigned to the phase.

Decisions for Entrustable Professional Activities will be based on observation of performance across a number of patient encounters once appropriate milestones have been achieved.

Governance: Structure of Governance of Phases, Themes, and Overall Curriculum

Principles:

Governance procedures incorporate appropriate representation from the UW School of Medicine faculty as well as faculty from across the WWAMI region.
Governance procedures are consistent with LCME requirements.
Curriculum management allows for an appropriate balance between central oversight and local initiative, innovation, and site optimization.
The governance process encourages continuous improvement of the curriculum.
All School of Medicine students have equal access to an equivalent curriculum designed to achieve the learning objectives defined in the curriculum.
Processes leading to decision-making at both levels of governance are based on open discussion, transparency, shared governance, and iterative consensus development.

Governance Structure:

Governance occurs at two levels: the Phase/Theme Committees and the Curriculum Committee. The Curriculum Committee reports to the Vice Dean for Academic Affairs as Chief Academic Officer. Iterative discussions and consensus development will occur within each level and between levels.

Three Phase Committees (Scientific Foundations Phase, Patient Care Phase , and Explore and Focus Phase) and a Themes Committee:

These committees will report to the Curriculum Committee. Phase and Themes Committee scope of responsibility:

Assures relevant curriculum is delivered as planned
Assures equivalency ofcurriculum across sites
Assures evaluation of student performance, teaching effectiveness, and curricular quality
Assures adequate opportunities for dialogue among regional faculty; consensus-based decision-making; sharing of information about successful educational practices; and promotion of evidence-based teaching methods
Assures incorporation of cross-cutting themes within the curriculum phase:
Participates in iterative dialogue with the Curriculum Committee, including:
Presentation of evaluation data for review
Identification of opportunities for faculty development
Discussion and evaluation of learning objectives
Dialogue with other Phase/Theme Committees as needed, while keeping the Curriculum Committee informed
Recommendations for membership:
Strong representation from the block or unit teams for the relevant phase, as well as experts in curriculum development and evaluation.
Each Committee should include students and representation from WWAMI regions.
The membership should be a mix of appointed and elected members.
Although members are selected to ensure broad representation of the SOM, members have the responsibility to function as “members of the whole”, working to optimize the curriculum for that phase, rather than to represent the interests of a particular constituency.
Committee size should not exceed 20 members.

Curriculum Committee:

The Curriculum Committee will serve as an LCME-mandated committee. It will represent all faculty and include voting student members. The Curriculum Committee’s scope of responsibility:

Authority and accountability for oversight of the learning objectives, curriculum implementation, and evaluation procedures for the curriculum, as per LCME guidelines
Reviews Phase/Theme Committee plans for curriculum content and pedagogical methods, to assure overall coherence of learning objectives, curriculum, and evaluation methods
Defines methods and options for evaluation of students through appointment of a sub-committee dedicated to this role.
Assures evaluation of student performance, teaching effectiveness, and curricular quality and responsiveness to address areas identified as needing improvement.
Participates in iterative dialogue with the Phase/Theme Committees, including:
Review of evaluation data, with discussion of areas that need change as appropriate.
Identification and communication of opportunities for faculty development.
Discussion and evaluation of learning objectives, with the Curriculum Committee responsible for general objectives (big picture) and the Phase/Theme Committee responsible for detailed learning objectives.
Tracks dialogue between Phase/Theme Committees
May also initiate additional curriculum development activities to refer back to the appropriate Phase/Theme committee as needed, (e.g., in response to changes in LCME requirements)
Recommendations for membership and terms of office:
Desired size: 18-20 members
Co-chaired by a committee member (academic co-chair) and the Associate Dean for Curriculum (executive co-chair)
Faculty committee members serve three-year terms. Members may serve two consecutive terms and it is anticipated that many will do so. One third of the committee membership will rotate (or be re-elected) each year.
Student committee members to serve two-year terms, with half rotating each year.
The academic co-chair will be selected from faculty members serving a second term. Co-chairs will serve three years: as co-chair elect; co-chair; and past co-chair.
Selection of faculty members:
A Nominating Committee, consisting of 5 people (executive co-chair, academic co-chair, co-chair elect and past co-chair, and fifth member selected from elected members) will prepare a slate to elect a total of 12 elected faculty members, with a minimum of 4 from the WWAMI region.
The 4 chairs of the Phase/Theme committees will serve as members of the committee
Nominating Committee consisting of 4 people (the Student Affairs Dean; a Regional Dean; and two MSA representative, one from the WWAMI region and one from Seattle) will prepare a slate to elect four student representatives: one from a WWAMI first-year site and one from the Seattle Foundations Phase; and two students in the Clinical Phases, one of whom completed Foundations in the WWAMI region and one of whom completed Foundations in the Seattle region.
Although members are selected to ensure broad representation of the School of Medicine, members have the responsibility to function as “members of the whole”, working to optimize the curriculum for that phase, rather than to represent the interests of a particular constituency.
Student members are encouraged to survey their colleagues when input is needed, and to debrief with fellow members who are unable to attend due to clinical or other academic responsibilities.

Role of SOM Faculty Council on Academic Affairs
The Council, chaired by the Vice Dean of Academic Affairs, will provide advisory oversight for the curriculum and related policy decisions; the council may initiate discussion of curricular issuers or respond to issues raised by committees

Management of Conflicts