Joseph Chen, Eve Clark, Hans House, Janna Lawrence, Frances Meyer, Jeff Pettit, Peter Rubenstein, Kate Thoma, Teri Thomsen, Kristen Gerjevic, Manish Aggarwal, Jill Bowman, Brandon Alleman, Nancy Rosenthal

Charge• Design an educational structure

– Increased flexibility– Increased integration– Earlier clinical experience– Enable individualized progress through the

curriculum– Ability to incorporate other goals

• Patient and societal needs• Maintaining competencies• Promoting student centered education and use of

educational technologies

First 2 weeks

• Intro to medical school – basic orientation and practical skills for success– Intro to searching the literature– Ethics, professionalism

• “Cornerstone” Mega-Case– “That which all other stones are compared”– Start to think like a doctor caring for a specific patient– Case starts with simple anatomy, physiology, but then

becomes more complicated as learners understand more– Can also address some psychosocial issues related to

medicine – coping with chronic disease, death, dying, etc.– Case can be re-addressed throughout the 1st or 2nd year

First 12 weeks

• Focus on basic principles of biochemistry, genetics, cell biology and embryology that must be understood before specific organ system curriculum starts.

• Combination of lectures and small group discussion sessions.

• Basic concepts of pathology such as inflammation, neoplasia, cellular injury, etc.

• Basic concepts of pharmacokinetics that are not easily fit into the organ-based blocks.

Organ System-Based Curriculum*(40 weeks)

Micro/ID/Immunology 6 weeks Cardiovascular 4 weeksRespiratory 4 weeksRenal 4 weeks Hematology / Oncology 4 weeksGastrointestinal / Nutrition 4 weeksReproductive / Endocrine 4 weeksNeurology / Psychiatry 6 weeksMusculoskeletal/CT/Derm 4 weeks

* Courses Co-Directed by a combination of basic scientists and clinicians

Continuity / Introduction to Clinical Medicine half-day

• Introduction to obtaining history

• Comprehensive physical examination

• Continuity of care experience– To start in January of 1st year– Seeing physicians interact with patients in

clinics or wards– Aim it to integrate with organ systems– Practical exposure to professionalism, ethics

Transition to Clinics

• 12 week course, similar to current FCP-4 and Ethics courses

• Structure can be determined– Chief complaints?– Organ system based?

Board review/ USMLE

• 4 week block

• Optional review sessions

• Take the boards any time in the month

• Time for remediation of courses not passed, if needed

Required 4 week Clerkships

• Medicine – outpatient /primary care • Medicine – inpatient • Surgery – inpatient • Pediatrics • Family medicine • Obstetrics and gynecology • Psychiatry • Neurology • Critical care or Emergency Medicine

Required Electives (2 weeks)

• Surgical specialties (3) □ Orthopedics□ ENT,□ Urology, □ Opthalmology, □ Cardiothoracic Surgery, □ Vascular Surgery□ Neurosurgery□ Interventional Radiology

• Med/Peds Specialties (2)□ EKG, Cardiology□ Nephrology, □ Pulmonary,□ Rheumatology

• Chronic Disease/Disability (1)□ Rehabilitation medicine□ Geriatrics□ Hospice/Palliative care□ Chronic care (4 weeks)

• Hospital-based Specialties (2)□ Pathology□ Lab medicine□ Radiology□ Anesthesia □ Dermatology

Keystone =

Subinternship • Keystone: “That stone which if not present,

would not be able to form an arch”• Must be a 4 week rotation• Any specialty with inpatient unit• Goal is to function as an intern• Culmination of progressive increase in

responsibilities

Senior Seminars • Near Match Day (before or after)• Revisit basic sciences for specific

medical conditions pertinent to their future career

• Taught by basic scientist, clinician, and an allied health professional

• Improves vertical integration of basic sciences with clinical sciences

• Week-long sessions • Required to take two• Examples:

– Obesity/Metabolic syndrome– Diabetes– Aspects of Medical Nutrition– Personalized medicine, etc.

• Foundation for lifetime learning– Focus on necessary skills to be a successful as a house officer– Intensive course of patient simulation for common high-yield

procedures as a house officer– ACLS, PALS– Reflective Writing– Review of ethics and professionalism– Evidence-based Medicine– Interdisciplinary Teams

Capstone = Highest, ultimate

stone

Assessment of Competencies

• Touchstone = “that which is used to compare with all others”– USMLE Step I and II

• Intermixed throughout curriculum

– End of 1st year,

– Before Step II,

– After core clerkships,

– After all clerkships

• Related to competencies to be developed by COM

• Global assessment using:

– OSCEs, Direct observations, Simulations

Increased integration• Integration of basic science curriculum into an organ-based

format which is less departmentally-based. • Each unit co-directed by a basic scientist and a clinician• Early clinical exposure allows exploration before deciding

specialty career focus (middle instead of end of 2nd year)• Transitions to clinic course that could be focused on

common chief complaints• Interdisciplinary education with new electives in chronic

disease management, geriatrics, rehabilitation, and pain control

• Return to basic sciences with Senior Seminars before or after Match Day

• Capstone at the end of 4th year that emphasizes practical house officer skills as well as reflective writing, evidenced based medicine, and working in interdisciplinary teams

Increased flexibility in curriculum

• Earlier clinical experiences give more time to see progressive change in roles in medicine

• 4 weeks for board review and USMLE Step 1 • Decrease in the required clerkships allows more

flexibility in student-centered learning• Electives among variety of disciplines ensures broad

exposure to many areas and strengths of UI CCOM• Departments will want to make clerkship experiences

positive to compete for students.• Increased time to work on Distinction Tracks• Increased elective time makes it easier to complete

independent scholarly activities• Time for reflective writing and expertise of the writing

program

What we didn’t address

• Specifics of how courses should be taught– Combination of lectures (minimized) and small

groups

• Inter-departmental priorities and ability to collaborate on teaching similar medical conditions

Joseph Chen, Eve Clark, Hans House, Janna Lawrence, Frances Meyer, Jeff Pettit, Peter Rubenstein, Kate Thoma, Teri Thomsen, Kristen Gerjevic, Manish Aggarwal, Jill Bowman, Brandon Alleman, Nancy Rosenthal