Curriculum Development Principles and Guidelines

Integrating basic science and clinical medicine through a four year biopsychosocial continuum.

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The principles and guidelines below provide the framework for creating an entirely new curriculum that began with the entering class in 1999. This radical departure from the current curriculum has been mandated by the Medical School Advisory Council and the Dean. The integration of current course contents into new interdisciplinary formats in the new curriculum is not a function of past course evaluations, but of a philosophy of education which focuses on learning and not just on teaching. Curricular design will be based on competencies, objectives, outcomes, adult learning principles, modern assessment techniques and continuous improvement. Each element of the curriculum should strengthen Rochester's biopsychosocial tradition by combining cutting-edge evidence-based medical science with the patient-centered art that has been medicine's distinctive trademark through the ages.

Curriculum Development Principles

General medical education focus, but with adequate electivity to enhance students' special interests, all emphasizing the knowledge, skills, attitudes and behaviors appropriate to the leaders of 21st century medicine.

• Knowledge base characterized by breadth, depth and flexibility
• Skills in the acquisition and use of knowledge with a commitment to lifelong learning
• Sensitivity to the world of the patient
• Biopsychosocial integration of curriculum and learning experience

Integration of the teaching of basic and clinical sciences across all four years of the curriculum.

• Clinical cases drive learning of science in the first and second years
• Basic sciences taught in clinical context and integrated with one another
• Clinical work taught in scientific context, with emphasis on basic mechanisms
• Return to advanced basic science curriculum in the third and fourth year
• Process should foster appreciation of scientific investigation and its impact on the growth of medical knowledge

Every course must have a statement of objectives, a plan for enabling students to meet those objectives, and a plan to assess students to ensure objectives have been met.

• Objectives are "mid-level" in detail, neither generalized concepts nor a detailed listing of every fact
• Objectives and assessment instrument must be approved by the Curriculum Steering Committee

Curriculum Development Guidelines

1. For the classroom setting
   Emphasis on active student learning through the school-wide use of multidisciplinary problem-based learning (PBL) in all courses.
   • All courses interdepartmentally integrated (no department names in course titles) with a single course director heading the course
   • Multidisciplinary faculty teams run each full-time curricular block with support from the Office of Curricular Affairs in such areas as faculty development, case development, assessment and evaluation, and computer-assisted learning
   • Students enter subjects at mid-level (four-chamber heart and circulation of blood) and revisit subjects with increasing depth and complexity (from molecular regulation of ion channels in the pacemaker to socioeconomic and cultural factors associated with heart disease)
   • Three 2-hour tutorials per week, no more than ten students per group
   • Maximum of 8 hours of lecture per week on average - not meant to "cover course content" but where most gifted and knowledgeable lecturers each give a series of lectures to orient students and explain complex, difficult, or cutting edge topics
   • Small group sessions consist of laboratories, conferences, seminars, etc. appropriate for each course and topic with no lecture presentations
   • Students challenged with responsibility for self-directed learning
   • Adequate time for self-study: no other scheduled curricular activities on Tuesday and Thursday afternoons to allow for individual and group self-study for tutorials

     First Year Prototypical Academic Week

     
     

   Assessment formats should be appropriate to the content and process of learning.

   • All exams consist of integrated questions covering the multiple disciplines in each block (e.g., single final exams at the end of each course)
   • Regular tutor and lab instructor evaluations of students with comments on attendance, preparation, participation, critical thinking skills, knowledge application to problem solving, and professionalism
   • Emphasis on student feedback of faculty teaching, program design, and student self assessment
   • Comprehensive exam at the end of years 2 and 3 using modern multi-format evaluation methods with formative evaluation of all students' strengths and weaknesses and remediation plans where appropriate
2. For the clinical setting
   All clinical courses and experiences must have clearly stated educational goals and objectives.

   Introduction to Clinical Medicine and Primary Care/Ambulatory Longitudinal Clerkship will be interdepartmentally integrated with a single course director for each.

   Departmental Core Inpatient Clerkship Directors will collaborate on the development of goals and objectives to assure that the clerkships complement rather than repeat each other.

   All clinical experiences should emphasize hands-on, independent student interaction with patients. Shadowing/observer experiences should be kept to a minimum.

   Principles of evidence-based medicine should stress the linkage between basic science and clinical practice and should be incorporated into the clinical curriculum.

   Case-based, interactive, small group sessions rather than lectures should be used to supplement clinical experience and assure that important core topics are covered during each clerkship.

   Students should be challenged with the responsibility and provided with the time for self-directed learning during clinical clerkships.

   Assessment formats should be multidimensional and should include (but not necessarily be limited to):

   • written evaluations by faculty members and residents who have worked with the student in the course of their clinical activities
   • formal course-end assessment of the students' knowledge base; NBME subject examinations or comparable valid instruments are suitable
   • interval performance-based evaluation through the use of standardized patients, OSCE's, etc. This type of evaluation is best suited to the year-end comprehensive evaluation periods after Years 2 and 3, rather than after each specialty clerkship

Course Design Outline

Mastering Medical Information: Foundations for a Lifetime of Learning

Data management and Information technology

Biostatistics; Epidemiology; Critical reading of the literature*; Evidence-based medicine; and Clinical trial design

*Uses literature on interviewing and on biopsychosocial "theme" contents to launch themes that will be integrated into all courses, with all final exams assessing theme contents included in courses:

Diversity; Ethics; Health Economics; Nutrition; and Prevention

Introduction to Clinical Medicine:

History (clinical side of medical information acquisition), physical examination (taught with anatomy and basic physiology), then complete patient work-ups, with emphasis on health promotion and disease prevention.

BPSM I and II; General Clerkship; Introduction to Doctoring; and Community and Preventive Medicine

Human Structure and Function:

Gross Anatomy; Histology; Embryology and Physiology

Molecules to Cells:

Biochemistry; Genetics; Molecular Medicine, Nutrition and principles of Endocrinology, Oncology and Pharmacology

Host/Defense:

Microbiology; Immunology; Inflammation; Blood-lymphoreticular; Introductory Pathology; Pharmacology: antibiotics, anti-inflammatories; and Dermatology

Ambulatory Clerkship Experience:

Includes all ambulatory components in integrated experiences

Family Medicine; Pediatrics; Internal Medicine; Women's Health; Psychiatry; Neurology; Dermatology; and Ambulatory Surgery: urology, orthopedics, ophthalmology, ENT, and General Surgery

**Students' actual clinical cases will supplement PBL cases to drive learning of sciences basic to medical practice.

Mind/Brain/Behavior:

Neuroscience (anatomy and physiology); Neuropathophysiology; Neuropharmacology; Psychopathology; and Neuroendocrinology

Integrated Systems:

Pathophysiology, including pathology by system, more advanced physiology, and relevant pharmacology

Module A: Cardiovascular; Pulmonary; Renal; and Hematology
Module B: Gastrointestinal; Musculoskeletal; Reproduction (male and female); and Endocrinology

Case seminars in years 2,3, and 4:

These bring together all the sciences and clinical material with increasing levels of depth each year. Year 2 case seminars, for example, revisit first as well as second year material. The Curriculum Development Group for this eight week course is the group course directors of all courses in the first two years who will design this comprehensive course to cut across all topics (e.g., a section on acid-base can revisit pulmonary, renal, and body fluids; a "cancer" section might cut across all systems from genetics to population-based risk factors).

Comprehensive assessments at end of years 2 and 3:

These are multi-station multi-format multi-day exercises that culminate in a formative assessment of strengths and weaknesses for every student and remediation plans where appropriate.

Inpatient/acute care experiences:

By the end of year two, students will already have had more ambulatory experience than in the current curriculum's four weeks of family medicine and the ambulatory portions of all other clerkships combined. Now the third year clerkships can be more intensive inpatient experiences in:

Adult inpatient care (3 months): Approximately 6 weeks in medicine and 6 weeks in surgery (medicine, family medicine, and surgery)

Women's and children's health (2 months): Approximately 4 weeks in OB/GYN and 4 weeks in pediatrics

Mind/brain/behavior (2 months): Approximately 4 weeks psychiatry and 4 weeks neurology

Urgent/emergent care (1 month) These must be completed by December of year four.

Electives: At least 5 more months of credit-bearing electives (at least 2 of which must be clinical rotations including one externship, which may be inpatient or outpatient: externship defined by increased level of clinical responsibility).

Hypothesis-driven Research:

This may be on natural or social sciences basic to medicine. Must be handed in and approved to enter match list in February.

Successful Interning:

Formerly part of the "senior seminar" (which will now focus on integration of all the sciences and clinical material), this final course covers practicalities from hospital routines to EKG reading.

Interdiscplinary Community Health Improvement Course:

A novel interdisciplinary community health improvement course involving the School of Nursing, the School of Medicine (including both MD and MPH programs), the Center for the Study of Rochester's Health, and the Rochester community. The course will incorporate previous related work such as the Health Action Electives and the Students of Rochester Outreach Program. This course will combine policy level understanding with placements in community agencies or coalitions focused on particular community health imporvement priorities as informed by course learning objectives and the Monroe County Health Action Process.