Innovations in Medical Education
A Proposal for Quality Improvement

Presented to the Educational Policy Council
June 14, 2006

Introduction

Medical education is a core mission and programmatic strength of the University of Wisconsin School of Medicine and Public Health (UWSMPH). Annual evaluations and external benchmarks provide ongoing feedback about the quality of medical student education. Students at the UWSMPH consistently perform higher than the national average on USMLE Steps 1, 2 & 3. Medical students match to top rated programs and are able to match within their top three choices. In annual surveys, residency directors rate their interns from the UWSMPH more highly in preparation and competency than interns trained at other schools. More than 35% of all students participate in a sponsored research project, 25% participate in international electives and 85% of the class participates in community service programs.

UWSMPH medical students provide positive ratings of their educational experiences on the annual AAMC Graduation Questionnaire. Clerkship and course evaluations ranks cluster in the 1’s and 2’s on a 1-5 point rating scale. Faculty teachers are perceived as dedicated and available to help students succeed in learning course content.

While many indicators for medical education at UWSMPH are positive, current and forthcoming challenges will require the school to be more flexible and responsive to continue to provide innovative educational programs for our students and to develop national models for medical education for adoption at other schools and programs.

New Opportunities

UWSMPH is proud of its accomplishments in medical education. We strive to provide outstanding, innovative educational opportunities, lifelong learning skills and an integrated, holistic curriculum. A number of new opportunities are presently available that will allow us to reach our goal of providing the very best available programs in medical education.

• The Health Sciences Learning Center provides an outstanding learning environment which can support curriculum and assessment with state of the art technology and facilities.
• We have recently changed to become an integrated school of medicine and public health, which offers new opportunities for blending medical and public health curriculum content.
• The Wisconsin Partnership for Health has awarded a four year Innovations in Medical Education grant to enhance medical student education and align the content to help achieve the goals of Healthiest Wisconsin 2010.
• The UWSMPH has received a four year NIH BASIC Training in Medicine grant to integrate behavioral and social sciences content into medical education curriculum.
• We are developing the Wisconsin Academy of Rural Medicine to address the shortage of physicians practicing in rural areas.
• We have established a vibrant research program and research honors for medical students, in addition to our excellent MSTP program, to address the need for physician scientists.
• Medical students are active leaders in community service projects for underserved patients in our region, providing (under faculty guidance) clinical care at five sites, health screening fairs and numerous health education programs for middle and high school students.
• New resources are available to assist in curriculum development in target areas by partnering with the new UW Center for Global Health and Center for Cultural Diversity in Healthcare.
• UWSMPH has recently established an MPH degree and anticipates a dual MD/MPH degree will be available for 07-08.

Old Challenges

• Current UWSMPH medical student curriculum continues to rely heavily on old pedagogic models for teaching and assessment. This was specifically criticized during our last Liaison Committee on Medical Education (LCME) accreditation review.
• Historically, medical education at the UWSMPH was organized through a strong departmental structure. Despite excellence of individual instructors and individual courses, this structure fosters a lack of vertical and horizontal integration of curricula across the eight semesters of medical school.
• LCME increasingly expects strong central oversight and control of medical student curriculum by the office of medical education. At the last LCME visit, site visitors recommended strengthening the central oversight and authority of the Educational Policy Council.
• New LCME standards have been established since the medical school’s last accreditation. These standards include requiring courses and clerkships to have clear goals and objectives, tied to the school’s chosen competencies. Achievement of the competencies must be measured through appropriate assessment modalities.
• Additional new standards require professional development in teaching skills for all faculty and residents. Faculty and residents must be knowledgeable about the medical school curriculum and how their teaching fits within the curriculum content map. Currently there is not enough staff to meet this standard.
• Students must receive timely mid course/clerkship feedback to allow them to address any identified deficiencies. Courses and faculty must receive timely evaluations to incorporate feedback to improve teaching. Currently there is not enough staff to meet this standard.
• Clerkships must establish a minimum set of clinical conditions that students will see while on that rotation. A documentation system must be in place to allow clerkship managers to identify students not meeting the minimum clinical guidelines, so that alternate educational experiences may be provided.

Solutions

A perfect storm is in place for the University of Wisconsin School of Medicine and Public Health to become the premier medical education institution in the country. The Health Sciences Learning Center provides the facilities, technology and information management resources. The Wisconsin Partnership Fund, the NIH BASIC Training and CDH’S EXPORT Center grants provide over 5 million dollars of new funding over the next four years. The school is integrated within a campus with world renowned, cutting edge basic and translational research and is partnered with the full range of health professions and graduate programs. The school is formulating its vision as it integrates the disciplines of medicine and public health into education, research and service. The school has a track record of successful implementation of high profile national demonstration grants for medical education, including the Interdisciplinary Generalist Curriculum and the Undergraduate Medical Education for the Twenty-first Century projects. Since implementing these initiatives in the last decade, the school has been ranked 4th, 5th or 6th in the US News and World Reports annual rankings for medical schools’ primary care education. The Standardized Patient Program and Clinical Assessment Center have provided expertise for more than 15 years on the use of OCSEs and SPs in teaching and testing. The Madison campus has a well established Teaching Academy and the school offers MEDAL and T4T professional development programs for teaching skills. Finally, a mission based budgeting model is in place to assure continued fiscal support for the core mission of education.

One important gap needs to be addressed before the UWSMPH medical education can truly reach its full potential. The school must transform from departmentally based curriculum control and oversight to a structure that promotes integration and a holistic curriculum. The Educational Policy Council must be charged with the responsibility to ensure that the schools curriculum supports its educational mission and defined competencies. The EPC must have the authority to define new content areas that must be included in medical student education. It also must have the ability to "right size" existing courses and clerkships, with regard to both allocation of time and depth of content presented.

The EPC cannot exert this authority and oversight without resources to provide key data and information needed to make these decisions. The new faculty and staff supported by the IME and BASIC grants must be responsive to the direction of EPC in developing an integrated eight semester. The administrative staff in Academic Affairs must also support the EPC through its ongoing work in curriculum management, student assessment and course evaluation.

Next Steps

The following steps must be accomplished to allow the EPC to move forward on important curriculum innovations and revisions:

1. Develop a mission statement for medical student education for the UW School of Medicine and Public Health. (06/06)
2. Establish the Accreditation Council for Graduate Medical Education competencies as the measure for evaluating achievement of the education mission. (06/06)
3. Establish goals for education in each year of training for the six competencies. (06/06)
4. Implement an electronic tracking system for curriculum mapping. Students, IME team, course/clerkship directors will assist. (Fall 06)
5. Review all eight semesters of curriculum for content, gaps and overlap, and methods of assessment. IME team, course/clerkship directors and administration will assist the EPC. (06/07)
6. Review and/or develop learning objectives for all courses, clerkships and instructional units (lectures, labs, small groups), defined within the six competencies. Course instructors and IME team will assist. (06/07)
7. Formalize the relationship between the EPC, the IME Curriculum Faculty Leaders and Program Managers and education administrators to facilitate change (07/06)
8. EPC will recommend high priority changes in all eight semesters. (These areas include incorporating new content --public health, cultural competence, musculoskeletal, dermatology, BASIC topics--, new clerkship guidelines, rightsizing/downsizing historically established courses and clerkships and addressing the imbalance in credits in the first semester of the Med 2 year. (12/06)
9. Implement additional new curriculum changes as tolerated. (07/08)
10. EPC will establish an ongoing quality monitoring process to assess achievement of education mission and goals for all four years of training. The current rotating course reviews should continue. This process would provide an additional assessment of quality and outcomes. (Fall 06)