CURRICULUM

INTEGRATED CASE DEVELOPMENT AND INTERDISCIPLINARY FACULTY COLLABORATION

Sara M. Lamb, Rick Ash, Michele Haight & Janet Lindsley

University of Utah School of Medicine
Salt Lake City, Utah 84132
USA

*Presenting Author

PURPOSE
To promote interdisciplinary faculty collaboration through the development of integrated case content (clinical medicine, medical arts, basic science).

METHODS
Six to ten core clinical and basic science faculty met weekly for 2-3 hours over the course of 20 weeks to brainstorm and develop integrated patient cases and accompanying discussion questions for Phase I of a newly integrated medical school curriculum. Case content included: patient history, physical examination, laboratory, imaging, gross and histopathologic data. The clinical problem provided the context for all faculty to develop content and questions. The case was posted at the beginning of each week for students to review. Faculty supervised students who met in small groups (8) every Friday to analyze the case and answer the questions.

RESULTS
The process of case development has become the cornerstone for successful integration of all content areas into our new curriculum. Fourteen integrated cases were developed for Phase 1. Faculty found that the process improved coordination of their teaching. Baseline Phase I survey data indicated that 100% of the core faculty found the integrated cases to be an effective teaching method and 87 % felt faculty collaboration was useful. Additionally, students qualitatively identified the integrated cases as the most valuable component of the curriculum.

CONCLUSIONS
The process of interdisciplinary, integrated case development appears to enhance collaboration among faculty and provides an educational activity that is valued by students. This process warrants further study.

AN INTEGRATIVE APPROACH TO TEACHING CLINICALLY ORIENTED EMBRYOLOGY

Elmus G. Beale* & Bhargavi Patham

Texas Tech University Health Sciences Center
Paul L. Foster School of Medicine
El Paso TX, 79922
USA

*Presenting Author

PURPOSE
To understand congenital defects one must know embryology. We have found that combining embryology with pathophysiology in an active learning, clinical presentation context is an effective way to teach clinically oriented embryology.

METHODS
This integrative approach requires a basic scientist (embryologist) and a clinician who collaborate as co-lecturers / co-discussion leaders. For example, the focus of a recent 2-hour class at our institution was “Congenital Heart Disorders: Left-to-right Shunts”. This class followed others in which students received instruction on the clinical presentations of chest pain and abnormal heart sounds, followed by heart anatomy, physiology and embryology. Among the shunts covered in this class were atrial septal defects (ASD), patent foramen ovale, ventricular septal defects, and patent ductus arteriosus. For ASDs, the embryologist presented a brief review of atrial septal development and asked students to discuss how each of the 3 types of ASD (primum, secundum and venosus) might arise. The clinician then used diagrams of the circulatory system to guide students to deduce ASD symptoms and signs. The other shunts were then sequentially discussed in a similar fashion.

RESULTS
The efficacy of this active-Learning approach is excellent as evidenced by high student attendance, attention and participation in class, and by positive student evaluations.

CONCLUSION
Integrating basic and clinical science is effective when basic scientists and clinicians present complementary information together in a clear clinical context that involves active participation of students. This approach is effective for teaching pathophysiology along with any other basic science discipline.

DOES ONE SEMESTER LESS OF PRECLINICAL STUDIES ADVERSELY AFFECT UNDERSTANDING OF CLINICAL PROBLEMS?

Birgitta Björck* & Hans Gyllenhammar

Department of Medicine
Karolinska Institute
Karolinska University Hospital Huddinge
SE14186 Stockholm
Sweden

*Presenting Author

PURPOSE
The new Karolinska curriculum is theme-based and integrated with basic science and clinical science side by side throughout the 11 semesters. Semester 1 to 4 are principally basic science with 10 percent clinical and semester 5 to 11 clinical with 10 percent basic science. One consequence is that the preclinical studies are now one semester shorter than in the old curriculum when students enter the first major clinical course in semester 5 (clinical medicine). In 2009 half the number of students in clinical medicine were from the old curriculum and half from the new but both taking the same course. This offers a unique opportunity to compare the new and old curriculum within the same course in respect to the effect of shortened preclinical stage.

METHODS
The two groups of students were integrated in the course following the same schedule irrespective if they were semester 5 or semester 6 students. The tests in internal medicine taken during the course as well as the students evaluation questionnaires were the same for all students but after correction and compilation they were separated thus permitting comparison of the two groups. At this time 2 of 3 exams in internal medicine have taken place.

RESULTS
The test results for the 2 first exams in internal medicine were almost identical for the two groups of students. When analyzed by subject this also held true as well as when individual questions in the test were analyzed. There is no difference in teacher evaluations of the two groups clinical rotations. In student evaluations of the course there was a trend towards semester 5 students preferring lectures whereas term 6 students preferred clinical case seminars.

CONCLUSION
Integration of clinical- and basic science also means that students meet clinical training earlier in their studies with less preclinical studies and training. The two groups of students in this study differ by 1 semester in their preclinical training but show similar results in theoretical exams and in evaluations of practical skills training.

PREPARATION FOR CLINICAL CLERKSHIPS: COMPARISON OF TWO PRECLINICAL CURRICULA

Giulia A. Bonaminio*, Anthony M. Paolo & Benito Berardo

University of Kansas School of Medicine
Kansas City, KS 66160
USA

*Presenting Author

PURPOSE
Third-year clerkship directors rated students’ preparation for clerkships in the new, integrated pre-clinical curriculum higher in medical knowledge than in the discipline-based curriculum. We wanted to determine if faculty
ratings and clerkship performance supported this finding.

METHODS
At the end of the first clerkship rotation, clerkship directors rated students’ level of preparation on ACGME competencies. Faculty rated students on the competencies using a clinical performance rating form (CPR). Internal Medicine, Pediatrics and Surgery were chosen for comparison because their CPR forms were collected electronically. USMLE subject exam scores and clerkship grades were also compared.

RESULTS
For medical knowledge, directors rated students in the integrated curriculum significantly higher than students in the discipline-based curriculum. Overall, there were no significant differences between curricula on any faculty rated CPR competency. Students in the integrated curriculum were rated higher in practice-based learning in Internal Medicine. They were rated lower in practice-based learning and systems-based practice in Pediatrics and lower in practice-based learning and professionalism in Surgery. There were no differences between the curricula on clerkship grades or subject exam scores.

CONCLUSIONS
Although directors indicated that students in the integrated curriculum were better prepared in terms of medical knowledge, faculty ratings, exam scores and grades did not support this finding. The lack of agreement may reflect method variance. Directors used a general gestalt rating for each competency, while faculty were asked specific questions within each competency. Further, subject exams and clerkship grades were mostly objective while the ratings were subjective.

INTEGRATED BASIC AND CLINICAL SCIENCE CASE REVIEW USING HUMAN PATIENT SIMULATION

Kristina Brown, OMS III*, Andrea Nazar & Craig Boisvert

*Presenting Author

PURPOSE
Human patient simulators are often simply used for clinical scenarios. However, human patient simulators can be integrated into basic science curriculum via patient case studies. This research focused on the use of human patient simulators during components of cardiovascular and respiratory basic science case studies.

METHODS
Second year osteopathic medical students performed history and physical exam skills on human patient simulators in group settings of 4-5 students. During these encounters, a faculty member guided the students through correct communication and physical examination techniques. In addition, the faculty member reviewed basic science step one board review material pertinent to the case presentation, including pharmacology, microbiology, pathology, and physiology. Before the encounter, the students were given a pre-test of the concepts they would cover during the case. After the encounter, the students were given a post-test and a questionnaire.

RESULTS
The results of the post encounter questionnaires showed 100% of the 51 students thought the experience was worthwhile and would repeat the experience if given the opportunity. The students rated the value of the session 9.7/10. Pre-test scores showed an average of 38% while the post-test average increased to 86%.

CONCLUSION
Basic and clinical science integration with human patient simulators enhances student participation, learning, and understanding of complex case material. By expanding the project to more organ systems and to larger group settings, more students will receive greater integration of basic science course material with clinical hands on simulated training.

DEPARTMENT OF SCIENCE EDUCATION: AN INTEGRATED FRAMEWORK FOR LEARNING WHAT, HOW MUCH AND WHEN

Patrick J. Gannon1*, David Batinelli, June Scarlett, Carole Ingrassia, Jeffrey Kraut & Lawrence Smith

Hofstra University School of Medicine in partnership with
North Shore LIJ Health

*Presenting Author

PURPOSE
In many traditional medical schools pre-clinical science faculty are selected from basic science departments and serve as short term educators. Cross departmental faculty may also come together as an Academy of Medical Educators. In our new approach we created an identity and consciousness, within a departmental setting, that promotes collaboration and scholarship. Departmental goals reflect and complement the cultures of our university, health system and the community.

METHODS
Core departmental faculty act as multidisciplinary content experts, both within the standard basic sciences and outside, from anthropology through medical narrative. With no traditional basic science courses, all are presented longitudinally, at the appropriate level, with primary exposure then revisits to refresh and advance. Faculty monitor progress of their primary discipline and collaborate to promote interdisciplinary integration. Recruitment, which was based on these fundamental principles, allowed candidates to be selected not just for their knowledge, but for their enthusiasm and an ability to think longitudinally and out of the box.

RESULTS
As the medical educator community became aware of our new approach to science education, considerable excitement became evident. Recruits were well aware of the wave of changes sweeping across medical school communities in the US, and how this was exemplified in our new approach to creating a unified home of sciences
that had a broad reach beyond traditional disciplines.

CONCLUSIONS
The right people, imbued with our way of thinking, were willing to take a chance and move in a new direction, away from traditional approaches such as large group lecture teaching, to facilitation of student generated learning in an integrated cross disciplinary department.

TEACHING ANATOMY IN AN INTEGRATED UNDERGRADUATE MEDICAL CURRICULUM: EXPERIENCES FROM THE UNIVERSITY OF KANSAS, SCHOOL OF MEDICINE

Robert M. Klein, Michael Karr*, George C. Enders, Dianne Durham,
James L. Fishback, Anthony Paolo, Pamela K. Shaw & Giulia A. Bonaminio

Departments of Anatomy and Cell Biology, Pathology and Laboratory Medicine, Otolaryngology-Head and Neck Surgery, Psychiatry and Behavioral Sciences, and Pediatrics and the Office of Medical Education,
University of Kansas School of Medicine (KUSOM)
Kansas City, KS 66160
USA

*Presenting Author

PURPOSE
In 2006, the KUSOM instituted a technology- and module-based, integrated medical curriculum. The curriculum begins with Foundations of Medicine (FOM), Genetics and Neoplasia, Inflammation and Immunity and progresses through systems during the first year: Cardiopulmonary, Gastrointestinal Nutrition (GIN), Renal/Endocrine, and Reproduction and Sexuality. In the second year, the modules are: Musculoskeletal, Brain and Behavior (B&B), Blood and Lymph, Infectious and Parasitic Diseases, Medicine Across the Lifespan (MAL), and Integration and Consolidation.

METHODS
Tablet PCs are used to integrate technology components and learning concepts, providing 24/7 access to all curricular content. Lectures decreased by 40% and are podcast using Camtasia Relay. Lectures were replaced by small group, e-Learning, and formative activities. Histology and cell biology labs begin in the first year FOM module and continue as integrated histopathology laboratories using digital videos, virtual microscopy, and electronic quizzes. Human Anatomy begins with thorax dissection in Cardiopulmonary and continues in GIN (abdomen), Reproduction and Sexuality (pelvis), Musculoskeletal (extremities), and B&B (head and neck) modules. Human Anatomy uses team dissection, cadaver teams, a radiological anatomy website, and lectures for content dissemination. Embryology is introduced in FOM, focusing on concepts of early development and is subsequently integrated into appropriate systems/modules. For 2010, key basic and clinical embryology concepts were reviewed in MAL with clinical cases. Neuroscience is now integrated with head and neck anatomy and behavioral sciences in the B&B module using clinically-oriented labs and small groups.

RESULTS
A few early technical problems have been overcome and student satisfaction with the curriculum has been high.

CONCLUSION
The tablet PC can be used effectively to integrate anatomical content in an electronic curriculum which includes traditional human anatomy, neuroscience, and histopathology labs coupled with state-of-the-art media.

DEVELOPING A MODEL TO INTEGRATE EVIDENCE BASED MEDICINE INTO A CROWDED CURRICULUM

Stephen D. Laird*, John H. George, Sondra M. Sanford & Susan Coon

A.T. Still University Kirksville College of Osteopathic Medicine
Kirksville, MO 63501
USA

*Presenting Author

PURPOSE
Adding new material into a crowded curriculum without sacrificing existing course content and adding faculty contact hours can be a challenging task. Kirksville College of Osteopathic Medicine (KCOM) developed a model to integrate evidence based medicine (EBM) content into its curriculum and add a new course.

METHODS
KCOM instituted a faculty development workshop series using Diffusion Theory to gain faculty support to accelerate infusing EBM concepts into a full curriculum and cultivate cultural change. KCOM used a pretest-posttest design without a control group, actuated multiple quality circles, initiated a curricular mapping tool guide EBM planning, and brought in neutral third party faculty from an allopathic partner school to lead discussions. Faculty attitudes, confidence levels, and courses that included EBM applications were measured.

RESULTS
Data collected from the workshop series found 94% of faculty agreed to find ways to incorporate EBM into their classes. Summative evaluations revealed a statistically significant increase (PCONCLUSIONS
Evidence suggests that a faculty development model emphasizing a “bottom to top” approach is effective in achieving workplace culture changes and seamless curricular transitions. Results demonstrate that a consensus building model is conducive to engaging faculty, garnering support, and effectuating curricular change.

INTERPROFESSIONAL TRAINING: ELECTRONIC HEALTH RECORDS, EVIDENCE-BASED MEDICINE & MEDICAL INFORMATICS

Bruce W. Newton*, Janice K. Hart & Steven E. Boone

The University of Arkansas for Medical Sciences (UAMS)
Little Rock, AR, 7220
USA

*Presenting Author

PURPOSE
Health professionals in hospitals and private practices will soon need to use electronic health records (EHR). Thus, UAMS recognized that undergraduate health-related students must learn EHR skills to enter the workforce. Standardization of EHR language will facilitate translational research, so training in Medical Informatics (MI) & Evidence-Based Medicine (EBM) is needed.

METHODS
UAMS identified strengths and weaknesses of our existing curricula based on competencies from the Joint Work Force Task Force Training: Health Information Management and Informatics Core Competencies for Individuals Working With EHR, & Competency M8 in Scientific Foundation for Future Physicians. Each college will identify core objectives their students will master in EHR, EBM & MI. Students will use EHR, EBM & MI starting with their first patient care encounters in an interdisciplinary environment & in college specific curricular activities. Mock patient EHR will be used in classes, clinical simulations, and standardized patient learning activities. Web-based instructional modules will be used to supplement face-to-face training. Sharing of expertise and educational modules will minimize duplication of time and effort. Clinical librarians will participate in EBM and MI training. All first year classes would be introduced to EHR issues via an interdisciplinary seminar series. The Center for Clinical Skills Education will use the patient database for interdisciplinary OSCE encounters.

RESULTS
Program evaluation will be followed by the creation of enduring materials and expansion of the program. The evaluation and assessment plan will focus on evaluation of the materials in terms of usability, efficacy in producing knowledge, attitude, and behavior change toward use of EHR, MI, and EBM.

TOWARDS A COMPREHENSIVE E-BOOK FOR DELIVERING LEARNING MATERIALS IN A CLINICAL PRESENTATION-BASED CURRICULUM

Curt M. Pfarr*, Sanja P. Kupesic, Bhargavi Patham, Herb Janssen, Martha Guerra, Jose Lopez, Lizeth Coral, Jerry Rodriguez, Richard Brower, David J. Steele & Tanis Hogg

Texas Tech University Health Sciences Center
Paul L. Foster School of Medicine
El Paso, Texas
USA

*Presenting Author

PURPOSE
The Paul L. Foster School of Medicine is a new medical school located in El Paso Texas, just completing its inaugural academic year. The curriculum for the first two years is based on ~120 clinical presentations that represent signs and/or symptoms that would lead individuals to seek medical care. Each clinical presentation begins with an ‘inductive scheme’ session presented by an expert physician followed by 3-4 days of relevant basic and clinical science. This is followed by a related ‘medical skills’ session that focuses on acquiring interpersonal and diagnostic skills through the use of simulation technologies and standardized patients. Finally, a physician-run ‘worked case example’ small group session reinforces the acquired knowledge and skills by thorough review of several actual clinical cases. While this curriculum provides a highly dynamic and integrated presentation of basic science and clinical material, organizing and searching through the sometimes bewildering assortment of learning materials has proven daunting to the student. The goal of this project is to provide user-friendly software that will enable the student to efficiently navigate a comprehensive set of integrated learning materials, learning objectives, self-assessment items and web-based interactive tutorials.

METHOD
Currently we are using the iLios curriculum management software developed originally by the University of California at San Francisco School of Medicine. This software is linked to a comprehensive database containing learning objectives, session-related materials (e.g., PowerPoint and Camtasia files) and assessment items. The students access a calendar and relevant materials using the portal WebCT. However, the assigned reading is contained in more than 15 individual textbooks, a necessary complexity due to the integrated clinical presentation model. We are currently upgrading the iLios system, which will include enhanced student navigation software. This ‘E-book’ software will provide all of the previously available learning and assessment materials, and in addition provide all of the required reading materials in both web-based and printable formats. Links to clinical-presentation based interactive web-tutorials will be a prominent feature of the E-book. The navigation system is designed so that students can reach any place within the E-book within seconds. Furthermore, students will be able to bookmark and annotate individual pages, and create customized study portfolios.

RESULTS
A pilot E-book project, scheduled for completion in November 2010, will use a clinical presentation from the MS2 ‘Reproduction’ unit to beta-test the functionality of the upgraded iLios software and interactive modules. We will solicit feedback from MS 2 students in our inaugural class during this testing phase.

CONCLUSION
We anticipate the completion of the enhanced version of iLios, the E-book, and corresponding interactive web-based modules in March 2011. This resource will improve student access to the content of our curriculum and provide faculty with additional opportunities to enhance integration.

A CONTEMPORARY METHODOLOGY FOR TEACHING CLINICALLY ORIENTED IMMUNOLOGY

Janet F. Piskurich* & Bhargavi Patham

Department of Medical Education
Texas Tech University Health Sciences Center
Paul L. Foster School of Medicine
El Paso TX, 79922
USA

*Presenting Author

PURPOSE
Paul L. Foster School of Medicine is a new medical school with a clinical presentation-based curriculum where students learn basic science relevant to clinical science in the context of common patient presentations. Combining immunology and pathology in this context has emerged as an effective way to teach clinically-oriented immunology.

METHODS
This integrative approach requires an expert immunologist and a clinical pathologist who collaborate as lecture/discussion leaders. For example: the focus of a recent 2-hour session was “Vasculitis”. Preceding sessions centered on the clinical presentation of abnormal pulse, providing instruction in the control of heart activity, vascular development and physiology. Our integrated immunology/pathology session focused on diseases causing large, medium and small vessel vasculitis. For each, symptoms, type of vascular involvement, epidemiology, immune mechanisms, gross pathology and histopathology were presented in an active interplay between clinical pathologist, immunologist and students. Clinical cases were provided to facilitate further discussion.

RESULTS
Effectiveness and students’ perception of the usefulness of this active-Learning approach are excellent as evidenced by high attendance, attention and participation in class, positive evaluations and good scores on formative and
summative evaluations.

CONCLUSIONS
Integrating basic and clinical science is effective when basic scientists and clinicians co-present complementary information in a relevant clinical context that involves active participation of students. This approach is effective for teaching immunology as well as other basic science disciplines.

DISTINCTION IN MEDICAL EDUCATION (DIME) AT ROBERT WOOD JOHNSON MEDICAL SCHOOL: 3 YEARS LATER

Norma S. Saks

UM.D.NJ-Robert Wood Johnson Medical School
Piscataway, NJ 08854
USA

PURPOSE
The Distinction in Medical Education Program (DIME), implemented in the 2007-08 academic year, is an enrichment program to recognize medical students who participate as teachers and tutors, as collaborators with faculty to develop course materials, as course representatives and student curriculum committee members, etc. The DIME program prepares medical students to teach and engage in educational scholarship. We hope it will promote careers in academic medicine.

METHODS
Requirements for achieving DIME include completion of an M1-M2 medical education elective, teaching experience, completion of an M3-M4 medical education elective, and completion of a scholarly project. DIME projects are mentored, and judged acceptable by a committee of faculty.

RESULTS
The non-credit elective in years 1 and 2 has enrolled 94 students, 39 students have completed the attendance requirement, and 16 have completed the elective. Twelve students have submitted a preliminary application for DIME. Two students have completed scholarly projects in education and will graduate with Distinction in Medical Education in May, 2010.

CONCLUSION
Several challenges have been addressed regarding the DIME Program during the first 3 years: (1) Student perceptions about rigor of DIME, and time it takes to plan and complete a scholarly project; (2) Identifying core and non core experiences in the M1-M2 DIME non-credit elective; (3) Recruiting faculty to mentor students, develop electives, and participate in other aspects of the program; (4) Deciding on criteria for judging scholarly projects. Faculty are working together to assure the success and continuation of the project.

INTEGRATING MICROBIOLOGY, IMMUNOLOGY AND INFECTIOUS DISEASES

L. Stevceva*, G. Simpson, J. Piskurich & B. Tobin

The Paul Foster School of Medicine
Texas Tech Health Science Center
El Paso, TX
USA

*Presenting Author

PURPOSE
The Paul Foster School of Medicine in El Paso, Texas is a new medical school that implements a scheme-based curriculum teaching basic scientific concepts through clinical presentations. We experimented by bringing together microbiology, immunology and infectious diseases.

METHODS
A study group consisting of faculty teaching microbiology and immunology, and infectious diseases specialists met regularly and discussed topics in microbiology and immunology that were to be presented to first year medical students. Integrated sessions were also created where in microbiology and immunology topics were covered starting with clinical case presentation followed by basic scientific concepts in microbiology and immunology and a final discussion that involved microbiology, immunology faculty and infectious diseases experts.

RESULTS
During group discussion and curriculum planning, the infectious disease specialist’s expertise brought a different dimension and clinical perspective to the curriculum by influencing the direction and emphasis of the micro/immuno topics.

The integrated lecture sessions resulted in increased attendance. Rather than being presented as simple basic scientific concepts microbial causes of disease were presented in context of infectious diseases that they are causing followed by immune responses to the infection.

This approach generates a lot of interest by the students and results in a very lively discussion that touches not only on infectious diseases topics but also looks at them from public health perspective.

CONCLUSIONS
Microbiology, immunology and infectious diseases are disciplines that naturally blend and complement each other. Integrating infectious diseases expertise in teaching microbiology and immunology reinforces emphasis on clinically relevant perspective and prepares medical students for clinical learning.

FUNDAMENTALS OF MOLECULAR MEDICINE: MEDICAL STUDENTS’ PERCEPTIONS