http://www.healthcare.uiowa.edu/2020/index.html
Take Home Points
• The Carver College of Medicine provides
an outstanding medical education
• There is room for improvement (and
always will be)
• We are committed to continued
development of the best possible medical
education and learning environment
Aim of CCOM
Medical Education
• To provide an educational foundation that
prepares graduates for entry into a GME
program of their selection, including
whether to pursue a career as a clinician,
scientist, and/or educator.
1995 Curricular Revisions
• Many excellent changes:
- Some new & integrated & centrally
managed courses
- Some new clerkships & adjustments in
clerkship time
• Learning environment enhanced by
investment in facilities, course
management and student services
Outstanding Results
• Pass rates for USMLE examinations
excellent (97-100%)
• <1% academic attrition over last decade
• Excellent student satisfaction scores on
AAMC Graduation Questionnaires
• High level of satisfaction with IA graduate
performance in residency programs
Case for Curriculum Renewal
Growing Disconnections
• ~ 80% of medical education focused on
biology yet 60% of premature deaths due
to “non-biologic” factors
• ~ 80% of clinical education occurs in
inpatient settings yet 80-90% of medicine
practiced in outpatient arena
• Sub-cellular/molecular focus of scientific
inquiry presents a growing challenge for
basic science faculty to demonstrate its
broad applicability to clinical medicine
Growing Disconnections
Year
Step 1
Step 2
(# Topics < X)
(# Topics < X)
04
2/20
3/22
05
2/20
5/22
06
4/20
3/22
07
5/20
4/22
08
8/20
7/22
09
14/20
6/22
Case for Curriculum Renewal
• Growing Disconnects
• Exponential ↑ in knowledge
• Changing environment
– Societal demographics
– Health care reform
• Technologic advances
– Availability and management of information
– Methods of delivering curriculum
Case for Curriculum Renewal
• LCME Report identified:
– a need for the CCOM to review its entire
curriculum (ED-35)
– a need for greater central oversight for the
curriculum (ED-33)
• Dean Rothman’s charge to systematically
review, revise and implement a renewed
undergraduate medical education
curriculum for the CCOM
Steering Committee Charge
• Develop a framework for curriculum renewal
• Support modeling committees by providing
information and resources
• Synthesize modeling committees’ work into a
consensus curriculum
• Work with departments to define core knowledge
for a broad-based medical education
• Communicate progress to the larger CCOM
educational community
Modeling Committee Charge
• Design an educational structure that will
– address patient and societal needs that are
anticipated to significantly impact healthcare in
the near future
– improve integration of basic, clinical, and social
sciences within and across all four years
– provide earlier clinical experience and appropriate
skill development
– promote learner-centered education, student wellbeing, engagement, and active learning
Curriculum Renewal
• Convened Steering Committee - 11/09
• Charged 4 modeling committees to develop
a proposed new curriculum - 4/10
• Held retreat to present the 4 models - 9/10
http://www.healthcare.uiowa.edu/2020/committees.htm
• Gathering feedback on curricular themes of
models (today)
Modeling Committee Chairs
Modeling Committee Members
Bridge to the 21st Century
2M: Two Metaphor Education
Reciprocal Integration
Nancy Rosenthal, Chair
Pathology
George Bergus, Chair
Family Medicine
Vincent Liu, Chair
Dermatology
Clinical Centered Education with
Reinforced Foundations
Marc Pizzimenti , Chair
Anatomy/Cell Biology
Manish Aggarwal, Medical Student
JoAnn Benda, Pathology
Jason Anderson, Medical Student
Charles Clark, Orthopaedic Surgery
Brandon Alleman, Medical Student
Allison Boardman, Medical Student
Rick Axelson, OCRME
Mara Determan, Medical Student
Jill Bowman, Medical Student
Amy Dowden, Internal Medicine
Donald Brown, Internal Medicine
Joseph Chen, Orthopaedic Surgery
Randy Grout, Medical Student
Paul Christine, Medical Student
Mary grace Elson,
Obstetrics/Gynecology
Jeff Emrich, OSAC
Eve Clark, Radiology
Collin Kreple, Medical Student
Sarah England, Physiology/Biophysics
Jill Endres, Family Medicine
Kristen Gerjevic, Medical Student
Linda Madson, Psychiatry
Daniel Fox, Medical Student
Joshua Fischer, Medical Student
Hans House, Emergency Medicine
Nick Pantazis, Anatomy/Cell Biology
Michael Haugsdal, Medical Student
Jaci Haugsdal, Medical Student
Janna Lawrence, Hardin Library
Benjamin Reinking, Pediatrics
Eric Kaiser, Medical Student
Frances Meyer, Internal Medicine
Penny Rembolt, OSAC
Darren Hoffmann, Anatomy/Cell
Biology
Sobia Khaja, Otolaryngology
Jeff Pettit, OCRME
Adrienne Samar, Medical Student
Jeff Murray, Pediatrics
Erwin Shibata, Physiology/Biophysics
Peter Rubenstein, Biochemistry
Amal Shibli-Rahhal, Internal Medicine
Jack Stapleton, Internal Medicine
Kate Thoma, Family Medicine
Deborah Segaloff,
Physiology/Biophysics
Jane Viner, Medical Student
Mark Smith, Radiation Oncology
Michael Takacs, Emergency Medicine
Teri Thomsen, Neurology
Linda Walton, Hardin Library
Sonia Sugg, Surgery
Kelly Thormodson, Hardin Library
Robert Yang, Orthopaedic Surgery
Liz Takacs, Urology
Jerry Weiss, Internal Medicine
Christine Ziebold, Pediatrics
Gerry Wickham, OSAC
Ann Willemsen-Dunlap, Anesthesia
William Zeitler, OSAC
Paul Leonard, Anesthesia
Emerging Themes
from Curricular Models
• Greater integration of basic/clinical/social sciences
across 4 years
– Sub-cellular/molecular focus of scientific inquiry makes
collaboration between basic science and clinical faculty even
more important
• Organizing themes or principles
– Conceptual organization of knowledge leads to better learning
• Earlier clinical exposure
– Models suggest ambulatory experience, which more accurately
reflects delivery of care
• Individualized educational programming
– Current curriculum is more structured than most
Greater Integration
Across 4 Years
•Interdisciplinary courses/clerkships
•“Linking” courses
•“Blocked” Clerkships
• Foundations course
•“Threads” or “themes” across all 4 years
•Recurring short courses/seminars
•Team teaching/collaboration
Greater Integration
• Clinical expertise linked to a well
organized knowledge
– Knowledge organized into schemes
– 2+2 curriculum imposes discipline-based
knowledge as organizing scheme
• Educational research supports providing
conceptual structure of the content to be
learned
– Greatest value for students experiencing difficulty
in seeing how concepts relate to one another
Potential Curricular Structures
• Discipline based (current)
• Organ based
• Complaint based
• Mechanism of disease based
Earlier Clinical Exposure
• Continuity of care experience
• Start clinical exposure earlier
Individualized Learning
• Greater variety of clerkship electives
• Reduction in required clerkships
Curriculum Renewal - Timeline
• November 2010-January 2011
Dissemination of potential curricular innovations to
College, departments, faculty, staff, and students
• August 2011
Initial implementation of curricular changes
Questions
• What are the most important issues in the
curriculum renewal for your department?
• How can your department contribute to a
renewed curriculum?
• Which elements of the current curriculum
do you consider essential?
• Suggestions for improved use of
technology?
• Other suggestions?
Information about the 4 Models:
http://www.healthcare.uiowa.edu/2020/committees.htm
Information about the current curriculum:
http://www.medicine.uiowa.edu/osac/curriculum/index.html
Bridge to 21st Century Medicine
Centered Education with Reinforced Foundations
RECIPROCAL INTEGRATION CURRICULAR MODEL
Basic Sciences Boot camp
1st Year
Dec
Foundations of Clinical Practice
PPD
Re-evaluation of pedagogical techniques (e.g.
Communication
small groups)
Mentoring
Learning Communities Connection
Small Group Component
Re-evaluation of assessment, value, resources,
Attaching EMR to H&P
and time
Jan
Feb
March
Systems and Disease
April
Human Organ Systems
Physiology
Histology
Immunology
May
June
Pharmacology
Pathology
Microbiology
** Integrated Small Group **
Foundations of Clinical Practice***
Physical Exam Skills
Introduction to Presenting Complaint Learning (PCL)
Evidence based medicine
Break
Oct
Nov
Foundations of Basic Sciences
Anatomy, Neuroanatomy, Embryology
Biochemistry
Genetics
Cell biology
(Intro/Basic) histology*
Intersession
Sept
Break
Aug
Intersession
July
Continuity of Care Clerkship
Jan
Feb
March
April
** Integrated Small Group **
Foundations of Clinical Practice***
Physical Exam Skills
Introduction to Presenting Complaint Learning (PCL)
Evidence based medicine
Intersession
Pharmacology
Pathology
Microbiology
Foundations of Clinical Practice
May
June
Internal Medicine Block (Composed of
Inpatient and Outpatient)
Intersession
Dec
Break
Break
Human Organ Systems
Physiology
Histology
Immunology
Nov
Complete Step 1
Oct
Clinical Beginnings
Sept
Systems and Disease
Boards Preparation
Aug
Intersession
July
2nd Year
**Must be taken during the M3 Year**
Continuity of Care Clerkship
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
March
April
May
June
3rd Year
Family Medicine and Cognitive Behavioral Sciences
(Encompassing Family Medicine, Community Based Primary
Care, Dermatology, Psychiatry, and Neurology)
**Student must take either FM/CBS block or OB/GYN Pediatric
block during the M3 year. One could be moved to a different
position allowing 3 more electives in the M3 year**
**Must be taken during the M3 Year**
Elective
Elective
OB/GYN and Pediatrics Block
Intersession
Intersession
Intersession
Surgical Block (Encompassing General Surgery, Ophthalmology,
Orthopedic, Otolaryngology, and Urology)
**Student must take either FM/CBS block or OB/GYN Pediatric
block during the M3 year. One could be moved to a different
position allowing 3 more electives in the M3 year**
Continuity of Care Clerkship
Jan
Feb
March
April
Intersession
Critical Care Block (Encompassing Emergency Medicine,
Critical Care, Anesthesia, EKG, and Radiology)
**Must be taken in the M4 Year**
Continuity of Care Clerkship
May
Commencement
Dec
Elective
Sub-Internship
Elective
Elective
Elective
Nov
Elective
Oct
Complete Step 2
Sept
Elective
Aug
**Pre-requisites of Medicine, Surgical, and
either FM/CGS or OBG/Peds Block
required**
July
4th Year
June
Residency
2M Model: Two Metaphor Education
Knowledge Acquisition • Clinical and Professional Development
Year 2
Semester 1
Monday Tuesday Wednesday Thursday Friday
Classroom Classroom Lecture or Classroom Classroom
AM
learning learning
Tests
learning learning
Topics in
Teach
PM 1 Dissection Dissection
Free
Medicine
dissection
PM 2
Clinical
Experience
Free
Topics in
Clinical
Learn
Medicine Experience dissection
PM 3
Free
Clinical
Skills
Topics in
Medicine
Clinical
Skills
Learn
dissection
Language of Medical Science (LMS) introduces
students to the vocabulary of medical concepts
and knowledge, laying the essential foundation
for future learning in medicine. Afternoons
rotate through three weekly schedules (shown
at left). In CPD, Clinical Experience sessions
include mentoring with various healthcare
professionals, and Clinical Skills sessions cover
EMRand normal H&P.
Social determinants of health
Graduation
Internal Medicine (6)
Family Practice (4)
Geriatrics (2)
General Surgery (6)
Selectives (6)
Topics in Medicine Groups
Capstone Conference
ACLS/etc. training
Residency Boot Camp
Topics in Medicine
Groups
Clinical Skills Groups
Electives
Topics in Medicine Groups
Clinical Skills Groups
Capstone
Course
Sub-I (4)
ER or ICU (4)
Lab/EKG (2)
Clinical Skills Groups
Longitudinal Clinical
Experience (weekly)
Development and Aging
Behavioral health
Psychiatry (6)
Neurology (4)
Ophthalmology (2)
Clinical Experience Groups
Longitudinal Clinical
Experience (weekly)
Threads
Basic sciences
Clinical Experience Clerkships
Pediatrics (6)
OB/GYN (6)
Pathogens &
Human Responses
USLME Step 1
Cl inical and
Professional
Devel opment
Molecules to
Mendel
Clinical Presentations
Cardio
Pulmonary
GI
Renal
Reproductive
Special Senses
Endocrine
Human Structure
Neurology
MSK
Skin
Blood
Didactic
Language of Medical Science Clinical Presentations
Year 4
Year 3
Mortalityand Morbidity-style Conferences
Language of Clinical Medicine
Semester 2
Summer: Service, Research, MECO, etc.
Semester 1
Preventive Health
EBM, imaging, pathology
Patient care
Pain
Economics, greening
Medical ethics, law
Patient safety
Professionalism
Mechanisms of Disease
Spiral Curriculum
Clinical Skills (HX + PE)
Continuity of Care
1
2
Ischemia
Metabolic
Neoplasia
Neuropsychiatric
3
Inflammation
Genetic
Trauma
Socio-behavioral