MRRN
September 14, 2011
CMU College of Medicine
• Starting a new medical school
• Accreditation – LCME
• Strategic Planning
• Educational Program design and development
• Fund raising
• Organizational change – the university
• Getting the community on board
• Managing politics – competing health systems, etc.
• Recruiting faculty
• And, lots more…
Medicine’s Challenges (Macy)
• Accelerating pace of scientific discovery
• Calls for more public accountability
• The economy
• Rising cost of health care
• Shortfalls in health care quality
• Racial/ethnic disparities
• Rising burden of chronic illness/disability
• Aging population
Challenges/needs
• Re-define foundation sciences of medicine
• Psychology, social science, quality improvement,
decision science, epidemiology, EBM, CQI…
• Facilitate problem solving and self-directed
learning skills
• Certification and maintenance of certification
• Assure students experience continuity of care
• Students need skills in continuous
improvement and safety
Challenges/needs
• Increase emphasis on community-based
education rather than the hospital
• Prepare students to work as team members
(inter-professional teams)
• Increase knowledge of public health and nonbiological determinants of health and disease
• Foster long-term relationships between students
and faculty
• Develop teaching and mentoring skills of faculty
Needs Assessment - CMED
• LCME
• USMLE
• AHRQ, HHS, CMS,IHI, IOM, etc. – care quality, safety,
•
•
•
•
•
•
patient experience, control costs, etc.
Other curricula (content, models, organization)
AAMC – HHMI- competencies
AAMC Training Physicians white papers
ACGME/ABMS – competencies, MOC, etc.
Local disease/health data
Literature of medical education
IHI Goal: Crossing the Quality Chasm
• Care that is:
• Safe, Effective, Patient-Centered, Timely, Efficient,
Equitable
• Evidence-Based
• Personal
• Holistic, and CARING
Competencies – ACGME-plus
1.
Patient care
Consider procedural skills as a competency?
2.
3.
4.
5.
6.
7.
Medical knowledge
Communication & interviewing
Professionalism
Practice-based learning &
improvement
Systems-based practice
Community and population health
Future Practice of Medicine
• Patient-centered care
• Patients as individuals and member of population to
be cared for supporting health assessment, patient
outreach, illness prevention strategies
• Systematic assessment and improvement of quality
indicators for physicians, hospitals, systems, patient
populations
• Coordinates and delivers care through organized
systems
• Places value on cost-effective care
• Helps address constraints on health care resources
Helps to define physician skill set for future
Local needs/challenges
• Physician shortage current – perhaps 1,000
• By 2020 – 6,000
• Closing the gap and the ongoing loss of physicians to
their communities through retirement, etc.
• Distributional issue
• Recruiting to rural environment
• Retaining physicians in rural environment
• Who will come, who will stay?
• Pipelines-AHEC
• Specialty distributional issue
11
Complexity of undertaking…
What is unique about CMED?
• Location
• Mission, vision
• Curriculum
Mission
• Prepare exceptional physicians
• Improving access to individualized,
essential care (health care delivery)
• Focus in rural and medically
underserved regions of Michigan
• Rural/small community focus
• Differentiated skill set
• Generalist focus: (FM,IM, Peds, Gen Surg, Ob/Gyn, Psych, EM,
PM&R)
Vision
• Excellence in instruction/active learning
• Team-based learning experiences
• Early patient contact
• Student-centered environment/program
• Patient-Centered care
• Residencies (new, distributed)
• Community-based, 11 affiliations thus far
Feedback &
Revise
Evaluate
Instruction
(Summative)
Develop
Objectives
Develop
Assessment
s
Design
Instruction
Assess
Needs
Manage
Instruction
Iterative
Process
Implement
Instruction
Revise
Instruction
Evaluate
Instruction
(Formative)
Develop
Instruction
Pilot
Instruction
LMCE: Integrated MD Curriculum
Formal Knowledge/ Courses
Clinical Experience
Inquiry, Discovery, Innovation
Year I
Year II
Year III
Year IV
Course Structure
YEAR 1
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46
MED 630: FOUNDATIONAL SCIENCES OF MEDICINE
(21 wks)
MED 600: SOCIETY AND COMMUNITY MEDICINE
MED 610: ESSENTIALS OF CLINICAL SKILLS
MED 620: THE ART OF MEDICINE
MED 640: REPRODUCTIVE/
HUMAN DEVELOPMENT
(8 wks)
MED 600
MED 610
MED 650: CARDIO/PULMONARY:
WELLNESS & DISEASE
(10 wks)
SOCIETY AND COMMUNITY MEDICINE
BREAK
(2 wks)
4
SPRING BREAK
3
WINTER BREAK (3 wks)
2
ORIENTATION
1
ESSENTIALS OF CLINICAL SKILLS
MED 620
ART OF MEDICINE
YEAR 2
47 48 49 50 51 52 53 54 55 56 57
MED 740: NEUROSCIENCES/BEHAVIOR:
WELLNESS & DISEASE
(12 wks)
MED 610: ESSENTIALS OF CLINICAL SKILLS
MED 620: THE ART OF MEDICINE
MED 620: THE ART OF MEDICINE
MED750:
MUSCULOSKELETAL/
DERMAL
(4 wks)
MED 760:
GASTROINTESTINAL:
WELLNESS &
DISEASE (4 wks)
SOCIETY/COMMUNITY MEDICINE
ESSENTIALS OF CLINICAL SKILLS
SPRING BREAK
MED 610: ESSENTIALS OF CLINICAL SKILLS
MED 750:
MUSCULOSKELETAL/
DERMAL
(4 wks)
MED 600: SOCIETY/COMMUNITY MEDICINE
WINTER BREAK (3 wks)
MED 600: SOCIETY AND COMMUNITY MEDICINE
BREAK (2wks.)
MED 730: RENAL/ENDOCRINE:
WELLNESS & DISEASE
(10 wks)
58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94
MED 760:
GASTROINTESTINAL
(3 wks)
MED 770:
HEMATOLOGY/
ONCOLOGY
(5 wks)
SOCIETY/COMMUNITY MEDICINE
ESSENTIALS OF CLINICAL SKILLS
THE ART OF MEDICINE
THE ART OF MEDICINE
95 96 97 98 99 100 101 102 103
BOARD PREP
RESEARCH PROJECT
YEAR 3
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
HOLIDAY
BREAK
(2 wks)
1
LONGITUDINAL CLERKSHIPS
30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
LONGITUDINAL CLERKSHIPS
CC - A
(4 wks)
CC - B
(4 wks)
CC - C
(4 wks)
CC - D
(4 wks)
YEAR 4
CC/CE
(4 wks)
CC/CE
(4 wks)
CC/CE
(4 wks)
CC/CE
(4wks)
CC/CE
(4 wks)
CC/CE
(4 wks)
CC/CE
(2 wks)
2 wk.
Holiday
break
51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81
CC/CE
(2 wks)
82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100
CC/CE
(4 wks)
CC/CE
(4 wks)
CC/CE
(4 wks)
CC/CE
(4 wks)
CC/CE
(4 wks)
Curriculum
• College culture: respect, compassion, inclusiveness,
social responsibility, excellence, innovation, curiosity
• Integration of foundation and clinical science
• Anatomy, biochemistry, physiology, pharmacology…
• Psychology, decision science, continuous improvement…
• Early clinical experience
• Continuing foundation science education
• Schemata and Patient Presentation model, simulated
patients and families (relevancy)
• Team-based learning (learning communities, in practices,
in the hospital, friendly competition-game theory)
• Inter professional (PA, PT, et al.)
• Self directed learning/cognitive science
Knowledge Scheme for Anemia
ANEMIA
MACROCYTIC
NORMOCYTIC
MICROCYTIC
B12/Folate def.
Iron deficiency
Alcohol abuse
(diet, chr. Loss)
Chemotherapy
Sideroblastic
PRODUCTION I
Aplastic anemia/rbc aplasia
Myelodysplasia/Malig.
CRF/Anemia of chr. Dis.
INCREASED
DESTRUCTION (>2%
retics)
INHERITED
HbOPATHY
Sickle cell
Thalassemia
Unstable HB
MEMBRANE/
METABOLISM
Spherocytic
HMO shunt,
Glycolytic
BLOOD LOSS
Visible/Occult
Classification
Mechanism
ACQUIRED
IMMUNE
Coombs pos.
Drug related
Cold agglutinin
Infection
Mechanical
TTP/HUS
Malaria
Causation/
Cases
Flow Diagram of the Learning Process
1. Provision of
schemata and
assigned readings
6. Review of
relevant anatomy
and practice
physical
examination
11. Discussion of
ethical &
professionalism
issues
2. Students
prepare for
instruction of
coming week
3. Socratic session
discussion of basic
science principles
7. Socratic
discussion of
diagnostic process
8. Socratic
discussion of
treatment, focus on
pharmacology
12. Open question
& answer sessions
4. Large group
discussion of
clinical skills
9. Small group/
team work to
identify and solve
problems from PPs
13. Journal club/EBM
session relevant to
PP-diagnosis/
treatment
Orange: large group information sharing and discussion sessions
Blue: small group sessions
Gray: clinical experience
Yellow: large group Socratic sessions (questions based upon PPs)
Green: student self-study sessions
14. Small group
discussion of
problems/solutions
clinical experience
5. Discussion of
“Patient
Presentations” for
the week
10. Discussion of patient
management &
adherence challenges –
Society/Community
15. Formative
assessments/
Discussion
Typical Student Schedule for a Week of Instruction for Years 1 & 2
Day
Time
8:00-8:50
9:00-9:50
9:50-10:00
10:00-10:50
Monday
Tuesday
Wednesday
Socratic discussion of
algorithmic approach
to condition
classification,
etiology,
pathophysiology ,
diagnosis, treatment,
etc.
Learning Goals:
Diagnosis and
Evaluation of relevant
conditions
Imaging & Lab
Normal vs. Abnormal
Learning Goals
Society Matters in
Health Care
Patient presentationbased: management,
adherence issues
Learning Goals
Art of Medicine
Ethical Issues
relevant to patient
presentations
Large Group- C
Questions and
answers on patient
presentations – open
student session
Optional
Large Group BC
Large Group C
Questions and
answers on patient
presentations – open
student session
Optional
Large Group BC
Large Group C
Society Matters in
Health Care
EBM/Journal Review
related to patient
presentations
Large Group C
Break
Applied
Pharmacology
Management of
relevant conditions –
Break
Self-Study
Break
Clinical – Facilitator
review of problem
solving results for
patient presentations
Interactive patient
presentation-based
session to help
students assess their
understanding of
concepts presented in
self-study preparation
Teams
Large Group BC
Break
Essentials of Clinical
Medicine
History & Physical
Examination
Learning Goal Socratic, role play,
video, session.
Patient presentations
distributed:
Team
Large Group C
Interactive patient
presentation- based
session to help
students assess their
understanding of
concepts presented in
self-study preparation
12:00pm-1:00pm
Break
Learning Goal
Large Group B
Break
1:00-1:50
Clinical: Review
anatomy,
practice physical
exam, Facilitated
11:00-11:50
2:00-2:50
3:00-3:50
4:00-4:50
Team
1 hr B, Anat. Lab
1 hr C, LG B
Self-Study
Anatomy
Self-Study
Thursday
Friday
Self-Study
Self-Study
Break
Self-Study
Team Facilitators
Small Groups
Break
Self-Study
Clinical – small
group/team work on
cases – identify and
solve problems (2:00
– 5:00 pm)
Team
Clinical – small
group/team work on
cases – identify and
solve problems
(2:00 – 5:00 pm)
Team
Facilitator joins group
from 4:00 to 5:00 pm
Facilitator joins group
from 4:00 to 5:00 pm
Break
Break
Clinical session in
family medicine
practice
Formative
Evaluation
Large Group BC
Formative
Evaluation Feedback,
Review plans for next
week
Large Group BC
Self-Study
Encounter with
cardiac patient(s)
Practice V
Self-Study
Example Student Schedule for a Week of Instruction for Year 3 Longitudinal Integrated
Clerkship
Session &
Schedule
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday-Sunday
Inpatient rounds if
students have
patients in hospital
Pre-round if students have patients in hospital
Patient Care work
Patient Care work
3-self-directed learning, based on patient panel, 2small group case presentation/ discussion
sessions.
Patient Care work and end-day rounds as
appropriate
Community
and Art of
Medicine
Curriculum
Tutorials in
basic and
clinical
science
Patient Care
work
Afternoon
Patient Care work
Morning
Patient Care work
In-patient attending physician rounds
Total instructional
hours/ week: 5
hours rounds, 6
hours small group
sessions = 11/week
Curriculum
• Longitudinal clinical skills curriculum – integrated with
anatomy, imaging, physical examination, interviewing
• Longitudinal courses: Art of Medicine, Society &
Community Health
• Clinical and health services/delivery research
• Lean, process and quality improvement – including as research, at
the practice and system levels
• Population health, epidemiology, community health
• Evidence-based medicine (proven practice)
• Health system, care delivery, business of medicine, financing…
• Assessments: to facilitate success for individual and team
(simulations, mannequins, simulated patients, actual
patients)
Curriculum
• Longitudinal, integrated clerkship
• Gradual transitions as skills/knowledge develop
• Focus on self assessment, lifelong learning, practice-
based learning and improvement…
• Rural/small community emphasis
• Clinical experience based there
• Community faculty as preceptors and facilitators
• GME in the rural/small community setting
• Patient Centered Medical Home
CMU College of Medicine
Office of the Dean
208 Rowe Hall
Phone: (989) 774-7547
Web site: www.cmich.edu/med
26