University of South Florida College of Medicine
University of South Florida
College of Medicine
LCME Institutional Self-Study
Report of Committee Four:
Educational Program for the MD
Study Year 2005-2006
The contents of this report represent the judgments and opinions of the members of this Self-Study Committee. The committee has made every effort to ensure that the information represented is accurate. The LCME administrators have not audited the data in the text of the report and there may be some discrepancies within the database or executive summary as a result. While every attempt has been made to provide and evaluate information accurately and objectively, the committee acknowledges that any errors of fact in this report are unintentional.
(Printed October, 2006)
Table of Contents
I. Executive Summary/Key Issues 3
II. Responses to Questions in Guide to Institutional Self-Study 6
III. Analysis of Recommendations and Deficiencies Relevant to Committee as Identified by Most Recent LCME Review in 1999 22
IV. Major Changes Since Last LCME Review in 1999 23
V. Areas of Strength 23
VI. Areas of Concern and Challenges 24
VII. Review of Compliance with Established LCME Standards 24
VIII. Recommendations, Possible Solutions and Strategies 53
IX. Issues of Concern Relevant to Other Committees 54
X. Attachments 54
XI. Narrative of Process 54
XII. Database Accuracy 55
XIII. Committee Membership 55
Executive Summary/Key Issues
Educational Objectives
• The creation of the Educational Objectives for the College of Medicine involved all stakeholders in the college, including administration, faculty, and students. These deliberations resulted in new college-wide objectives and competencies for medical education, encapsulated by the mnemonic USF CARES. The members reviewed past records of others having undertaken similar tasks. Authoritative and credible documents such as the Medical School Objective Project of the AAMC, the IOM reports on quality in healthcare, CanMeds, the Brown objectives, and the ACGME competencies were studied and adopted for comprehensive educational objectives for undergraduate medical education.
• USF CARES will provide an effective guide for on-going educational program planning and course evaluation. Each course has its own set of goals and objectives consistent with USF CARES. Student evaluation is now performed at all stages of the curriculum based on USF CARES. Also, individual course or clerkship objectives are examined on the basis of USF CARES. Future course development and program planning will be complemented.
• There are sufficient patient resources and clinical settings for achieving the college’s clinical learning objectives. The college uses a number of clinical settings (academic and community/private practice settings; inpatient and outpatient/ambulatory settings; primary care/tertiary care settings; etc) and has many physicians and patients with whom students can work during the course of their training. Student clinical experience during their clerkships is evaluated by logbook data, including diagnoses and demographics.
Structure of the Educational Program
• The educational program provides a general professional education that prepares students for all areas of post-graduate medical education. The College of Medicine has just completed a college-wide curriculum reform process for Years 3 and 4 which was preceded by the creation of a revised, integrated curriculum in Years 1 and 2. In order to ensure that the educational program provided for a general, professional education, consensus was built around identification of common diagnoses, symptoms, and syndromes determined by clerkship directors and clerkship-specific national organizations, national databases and logbook data from previous years. Based on our recent graduate-class distributions within the NRMP (National Resident Matching Program) medical subspecialties, the USFCOM educational program has been successful in preparing students for all medical careers.
• USF College of Medicine graduates select a wide variety of specialties for residency education; the class of 2004 matched to 17 different specialties, the class of 2005 matched to 19 different specialties, and the class of 2006 matched to 22 different specialties.
• The medical curriculum provides a balanced and innovative professional education that fosters the development of self-directed learning throughout all four years of the undergraduate medical education.
• There is consistency of educational quality and of student evaluation when students learn at alternative sites within a course or clerkship. Each course and clerkship has a single course director who informs faculty about the course-specific objectives and grading policies for the course.
• Faculty use a single evaluation system in each course and clerkship. The implementation of college-wide evaluation unites educational objectives and student evaluation in both formative and summative evaluations. Evaluation forms contain program-wide competency- and objective-achievement ratings as well as clerkship-specific ratings.
• All content areas required for accreditation are addressed in the curriculum. While the first-and-second year curricula include named courses in anatomy, physiology, microbiology, pathology and pharmacology, the contemporary context of these disciplines is also included in the other required courses during the first two years. The last major revision to the curriculum occurred within the Year 3 and 4 programs with the inaugural iteration starting in June 2005. A principal feature of that revision includes an interdisciplinary/interdepartmental approach to the organization of the required clerkships. In addition to the basic and clinical disciplines, the curriculum throughout the four years includes required behavioral and socioeconomic subjects.
• Data from the most recent AAMC Medical School Graduation Questionnaire for USF graduates (2005) reflect that USF graduates reported an “appropriate” amount of time was devoted to instruction in all areas surveyed except in nutrition and medical socio-economics issues. These are addressed later in this report.
• USMLE results for first-time takers from the USF College of Medicine in the three most recently completed academic years demonstrate success rates of 95-99% with the mean scores consistently at or above the national mean for each portion of the examination.
• During the third year, the amount of time spent in inpatient and ambulatory teaching is balanced with 50% of the clinical assignment in each setting.
Teaching and Evaluation
• Supervision of the medical student’s clinical experience is the responsibility of core faculty members. With few exceptions, the majority of the faculty on each clerkship are core faculty. Voluntary clinical faculty and residents serve in supplemental roles. Voluntary faculty must have a clinical faculty appointment, and they provide unique learning experiences for the student, such as a rural health experience. All faculty are uniformly given copies of both college (USF CARES) and individual clinical clerkship-learning objectives and receive ongoing feedback from the clerkship director.
• All faculty working with students on any given clerkship are expected to personally oversee all aspects of the student’s clerkship experience and meet with the student for both educational and feedback purposes. Direct observation of the student is encouraged whenever possible.
• Residents are an integral part of the teaching team. All residents are given college educational objectives and must attend a program on how to teach and evaluate medical students during their annual orientation. The faculty are expected to monitor the role of residents in the students’ educational program. The core faculty and residents evaluate and suggest areas of improvement for students’ acquired skills and expertise.
• Each course and clerkship uses multiple methods of evaluation. During the first two years of the curriculum, the more fact-based courses evaluate learning using primarily objective testing methods. Other methods of evaluation measure not only the student’s comprehension of the material, but also his or her ability to research, analyze, synthesize, and communicate information independently. These methods of evaluation include small-group problem-solving, participation in laboratory exercises, written assignments, and topic-based presentations. The third-and-fourth year clerkships evaluate the attainment of clinical skills and reasoning, problem solving, communication skills, and the development of appropriate behaviors and attitudes. This is accomplished by the use of nationally standardized and departmental written examinations, and by faculty assessments of students’ skills, behaviors, and attitudes. The Committee on Curriculum oversees the evaluation methods.
• A comprehensive system is to assure that core clinical skills defined in the college’s educational objectives, USF CARES, and clerkships have defined core clinical experiences documented by the logbook. These objectives form the basis of the uniform assessment tool used by all faculty in assessing students. There are several formal evaluations of the students’ clinical skills. At the end of the second year, an OSCE is performed for all students. During third year, several of the clinical clerkships require a clinical practice exam (CPX). During the fourth year, the students are videotaped performing a complete history and physical exam.
• The faculty of the college strongly believe that their graduates have a sound background in problem-solving, clinical-reasoning, and communication skills. The Clerkship Oversight Committee continually evaluates each clerkship’s success and provides sufficient clinical experiences for students’ acquisition of required skills.
Curriculum Management
• The overall curriculum is reviewed during the annual or semi-annual curriculum retreats. These retreats provide an update of national trends and innovations with a detailed review of the college curriculum evaluations, normative test scores, student responses to the AAMC Graduation Questionnaire, all college performance-based examinations, and any other information relevant to curricular assessment. Problem areas are discussed, and corrective plans are formulated. Particular attention is given to content, coordination, and outcome measures.
• The Committee on Curriculum conducts a formal, highly detailed review of each component of the curriculum every two years or more frequently when problems are detected. This process includes the review of all outcome measures, course materials, student assessment of overall course and faculty effectiveness, course directors’ responses to previous reviews, previous committee recommendations, and actions taken to address any problems. The USMLE sub-score analyses discuss adequacy of the course content as does the performance-based assessments of clinical skills including OSCE and CPX.
• The Vice Dean for Educational Affairs has had sufficient resources and authority to assure that the educational program can meet its objectives; however, during the self- study process it became apparent that in two areas the process for acquisition of resources has not been optimal. The scheduling of conference rooms for small-group sessions has been difficult because of limited centralized control of these resources. The dean has recently directed that the Office of Educational Affairs should assume control of these educational resources and that scheduling be centralized. The second area of concern has been the process associated with staffing the faculty required for the interdisciplinary courses. Since these courses are not the domain of any single department, the departmental chairpersons have not assigned faculty to these courses. This problem will be solved with the implementation of the AIMS program. Under this program, all faculty will be required to devote a certain percentage of effort to stipulated types of educational activities as part of their overall compensation package.
• Curriculum planning has been one of the particular strengths of the College of Medicine. All four years of the curriculum have been modified over the past seven years. Each major modification arose from discussions that occurred at a Committee on Curriculum Retreat and involved all major stakeholders in a collegial process of determining objectives and planning for their implementation and evaluation.
• The Committee on Curriculum has limited the number of contact or work hours required of a student per week. For Years 1 and 2, the limit is 28 hours per week of contact plus four hours per week for the Longitudinal Clinical Experience. During Years 3 and 4, the same work-hour limitations that are in force for the residents apply for the students (80 hours per week). As a result of the self-study process, the Committee on Curriculum has determined that the first year of the curriculum has substantially more contact hours than the national average (1132 vs. 830). The departmental chairs, course directors, and faculty involved in the Year 1 curriculum are working with the vice dean for education to reduce the number of contact hours to a level approaching the national average. In addition to reducing the number of contact hours, the proposal will encourage more independent learning experiences and less lecture format.
Evaluation of Program Effectiveness
• Measures demonstrating that the institutional objectives are being achieved by our students include indicators of effectiveness from both external and internal data. External metrics include results of USMLE and NBME subject examinations, student responses on AAMC Medical School Graduation Questionnaire, NRMP results, specialty choice of graduates, and program director surveys of PGY-1 performance. Internal metrics include student scores on internally developed written examinations, performance-based assessment of clinical skills including OSCE and CPX exams, review of logbook data in Years 3 and 4, student advancement and graduation rates, and a videotaped history and physical for fourth year students. All college-wide evaluation forms link the educational objectives with course-specific competencies.
• Information about our students and graduates is used to evaluate and improve the college’s educational program. The Committee on Curriculum reviews all of the external and internal data at its annual curricular retreat in conjunction with the senior administration. Areas needing improvement are noted, communicated to course/clerkship director, and re-evaluated the following year. Identified areas of concern are referred to the respective course/clerkships director for immediate attention.
2 Responses to Questions in Guide to Institutional Self-Study
1. Describe the level of understanding of the school-wide objectives for the educational program among administrators, faculty members, students, and others in the medical education community. Do these objectives serve as effective guides for educational program planning, and for student and program evaluation?
Committee Response: Administrators
Administration at the College of Medicine was intensively involved in the process of
developing the school-wide objectives USF CARES, and has a thorough understanding of these goals. Subsequent to the adoption of USF CARES, administrators and faculty members planned, developed, and evaluated all aspects of the undergraduate medical education program.
Faculty members
Members of the COM faculty have received copies of USF CARES by e-mail. Faculty based at the Moffitt Cancer Center did not receive email sent to the College of Medicine faculty distribution list (comfac), and may not have received a copy of USF CARES. This oversight has been corrected, and all COM faculty including those at the Moffitt server are now included in electronic mail sent to the comfac distribution list. The USF CARES document was recently re-sent to all faculty to assure that all faculty had received the school-wide objectives. All new faculty will be given a copy of the college’s mission statement and USF CARES as part of the new faculty orientation process.
Although HSC faculty members have received USF CARES, the level of understanding may still be less than thorough. Unless faculty members accept the concept of teaching according to the USF CARES competencies, USF CARES will not have the intended effect. Because all future student evaluations will be based on USF CARES objectives, faculty members must understand these objectives.
Students
All COM students have received USF CARES by e-mail. Also, USF CARES is presented and discussed during orientation and at the beginning of all courses and clerkships. Each course and clerkship’s objectives are related to the school-wide objectives. Students will be evaluated on the basis of USF CARES during each course and clerkship and will continually gain understanding of the school-wide objectives throughout the four-year curriculum.
Educational program planning
The objectives were developed to serve as effective guides for educational program planning, and that process is ongoing at present. Each course has its own set of goals and objectives that must be integrated with USF CARES. Future course development and program planning will be more easily made with the USF CARES objectives in mind.
Student evaluation
Although evaluation of the students is now performed at all stages of the curriculum using USF CARES, not every college-wide objective is addressed in each course or clerkship, even though assessment of all individual course or clerkship objectives are based on USF CARES. Because attitudes and professional values are significant, these areas are emphasized and assessed throughout the curriculum.
See Attachment 1 - USF CARES
2. Comment on the extent to which school-wide educational objectives are linked to physician competencies expected by the medical profession and the public. Summarize results from any associated outcome measures that demonstrate how well students are being prepared for the next stage of their training.
Committee Response: USF CARES reflects the students’ competencies. Authoritative and credible documents such as the Medical School Objectives Project of the AAMC, the IOM reports on quality in healthcare, CanMeds, the Brown objectives, and the ACGME competencies were studied and used in creating comprehensive educational objectives for undergraduate medical education.
These competencies are measurable. USF COM students perform well on the USMLE examinations and compete well with graduates from other medical schools for a broad spectrum of residency-training programs. This evaluation reflects a congruence of the school-wide objectives and the expectations of physicians by both graduate medical education programs and state licensing authorities. Feedback from the Graduation Questionnaire indicates that USF graduates consider themselves to be well prepared to enter graduate-level medical training. In addition, the USF CARES objectives mirror the competencies that would be expected of any medical doctor by our most important constituency, our patients.
3. Evaluate the adequacy of patient resources and clinical settings for achieving the school’s clinical learning objectives.
Committee Response: Sufficient patient resources and clinical settings exist for achieving the school’s clinical learning objectives. The school uses a number of clinical settings (academic and community/private practice settings; inpatient and outpatient/ambulatory settings; primary care/tertiary care settings; etc) and has many physicians and patients with whom students can work during the course of their training. Abundant clinical material is available for student training at all ages of patients (newborn to pediatric and adolescent to senior adult) including all specialties and subspecialties. Opportunities for clinical experience include, but are not limited to, oncology, transplant, infectious diseases, and international medicine.
The acquisition of logbook data during clerkships has allowed assessment of the adequacy and appropriateness of the clinical experience provided to students. Information is gathered and reviewed concerning the diagnoses encountered as well as the demographics of the patient populations being seen.
4. Delineate the mechanisms ensuring that the educational program provides a general professional education that prepares students for all career options in medicine. Cite relevant outcomes indicating success in that preparation.
Committee Response: The College of Medicine has just completed a college-wide curriculum reform process for Years 3 and 4. This had been preceded by the creation of a revised, integrated curriculum in Years 1 and 2. In order to ensure that the educational program provided for a general, professional education, consensus was built around identification of common diagnoses, symptoms and syndromes determined by clerkship directors and clerkship-specific national organizations, national data bases and log book data from previous years. A content review subcommittee for the Program to Advance Clinical Education (PACE) in Years 3 and 4 also contributed to the process, in consultation with the associate dean for Undergraduate Medical Education and a Year 3 and 4 oversight subcommittee of the Committee on Curriculum.
Review of our recent graduates (classes of 2000-2003) by residency program directors revealed that in the categories of Medical Knowledge (74%), Clinical Skills (74%) and Effective Interpersonal Skills (80%), the indicated percentages of our students were evaluated to be above their peers (percentages represent rankings of “above peers” and “well-above peers”). A self-evaluation by the graduates, comparing themselves to their peers in the categories of Medical Knowledge and Clinical Skills revealed that 71-73% of the students considered themselves to be above their peers in the categories of Medical Knowledge and Clinical Skills; the majority of the remainders in those categories considered themselves to be on a par with their peers.
The distribution of residency matches in primary care areas for the last three graduating classes has been 51% (class of 2004), 42% (class of 2005) and 41% (Class of 2006). Based on our recent graduate class distributions within the NRMP medical subspecialties, the USFCOM educational program has been successful in preparing students for all career options in medicine. USF College of Medicine graduates select a wide variety of specialties for residency education; the class of 2004 matched to 17 different specialties, the class of 2005 matched to 19 different specialties, and the Class of 2006 matched to 22 different specialties.
5. Discuss the types and sufficiency of educational activities to promote self-directed learning and development of the skills and habits of lifelong learning.
Committee Response: The medical curriculum provides for a balanced and innovative professional education that fosters the development of self-directed learning throughout all four years of the undergraduate medical education.
Year One:
Self-directed learning is introduced during the first course in the curriculum - the Professions of Medicine. Simultaneous with learning how to access sources of information via the library and online databases, students must research the most current information on a given subject. With the guidance of content-expert mentors, students are directed toward formulating appropriate questions and obtaining valid information. Various disease-specific cases are used as a basis for learning the skills to acquire reliable information relevant to clinical problems. These themes are subsequently carried through all of the basic foundation courses in the first-year curriculum with independent and group exercises and presentations that are designed to emphasize the importance of both independent thought and professional teamwork for successful problem-solving and presentations.
Year Two:
Skills and habits of lifelong learning are emphasized to an even larger degree during the second year through small-group problem-solving sessions, research reports requiring data analysis, and laboratory activities. Independent learning via intranet-posted laboratory exercises forms a crucial part of the learning experiences of the laboratory-based courses such as Pathology and Laboratory Medicine. A web-based format used to learn Physical Diagnosis fosters the student’s ability to develop self-direction, independence and time-management skills through preparation for hands-on skill sessions. These themes are further developed in the Clinical Diagnosis and Reasoning course and the Clinical Problem Solving course. Finally the Evidence-Based Medicine course, Longitudinal Clinical Experience, and Colloquium amplify and refine the development of self-directed learning skills by reading medical literature, evaluating information for relevance to the problem at hand, discussing literature and problems with experts and colleagues, and applying that information to individual circumstances.
Year Three:
The third-year curriculum builds on the independent and group-learning skills that are attained in the pre-clinical years: evidence-based medicine in decision-making and problem-solving, and consultation with colleagues in the diagnosis and treatment-planning of actual and virtual patients. Continued computer-based learning environments, as well as more traditional reading assignments are followed by individual presentations and critiques. In addition, students attend grand rounds presentations and clinicopathologic conferences with postgraduate residents-in-training and faculty for state-of-the-art presentations from experts to supplement independent learning and establish a lifelong pattern of continuing medical education.
Year Four:
The fourth-year curriculum continues to emphasize independent learning with traditional journal club assignments and independent study, students’ translation of clinical problems into clinical questions based on research of literature and analysis. They synthesize this research and present oral and written critiques of their work.
6. Evaluate the adequacy of the system for ensuring consistency of educational quality and of student evaluation when students learn at alternative sites within a course or clerkship.
Committee Response: Each course and clerkship has a single course director who informs all faculty about the course-specific objectives and grading policies. Although some clerkships may be conducted at different sites, the supervision for each course is under a single course director.
Faculty members use a single evaluation system for each course and clerkship. The implementation of a college-wide evaluation form unites the students’ educational objectives with both formative and summative evaluations. These contain program-wide competency- and objective-achievement ratings as well as clerkship-specific ratings and are reviewed by individual clerkship directors as well as collectively by all clerkship directors and department chairs. Currently, a centralized evaluation of sites is being implemented.
Faculty at all sites in a given clerkship report through a single clerkship director who supervises the entire clerkship. Communication between the clerkship director and site directors occurs in person, by telephone and electronically at least twice per rotation: at mid-term and at end-of-term. Often, communication occurs more frequently.
7. Comment on how well all content areas required for accreditation are addressed in the curriculum.
Committee Response: While the first-and second-year curricula include named courses in anatomy, physiology, microbiology, pathology and pharmacology, the contemporary context of these disciplines is also included in the other required courses during the first two years, including the Professions of Medicine, Ethics and Humanities, Molecular Medicine, Imaging for anatomy, medical neuroscience, Introduction to Behavioral Medicine, Physical Diagnosis I, Colloquium I, Longitudinal Clinical Experience I and II, Clinical Diagnosis and Reasoning, Physical Diagnosis II, Evidenced-Based Medicine, Clinical Problem Solving, and Colloquium II. For instance, content in pathology is covered substantially to slightly in 18 of the 19 first and second year courses; pharmacology is covered in 17 of the 19 courses; anatomy and preventative medicine content is covered in 15 of the courses; biochemistry, genetics, and physiology content is covered in 14 courses; and microbiology and immunology content is covered in 13 courses during years one and two.
The last major revision to the curriculum occurred within the year 3 and 4 programs with the inaugural iteration starting in June 2005. A principal feature of that revision includes an interdisciplinary/interdepartmental approach to the organization of the required clerkships. Clerkship rotations during the third year now include a 16-week Primary Care and Special Populations rotation (including Family Medicine, Internal Medicine and Pediatrics), a 16-week Inpatient rotation (eight weeks Medicine and Pediatrics; eight weeks Surgery), an eight-week Neuro-Psychiatry rotation, a four-week Newborn and Maternal Health rotation, and a four-week Emergent and Urgent Care rotation. The third year is 48 weeks in length, with 24 weeks (50%) spent in outpatient settings and 24 weeks (50%) spent in inpatient settings. Thus, students receive an equally balanced educational experience during their third year.
The fourth year curriculum consists of eleven four-week periods which includes an eight-week rotation in critical care, a four-week rotation in integrated clinical neuroscience, six required electives, four weeks for residency interviews and four weeks for USMLE preparation. Starting in June 2006, the 36-week fourth-year curriculum will change to include eight weeks of critical care, four weeks of oncology, four weeks of musculoskeletal and dermatology, five required electives and eight unscheduled weeks.
In addition to the basic and clinical disciplines, the curriculum throughout the four years includes required behavioral and socioeconomic subjects. The following topics are considered to be important content areas and are covered through lectures, small-group discussion, lab activities, and through clinical experiences: alternative medicine, biostatistics, clinical pathology, communication skills, community health, diagnostic reasoning, end-of-life care, epidemiology, evidence-based medicine, family violence/abuse, medical genetics, geriatrics, health care systems, health care quality review, home health care, human development/life cycle, human sexuality, medical ethics, medical humanities, medical jurisprudence, medical socioeconomics, multicultural medicine, nutrition, occupational health/medicine, pain management, palliative care, patient health education, population-based medicine, preventive medicine, rehabilitation/care of the disabled, research methods, substance abuse, and women’s health.
In reviewing data from the most recent AAMC Medical School Graduation Questionnaire for USF graduates (2005), USF graduates reported an “appropriate” amount of time was devoted to instruction in all areas surveyed except two. Exposure to seven topics was considered “appropriate” by a higher percentage of USF graduates than of all US graduates. USF graduates were comparable to all U.S. graduates in reporting an “appropriate” amount of time devoted to instruction in nine other areas. There were two content areas where the majority of USF students reported an “inadequate” amount of time devoted to instruction as compared to all US graduates (medical socioeconomics and nutrition). In only one topic, multicultural medicine, did a considerably larger percentage of USF graduates feel that an “excessive” amount of time was spent as compared to all U.S. graduates.
Laboratory and other practical exercises are included as part of the required learning throughout the basic sciences courses. For instance, the aim of laboratory exercises in the molecular medicine course is to apply knowledge gained from the course and textbook material to identify distinguishing histological features of basic tissue using a microscope. A general preview of materials is presented to the entire class. The class is then split into small learning groups in the laboratory to emphasize use of the microscope and review of the material presented to the entire class. Student participation, rapport with fellow students and faculty are also evaluated. Laboratory exercises are interspersed throughout the 10 week course, positioned to reinforce material covered in class and clinical correlations, as well as student presentations. In anatomy, the students participate in required labs in gross anatomy and histology. They collect the data and utilize and analyze material for identification of anatomical structures and histological features.
In each major section of the first-year physiology course, computer simulation/exercise is used. Some of these exercises require the student to alter parameters, examine the outcomes, and interpret the mechanism that had precipitated the results. Other exercises require the student to select tests and interpret the computer generated results identify the changes.
The first-year medical neuroscience course includes several clinical skills lab sessions during which students conduct limited neurologic exams in small groups comprised of their classmates. During these sessions, students learn about and practice clinical skills related to the neurological examination and can observe and become familiar with clinical findings suggestive of normal neurological function. Students evaluate neurological function and document their findings for patients’ records. This course emphasizes examination findings that represent the range of normal in the general population. Subsequent learning activities (in other courses) focus on clinical findings that are abnormal or diseased.
The pathology and laboratory medicine course offers approximately 22 hours of laboratory exercises designed for student case presentations. Eventually, students must observe glass slides in order to answer questions they have identified during the cases discussions. These observations are then formally correlated with the cases at the end of the exercises.
The pharmacology course uses 24 separate problem-solving sessions which require students to observe exercises (real or simulated) of biomedical phenomena in the laboratory. For example, students plot dose-response curves (determining relative potency, therapeutic indices, efficacy); they conduct Scatchard Analysis (receptor number and receptor sensitivity; competitive or non-competitive antagonists); they use a web-based conference from the CDC on tuberculosis; they give presentations relating to current issues in pharmacology (i.e. pharmaceutical company representatives and their interaction with medical professionals); and soon, students will research “virtual lab-based experiences” such as MacDog Lab, one that we have used previously.
Principles of Medical Immunology and Infectious Diseases (PMIID) switched from “wet lab” experiences in 2005 to computerized laboratory exercises. Students solve significant medical cases and are evaluated by multiple-choice questions at the end of each case.
In an effort to provide further data on the adequacy of the curricula, USMLE results for first-time takers from USF College of Medicine for the three most recently completed academic years are provided below. Note that pass rates range from 95% – 99% with USF COM mean scores consistently at or above the national mean for that test. (Source: National Board of Medical Examiners School Reports)
STEP 1:
| |Number |Percent |Mean |National Mean |
|Year |Examined |Passing |Total Score |Total Score |
|2005 |119 |97 |218 |218 |
|2004 |95 |96 |217 |216 |
|2003 |101 |95 |217 |216 |
STEP 2 CK:
| |Number |Percent |Mean |National Mean |
|Year |Examined |Passing |Total Score |Total Score |
|2004/05 |110 |99 |225 |220 |
|2003/04 |91 |99 |227 |218 |
|2002/03 |100 |99 |221 |216 |
STEP 2 CS:
|Year |Number |Percent |
| |Examined |Passing |
|2004/05 |103 |96 |
|2005/06 |Not available |Not available |
Additionally, data are displayed below illustrating the percentage of graduating students who agree or strongly agree (sum of the two categories) with the statement “Overall, I am satisfied with the quality of my medical education.” Consistently, the percentage of USF COM students agreeing or strongly agreeing with this statement was higher than the national mean of all medical students. (Source: AAMC Longitudinal Statistical Summary Report)
| |1999-2000 |2000-01 |2001-02 |2002-03 |2003-04 |2004-05 |2005-06 |
|Univ. of So. FL|89 |91 |89 |90 |90 |94 |Not available |
|National |87 |87 |87 |89 |89 |90 | Not available |
8. Assess the balance between inpatient and ambulatory teaching and the appropriateness of the teaching sites used for required clinical experiences.
Committee Response: Clinical experiences begin for students during their first year as part of the Longitudinal Clinical Experience I(LCE). Starting in November of their first year and continuing throughout the second year, students spend one-half day per week in a clinical setting with a physician. LCE I (during year 1) consists of 25 sessions of four hours each for a total of 100-clinical hours. LCE II (during Year 2) consists of 29 sessions or 116 clinical hours. Students are assigned to three separate physician preceptors for a longitudinal experience over the two years. Generally, each student has the opportunity to work with at least one primary care physician in an ambulatory practice setting and at least one specialist in an ambulatory or hospital setting. A combination of College of Medicine physician faculty as well as private physicians participate as preceptors for LCE I and II.
As mentioned earlier, during the third year the balance between inpatient and ambulatory teaching is equal. Students spend 50% of their time (24 weeks total) in ambulatory clinical sites and 50% (24 weeks total) in inpatient sites. Ambulatory-clinical-teaching sites include a combination of College of Medicine faculty practices, private-physician practices, and federally qualified health centers (i.e., community/migrant health centers). Inpatient-clinical sites include Tampa General Hospital, James A. Haley Veteran’s Administration Medical Center, Bay Pines Veteran’s Administration Medical Center, H. Lee Moffitt Cancer Center, All Children’s Hospital and Shriners Hospital. All of these inpatient facilities are academic teaching facilities of the College of Medicine and students assigned to these sites practice with and are supervised by College of Medicine faculty and residents.
The College of Medicine has numerous inpatient- and ambulatory-clinical teaching sites that encourage student learning. At some clinical sites, residents and students feel marginalized; however, faculty members are trying to improve students’ learning environment. A few private practices exist that limit students’ time with the physician for shadowing. Faculty are also addressing this criticism and in cases where the situation cannot be resolved satisfactorily, the practice is no longer used for student learning in the third and fourth years. In addition, with the transition this year to an entirely new third-year curriculum that includes 50% ambulatory and 50% inpatient, a few students have expressed concern that their inpatient clinical time has been compromised.
Student experiences at all teaching sites in a given clerkship are monitored by one clerkship director who is responsible for all aspects of the clerkship. This monitoring is accomplished by frequent communication between the clerkship director and lead faculty for that clerkship at each site. In addition, student experiences at each site are evaluated for appropriateness based on the student logbook data. The number of patients, their demographics and their diagnoses are all collected and are identifiable by the clinical site at which they were seen. This information is checked on an ongoing basis by the clerkship director and the Clerkship Oversight Committee.
9. Comment on the adequacy of the supervision of medical students during required clinical experiences. Discuss the effectiveness of efforts to ensure that all individuals who participate in teaching, including resident physicians and volunteer faculty members, are prepared for their teaching responsibilities.
Committee Response: Supervision of the medical student’s clinical experience on clinical clerkships is the immediate responsibility of the clinical clerkship director, who is always a core faculty member. The vast majority of faculty on every clerkship are core faculty. Voluntary clinical faculty and residents serve in supplemental roles. Voluntary faculty must have a clinical faculty appointment and are generally used to provide unique learning experiences for the student, such as a rural health experience.
A faculty oversight committee which reports to the Committee on Curriculum oversees clerkship content and structure.
All faculty are uniformly given both college and individual clinical clerkship learning objectives and have ongoing communication and feedback from the clerkship director. Clerkship logbook data that detail the clinical experience of the student on any given clerkship is available to the faculty working with the student. This data allows the faculty to provide the student as broad of an experience as is practical.
All faculty working with students on any given clerkship are expected to personally oversee all aspects of the student’s clerkship experience and meet with the student for both educational and feedback purposes. Direct observation of the student is encouraged whenever possible. The faculty are expected to monitor the role of residents in the students’ educational program. It is evident in practice, however, that in particular clerkships, the resident who spends significantly more time with a student may be in a better position to evaluate the student. The core faculty and residents provide input about the acquired skills and expertise of each student.
Significant effort is made to ensure that the faculty have access to up-to date teaching tools and skills. Faculty members have access to ongoing workshops at the college and are able to use the main campus resources as needed.
Residents, as an integral part of the teaching team, attend an instructional program on teaching, evaluation, and educational objectives begun three years ago and sponsored by the Office of Graduate Medical Education. This office also co-sponsors a separate, day-long program for rising senior residents focusing on their new roles as senior residents. It covers a variety of leadership skills including how to teach, evaluate and lead, and specifically addresses students and junior residents as learners. Participating in both of these workshops is the associate dean for medical education.
The students provide assessments of the teaching effectiveness of residents and fellows. Reviews of the Graduation Questionnaire completed by the 2003, 2004, and 2005 graduating classes show that many “agree” or “strongly agree” that “residents and fellow provided effective teaching during the clerkship.” In addition, many graduating students “agree” or “strongly agree’ that “overall, the teaching I received from residents and fellows enhanced the educational value of my clerkship.” Although four of the six required third-year clerkships scored quite well on this question in the latest survey (2005) with combined percentages above 80% (Pediatrics, Obstetrics-Gynecology, Internal Medicine, Psychiatry), two clerkships show room for improvement in this regard (Surgery 72.4% and 71.3%, Family Medicine 65.5% and 67.8%)
10. Evaluate the adequacy of methods used to evaluate student attainment of the objectives of the educational program. How appropriate is the mix of testing and evaluation methods? Do students receive sufficient formative assessment in addition to summative evaluations? Discuss the timeliness of performance feedback to students in the preclinical and clinical years.
Committee Response: The Office of Educational Affairs at the COM is staffed by individuals who have expertise in student assessment, and the evaluation of student assessment methods. The Vice Dean for Educational Affairs has extensive knowledge in the development of student assessment tools both for written examinations and in standardized patient programs. He also has wide-ranging experience in the development of other evaluation tools. The Associate Dean for Undergraduate Medical Education has skills and experience in assessment methodologies. Further, the office employs two educators who have doctoral degrees and a staff who administer the clinical skills center. There is also a designated individual who runs computerized administration of examinations and their evaluation.
For each of the last several years, Dr. David Swanson, who is affiliated with the NBME and the USMLE examinations, has directed an item writing workshop. His book on Constructing Written Test Questions for the Basic and Clinical Sciences has been available to participants. In addition, the Education and Design and Technology team works individually with course/clerkship directors on course development and especially on student evaluation methods. A PhD educator is available for outcome measures and objectives. The Office of Educational Affairs is developing a web-based resource for faculty development that will contain information regarding student evaluation methods. In addition, this office sponsors attendance at AAMC workshops concerning student evaluations. The College of Medicine sends approximately five faculty members to this meeting each year, including the Committee on Curriculum chair.
Course directors are encouraged to participate in their discipline-related course training and course directors work with their departmental faculty to review examination questions. For each block examination in years one and two, the course directors, and faculty who participated during that block meet to review and edit the exam, item by item. The associate dean, and all course directors attend these exam review sessions as well and critical discussion about individual written test items occurs at each meeting. These exam reviews are excellent methods that require periodic review of ones item writing skills and continual up-dating and improvement of the items on a particular exam.
Each course during the first two years of medical school has its own selective mix of evaluation methods, with some of the more factual-based courses testing with mostly objective methods, whereas the third and fourth year clerkships evaluate the attainment of clinical skills and reasoning, problem solving, communication skills, and behaviors and attitudes However, especially during the first two years, various methods of testing are used to measure not just students’ grasp of the material, but also their ability to find, analyze, synthesize, and communicate information independently. These include small group problem-solving, conducting laboratories, writing papers, topic-based presentations, etc. In addition, the Committee on Curriculum oversees the various evaluation methods and appraises these courses annually.
In years one and two, examinations are taken in a block, i.e. a single exam for all the courses offered during that semester. Students are examined using formative assessments and receive the results so that they may review, and if necessary, adapt their performance during a course. Each clerkship has a mid-term assessment that uses a centralized evaluation form. All other courses in the program that are over four weeks in length provide multiple assessments with feedback for each. (The only course that is less than four weeks in duration, "The Professions of Medicine," includes a mid-course quiz that provides feedback to students on performance). Course and clerkship specifics concerning evaluations are included in all syllabi. Students certainly receive this feedback in sufficient time so that remediation may occur.
For courses, performances on block examinations are released within 48 hours after the day of the examination. Final course grades are submitted to the registrar within three weeks of the end of the course. For clerkships, administrative policy states that all grades must be in within four weeks of the ending of clerkships. Submission of all grades and distribution of grades to students are closely monitored and enforced by the registrar’s office, the associate dean for student affairs and the associate dean for undergraduate medical education.
The third-and fourth-year clerkships use a common student evaluation form that includes narrative descriptions of student performance and non-cognitive achievement (a copy of this form is included in the database). Nearly all courses during the first two years provide a narrative evaluation of the student's performance, and these letters are placed into the students file. The Office of Educational Affairs is working on and has nearly completed the development of a common student evaluation form for the first two years.
See Attachment 2 - Student Evaluation Form
11. Describe the system for ensuring that students have acquired the core clinical skills specified in the school’s educational program objectives. Evaluate its adequacy. Are there any limitations in the school’s ability to ensure that the clinical skills of all students are appropriately assessed?
Committee Response: The University of South Florida has established its educational program objectives with the mnemonic “USF CARES.” This encompasses multiple competencies including the following:
• Understanding needs of patients
• Scientific approach to medical management
• Formulation of appropriate care plans
• Collaboration with others on the healthcare team
• Attitudes and values
• Reflection and renewal
• Ethics
• Skills
All USF faculty use this evaluation in the syllabus or description of each course/clerkship listing those "USF CARES" objectives that pertain to that particular course/clerkship. A separate list of clinical objectives states the expectations to be met by each clinical clerkship. The College of Medicine strives for a more comprehensive evaluation of the student’s clinical skills during all four years of medical school.
There are several formal evaluations of the student's clinical skills. At the end of the second year, an OSCE (Objective Structured Clinical Examination) is performed for all students. This evaluation is done as a collaborative effort between the College of Medicine and College of Nursing. Nine standardized patients have a checklist of expected competencies for each station. Students are given immediate feedback after each station about their performance by the preceptor observing them. The interaction is also videotaped so that students may review themselves. During third year, several of the clinical clerkships require a clinical practice exam (CPX). During the fourth year, the students are videotaped performing a complete history and physical exam. This videotape is reviewed with the student by internal medicine and family practice faculty. Although each student is required to pass these formal assessments, faculty continuously attempt to involve the student in clinical experiences. For example, a faculty member may ask the student to conduct a portion of the history and physical of a patient while the faculty member observes in the course of a clinical clerkship experience. Certainly, there is considerable variability among faculty in how they provide a student these experiences.
The uniform assessment tool "USF CARES" is used by all faculty to assess those competencies deemed essential by the college.
The College of Medicine strongly believes that its graduates have a sound background in problem solving, clinical reasoning, and communication skills. Beginning in the first year of medical school, the Professions of Medicine course helps to develop communication skills and critical thinking. In year two, the Clinical Diagnosis and Reasoning course presents the students with sample patients and allows the students to formulate a differential diagnosis using lab studies that might be helpful reaching the final diagnosis. These are just two of the many course examples taught to our students (please refer to the database ED-28 for a complete outline and examples).
We have identified the problem of inherent variability among evaluators as they assess students’ clinical skills. This difficulty faced by all medical schools and therefore is not viewed as a true limitation unique to USFCOM. Student logbooks will allow clerkship directors to monitor the number and types of patients being seen by each student during a clerkship and make adjustments, if necessary, to the clinical experience during the course of the clerkship. The Clerkship Oversight Committee provides ongoing evaluation of each clerkship’s success in providing the necessary clinical experiences for each student to acquire the clinical skills required for meeting the overall educational objectives.
12. Assess the adequacy of mechanisms for managing the curriculum and ensuring a coherent and coordinated curriculum. Do the curriculum as a whole and its component parts undergo regular, systematic review? Provide evidence that the school monitors the content covered in the curriculum to ensure that gaps or unwanted redundancies do not occur. Does the chief academic officer have sufficient resources and authority to assure that the educational program can achieve institutional goals and learning objectives?
Committee Response: An excellent relationship exists between the academic administration, the Committee on Curriculum and the student leadership. All parties have worked together as a team toward the common objective of providing the best educational experience possible. The members of the Committee on Curriculum take a global view of the educational process rather than a departmental one and thus ensure balanced and carefully thought out decision making. When problems are encountered, they are dealt with in an objective, collegial manner.
The overall curriculum is reviewed during the annual or semi-annual curriculum retreats. These retreats provide an update of national trends and innovations, a detailed review of the college curriculum evaluations, normative test scores, student responses to the AAMC Graduation Questionnaire, all college performance based examinations and any other information relevant to curricular assessment. Areas of concern are noted, discussed and corrective plans are formulated. Particular attention is given to content, coordination and outcome measures.
Individual components of the curriculum, i.e. courses and clerkships are evaluated several ways. At the conclusion of each component, the involved faculty and students complete online course evaluations administered by the Office of Educational Affairs staff. Each course director also completes a Course Director’s Evaluation which provides a detailed update of the course including successes, problems, concerns and future needs.
The Committee on Curriculum conducts a formal, highly detailed review of each component every two years or more frequently when problems are detected. This process includes the review of all outcome measures, course materials such as the course syllabus, assessments of overall faculty effectiveness, course directors’ responses to previous reviews and recommendations, etc. The reviewer interviews the course director privately as part of the review preparation and the course director meets with the entire Committee on Curriculum when the course review is presented and discussed. The student members of the Committee on Curriculum provide valuable input during these reviews.
The course reviews provide one method of monitoring curriculum content. The USMLE sub-score analyses also provide information on the adequacy of the course content as does the performance-based assessments of clinical skills including OSCE and CPX.
The Year 2 course directors work together to provide a detailed yearly curriculum plan and hourly schematic. This planning process has served very well to assure coordination, integration, completeness and relevance. It has been especially helpful to have the significant involvement of a number of both basic science and clinical faculty in this process.
In Year 1, the anatomy and physiology courses underwent a highly-detailed content review by a sub-committee of the Committee on Curriculum made up of both clinical and basic science faculty. While this process was very effective at detecting excesses, omissions, unplanned redundancies and relevancy, it was far too time-consuming to be used for all courses. The faculty and clerkship directors in Year 3 have an excellent perspective of the content of each of the specialty areas covered as a result of the integrated, multi-disciplinary planning that occurred during the PACE process. During the restructuring of the third and fourth years, careful attention was paid to the content, relevance and integration of the course material.
To date, the vice dean for educational affairs has had sufficient resources and authority to assure that the educational program can meet its objective; however, during the Self-Study process it became apparent that in two areas the process for acquisition of resources has not been optimal. The scheduling of conference rooms for small group sessions has been tedious at best because of the lack of centralized control of these resources. For example, scheduling a half a dozen rooms might involve dealing with an equal number of different offices each with their own priorities. The dean has recently directed that the Office of Educational Affairs assume control of these educational resources and that scheduling be centralized through that office. Additional staffing has been authorized, and scheduling software packages to assist this process are being reviewed. In addition, funding has been committed to uniformly equip similar rooms to expand the availability of functional rooms to meet the educational needs.
The second area of difficulty has been the process associated with staffing the faculty required for the interdisciplinary courses. Since these courses are not the domain of any single department, the departmental chairpersons have not assigned faculty to these courses. The course directors have had to rely on faculty volunteers, in the face of conflicting demands and priorities, to staff the courses. This process has been difficult for both the conflicted faculty and the course directors. Resolution of this problem appears to be eminent with the implementation of the AIMS program. Under this program all faculty will be required to devote a certain percentage of effort to the stipulated types of educational activities as part of their overall compensation package. Included in the stipulated options will be participation in the interdisciplinary courses. By making these activities a required component of faculty compensation, the resource pool has been substantially broadened and the educational activities are given a much greater priority.
13. Judge the effectiveness of curriculum planning at your institution. Describe efforts to ensure that there is appropriate participation in planning and that resources needed to carry out the plans will be available. How effective are the procedures to rectify any problems identified in the curriculum, and in individual courses and clerkships? Describe and evaluate.
Committee Response: Curriculum planning has been one of the particular strengths of the College of Medicine. All four years of the curriculum have been modified over the past seven years. Each major modification arose from discussions that occurred at a Committee on Curriculum Retreat and progressed from these considerations to involve all major stakeholders in a collegial process of determining the desired outcomes and planning for implementation and evaluation. The Program to Advance Clinical Education (PACE) will serve to illustrate the planning process which has culminated in complete restructuring of the third-and fourth-year curricula. PACE also illustrates the depth and breadth of the stakeholder involvement in this planning and implementation process. At the Annual Committee on Curriculum Retreat held November 2003, the Vice Dean for Education presented the basic rationale for revising the Year 3 and Year 4 curricula. This portion of the curriculum had remained essentially the same since the institution shifted from a three-year to a four-year curriculum in 1980. Following this retreat, an invitation was extended to the faculty, chairs, the entire student body and the larger HSC community to become involved in what came to be designated as the PACE process.
Formal presentations were made to all of these groups, and in January, 2004, working groups were formed and a PACE Subcommittee of the Committee on Curriculum was appointed. Over 100 faculty and students were involved in these working groups. In April 2004, a second retreat was held to review the presentations of the working groups. The groups continued their deliberations until June 2004, when their efforts culminated in a joint meeting of the PACE Subcommittee and the Committee on Curriculum. Both groups unanimously approved the PACE plan at this meeting. The Committee on Curriculum subsequently presented the plan to the dean and it was approved for implementation in late June 2004.
A PACE Implementation Committee and a Planning Committee were convened in July 2004. In December 2004, another PACE Retreat was held and presentations were made by the key committees. The curriculum changes were implemented in June 2005. From initial conception to implementation, the PACE process involved faculty, chairs, students, and administration and emphasized open communication and candid feedback. More than ample opportunity was provided for all individual stakeholders to have meaningful involvement in the process. Since these changes were incorporated, the new curriculum has been evaluated through formalized input from faculty and students and review of key outcome measures. After consideration, changes have been made, and these alterations have been carefully examined for effectiveness.
To date the resources needed to implement and sustain the educational plan have been sufficient. For example two doctoral level educational specialists have been added to the Office of Educational Affairs staff to facilitate and assist with the changes that are underway. Two of the four large classrooms have been remodeled and the technology upgraded and one other classroom is scheduled for renovation. An 8000 square foot state of the art Clinical Skills Lab has also been added. It is essential that the Vice Dean for Education continues to have both the necessary resources and the authority to fulfill the educational mission.
Problems in courses and clerkships may be identified in one of several ways including the following: individual student concerns, end of course evaluations, exam performance, student liaison meetings, and formal Committee on Curriculum reviews. Depending on the nature of the issue raised, problems may be addressed through a number of different mechanisms. Minor problems (often brought to light by individual students or student liaisons) are usually resolved without special intervention directly by the course and clerkship directors. More significant issues may require that the Associate Dean for UME work directly with course directors, chairs, and the Committee on Curriculum to attain resolution. When deemed appropriate, the Committee on Curriculum will request that the course director provide a plan for corrective action. The Committee on Curriculum sometimes exercises the option of requiring an out-of-cycle formal review (typically every two years) with regular follow-up reports. When issues are not resolved at the course director or chair level the Committee on Curriculum will make recommendations for corrective action to the College of Medicine administration. An example may serve to illustrate this process.
Based upon formal evaluations by both students and faculty the Integrated Neuroscience
Clerkship experience was determined to be inadequate. After attempting to correct the problems via the above procedures and after changing course directors three times without success, the entire clerkship was restructured with the content being distributed between the Neuropsychiatry and Critical Care Clerkships. In addition, a more student-oriented faculty member was hired to facilitate the process.
Following the implementation of the new third year curriculum in June 2005, it was recognized that close oversight of the newly formed clerkships was needed to ensure balance, consistency, appropriateness of educational experiences, and achievement of both clerkship and college wide objectives. The Clerkship Oversight Committee, a subcommittee of the Committee on Curriculum, was formed to accomplish this monitoring function. The COC met about every three months to review information such as the following: student logbook data, clerkship evaluations, shelf and clinical practice exam performance, and student grades. This information provided the opportunity for ongoing monitoring of the quantity and quality of the clerkship experience. This committee is responsible for providing recommendations to the Associate Dean for Undergraduate Medical Education and to the Committee on Curriculum for the modifications that would be needed in the educational program and provided the flexibility necessary to make those changes quickly, if needed. In addition, the clerkship directors and the Associate Dean for Undergraduate Medical Education meet regularly with liaisons from the medical school class. The clerkship directors in this environment are open to comments and suggestions from the medical students and are able to make changes to address student concerns on an ongoing basis. As a result of the work of the oversight committee and the diligence of the clerkship directors in meeting with student liaisons, concerns raised by faculty and students are typically addressed and resolved quickly. For example, the newly instituted Emergent and Urgent Care Clerkship was modified soon after its debut in response to issues identified early in its implementation vis-à-vis grading.
14. How does the curriculum committee assure that students have sufficient time for learning? Evaluate the workload and balance between education and service in the clinical years. Do students receive sufficient formal teaching during their clinical clerkships?
Committee Response: The Committee on Curriculum has established rules limiting the number of contact or work hours required of a student per week. For Years 1 and 2, the limit is 28 hours per week of contact plus four hours per week of Longitudinal Clinical Experience. During Years 3 and 4, the same work-hour limitations that are in force for the residents apply to the students which are 80 hours per week. However, students only rarely would actually have to spend 80 hours in the hospital.
As a result of the self-study process the Committee on Curriculum has determined that the first year of the curriculum has, at 1132 hours, substantially more contact hours than the national average of 830 hours. (JAMA Sept.1, 2004, vol 292, no.9) The departmental chairs, course directors and faculty involved in the Year 1 curriculum are working with the vice dean for education to formulate a proposal to the Committee on Curriculum to reduce the number of contact hours to a level approaching the national average. In addition to reducing the number of contact hours, the proposal will also focus on promoting more independent learning experiences and less lecture format.
Students themselves provide an assessment of the time requirements for each course or clerkship as part of the online standardized course evaluation. The Committee on Curriculum includes an evaluation of course time requirements as part of each formal course review done biannually.
Because the PACE Project provided a total redesign of all of the third-and fourth-year educational experiences, clerkships were created with a carefully considered balance between education and service as well as sufficient formal teaching time. For example, all clerkships have scheduled didactic sessions in addition to case-based and multidisciplinary conferences. Several clerkships employ weekly quizzes followed by item review sessions.
15. For schools that operate geographically separate campuses, evaluate the effectiveness of mechanisms to assure that educational quality and student services are consistent across sites.
N/A
16. Describe the evidence indicating that institutional objectives are being achieved by your students.
Committee Response: There are a number of measures used to provide evidence that institutional objectives are being achieved by our students. These indicators of effectiveness include both external and internal data.
External metrics include the following:
• Results of USMLE and NBME subject examinations*
• Student responses on AAMC Medical School Graduation Questionnaire
• NRMP results
• Specialty choice of graduates
• Program director surveys of PGY 1 performance
*Students must take and pass Step 1 and Step 2 CK/CS USLME exams in order to graduate. In addition, many of the courses and clerkships utilize NBME subject examinations (with minimum passing scores) as a component of the course/clerkship evaluation schema.
Internal metrics include the following:
• Student scores on internally developed written examinations
• Performance-based assessment of clinical skills including OSCE and CPX exams
• Review of logbook data in Years 3 and 4
• Student advancement and graduation rates
• Videotaped history and physical for fourth year students
• All college-wide evaluation forms link the educational objectives with course-specific competencies.
17. Discuss how information about your students and graduates is used to evaluate and improve the educational program.
Committee Response: These data are reviewed by a number of groups and individuals including but not limited to the following:
• The Committee on Curriculum
• The Office of Educational Affairs
• The Office of Student Affairs
• Course and Clerkship Directors
• Department chairs and departmental education committees
At the curriculum-wide level, the Committee on Curriculum reviews all of the above external and internal data at its annual curricular retreat in conjunction with the senior administrative leaders. Areas needing improvement are noted and reviewed the following year. Those areas of concern are identified and referred back to the respective courses and clerkships. In some instances, this review process has resulted in the creation of entirely new courses (e.g., Evidence-Based Medicine) or more broad curricular reform as is evidence in the recent restructuring of the entire Years 3 and 4 programs.
At the course or clerkship level, various performance measures including shelf and internally- developed written exams, OSCEs, and CPX exams all are used to gauge course/clerkship effective and guide improvements.
3 Analysis of Recommendations and Deficiencies Relevant to Committee as Identified by Most Recent LCME Review in 1999
• Continuing evolution of the educational program, including efforts to achieve greater content integration in the curriculum, more effective use of computer-based learning, and increased student engagement in active learning.
Committee Response: The University of South Florida College of Medicine provided an extensive update to the LCME on these issues in a letter of December 19, 2002. The following substantive changes were outlined as follows:
• a new three-week introductory course to our program, the Professions of Medicine, was initiated to emphasize professionalism, ethics and core skills;
• the first year was reorganized to permit the juxtaposition of Human anatomy, physiology, Physical Diagnosis, and Imaging for anatomy to improve integration, interdisciplinary teaching and demonstration of the basic sciences in context of clinical medicine; the Neuroscience block was similarly reorganized; the Ethics and Humanities course was moved to earlier in the year to transition from topics introduced in the Professions of Medicine;
• the second year of the curriculum was changed to an organ-system model preceded by a segment emphasizing core concepts; this model, by its nature, promotes context integration.
• a Longitudinal Clinical Experience for Years 1 and 2 was created;
• a colloquium program for each of the four years was created;
• an integrated Critical Care Clerkship was piloted in Spring 1999 and phased in with full implementation 1999/2000.
In addition, USF implemented the use of computer-based website, library resources, and electronic logbooks.
• The system and results of evaluation of the educational program to determine its effectiveness in achieving the full measure of cognitive and non-cognitive learning objectives.
Committee Response:
• Each course in the program developed educational competencies related to the college’s stated competencies and objectives, including comment regarding the methodologies for evaluating achievement of these competencies;
• An ongoing evaluation of the educational program was put into place utilizing standardized patients, an OSCE with a minimum standard of performance, a multi-station CPX (Clinical Performance Examination), the completion of a fully videotaped and reviewed history and physical examination, and use of a critical care simulator.
• We also continued to use external national measures of the knowledge domain
(USMLE).
4 Major Changes Since Last LCME Review in 1999
USF COM has continued in its process to upgrade and modify its curriculum throughout the period of time since the last LCME visit. At that time, plans were underway to complete a retreat process when the first and second year curricula were being reviewed. As a result of that process initiated in 1999, the College of Medicine has proceeded to modify its year one and year two curriculum to the format that we have today. We have now completed six years of an organ system model in the second year curriculum and five years of a block model in the year one curriculum. In 2004, the COM began the project to advance clinical education and to induce faculty and students in a collaborative group process that includes a new approach to the clerkship curriculum.
Over the last seven years, in addition to curricular change, the OEA has developed a center for advanced clinical learning staffed with nurses and other experts in standardized patient programming. The OEA has recruited two doctorally-trained educators to assist with faculty workshops and faculty development, providing other educational expertise to the college. The OEA has worked carefully with the curriculum committee to assure appropriate oversight of the curricular program and has worked with faculty from each year to improve the coordination and integration of the curricular program.
5 Areas of Strength
• USF CARES objectives document and its development process
• Strong students perform on step exams
• Positive student input on graduation survey and resident director survey
• Logbooks real-time picture of student experience in Year 3 and ability for ongoing corrections
• PACE process and PACE outcome
• Positive evaluations of graduates from residency program directors
• Positive self-evaluation by graduates
• Professions of Medicine course’s creative introduction and orientation to medical school
• The integration of Year 2 into an organ-based module curriculum
• PACE curriculum and CPX experience
• Creative Year 3 curriculum as a result of PACE
• In the AAMC Medical School Graduation Questionnaire reporting on the amount of time devoted to “orphan topics,” USF graduates response better than average on seven topics and comparable on nine topics.
• Interactive approach in Year 2 indicated by group instructor exam reviews
• Program utilizing the new clinical skills lab
• Continuity of the curriculum in developing skills in problem-solving, clinical reasoning and communication skills
• Excellent relationship of academic administration, Committee on Curriculum, student leadership in working together to affect curricular change
• Institutional willingness to support curriculum innovation
• Curriculum planning and revision
• New clinical skills lab - CPX exams and feedback to students
• Feedback from clerkship directors indicate improved preparation of students for clinical environment
6 Areas of Concern and Challenges
• Less than optimal use of USF CARES by faculty in course design and student evaluation
• In Year 1, students need more self-directed learning, fewer contact hours, and more integration of curricular content.
• In the AAMC Medical School Graduation Questionnaire reporting on the amount of time devoted to “orphan topics,” USF graduates responded less than average on two topics.
• First year is a work in process.
• Difficulty scheduling conference rooms for small group sessions due to lack of centralized scheduling capability
• Effectiveness of teaching of medical students by residents and fellows in two of six required Year 3 clerkships (2005 Graduation Questionnaire).
7 Review of Compliance with Established LCME standards
ED-1. The medical school faculty must define the objectives of its educational program.
Educational objectives are statements of the items of knowledge, skills, behaviors, and attitudes that students are expected to exhibit as evidence of their achievement. They are not statements of mission or broad institutional purpose, such as education, research, health care, or community service. Educational objectives state what students are expected to learn, not what is to be taught.
Student achievement of these objectives must be documented by specific and measurable outcomes (e.g., measures of basic science grounding in the clinical years, USMLE results, performance of graduates in residency training, performance on licensing examinations, etc.). National norms should be used for comparison whenever available.
It is expected that the objectives of the educational program will be used by faculty members in designing their courses and clerkships and in developing plans for the evaluation of students. The Committee on curriculum, working in conjunction with the chief academic officer, should review the stated objectives of individual courses and clerkships, as well as methods of pedagogy and student evaluation, to assure congruence with institutional educational objectives.
See response below to ED-1-A.
ED-1-A. The objectives and their associated outcomes must address the extent to which students have progressed in developing the competencies that the profession and the public expect of a physician.
There are several wide recognized definitions of the characteristics appropriate for a competent physician, including the physician attributes described in the AAMC’s Medical School Objectives Project, the general competencies of physicians resulting from the collaborative efforts of the ACGME and ABMS, and the physician roles summarized in the CanMEDS 2000 report of the Royal College of Physicians and Surgeons of Canada. To comply with this standard, a school should be able to demonstrate how its institutional learning objectives facilitate the development of such general attributes of physicians. A school may establish other objectives appropriate to its particular missions and context.
Committee Response: The objectives (USF CARES) were developed to clearly communicate the objectives of medical education at the COM. These objectives focus on eight competencies and are listed in the database section for this standard. The associated competencies for these objectives are found in the response to standard ED-27.
These competencies, all of which are measurable, reflect the expectations of the medical profession and the public. In terms of the expectations of the medical profession, the process of revising the competencies for the COM included an analysis of competencies valued in the CanMEDS report as well by other established medical schools. The competencies for the COM are in line with those of other medical educational institutions. In terms of performance measures, students from the COM perform well on national assessment tools including the subject examinations and Step examinations. Specifics on general performance and pass rates on the Step examinations are found in the response to ED-11, reflecting a congruence of the school-wide objectives and measurement of competencies and with the expectations on the medical profession.
In terms of expectations of the public or any medical doctor, the USF CARES objectives are competencies that would clearly be expected. Students of the COM, who are products of USF CARES, are accepted into a wide variety of residency programs where they have a documented record of success.
See Appendix 2 – USF CARES
ED-2. The objectives for clinical education must include quantified criteria for the types of patients (real or simulated), the level of student responsibility, and the appropriate clinical settings needed for the objectives to be met.
Each course or clerkship that requires interaction with real or simulated patients should specify the numbers and kinds of patients that students must see in order to achieve the objectives of the learning experience. It is not sufficient simply to supply the number of patients students will work up in the inpatient and outpatient setting. The school should specify, for those courses and clerkships the major disease states/conditions that students are all expected to encounter. They should also specify the extent of student interaction with patients and the venue(s) in which the interactions will occur. A corollary requirement of this standard is that courses and clerkships will monitor and verify, by appropriate means, the number and variety of patient encounters in which students participate, so that adjustments in the criteria can be made to ensure that all students have the desired clinical experiences.
Committee Response: During the college-wide reform process for Years 3 and 4 termed PACE (Program for Assessing Clinical Experience), the clerkships identified common diagnoses, symptoms, and syndromes important to the goals and objectives for the clerkships. To make sure that these institutionalized generated lists were congruent with those nationwide, they were cross-referenced to those in national organizations. Furthermore, faculty and students were surveyed for their opinions concerning the “top-10 diagnoses” per clerkship. The curriculum committee of the College of Medicine through the Year 3 and Year 4 subcommittees monitors the number and the variety of patient encounters. A chart summarizing the criteria for patient experiences is located in the data base for this standard.
The extent of student/patient interaction is carefully monitored by a required electronic logbook and the associated database tracks all student experiences. Compliance is monitored by generating weekly reports concerning specific logbook requirements and assessing students’ progress toward attaining specific diagnoses and skills within a clerkship. The Office of Educational Affairs, the Associate Dean for UME, the clerkship director and the Associate Dean for Student Affairs facilitate monitoring this data and clerkship directors assure the adequacy of the experience.
ED-3. The objectives of the educational program must be made known to all medical students and to the faculty, residents, and others with direct responsibilities for medical student education.
Among those who should exhibit familiarity with the overall objectives for the education of medical students are the dean and the academic leadership of clinical affiliates where the educational program takes place
Committee Response: USF CARES and their associated outcomes have been widely distributed throughout the COM. All administrators, faculty members, and students have received this information. In addition, evaluation of students is done at the end of the course with a newly developed format in which the evaluation tool is based on these objectives and outcomes.
Issues relating to this part of the standard, as well as solutions, are addressed below:
1. Although administrators may be fairly clear about USF CARES, faculty members, students and others in the medical community may still have to appreciate the importance of USF CARES in designing courses and measuring objectives. Therefore, in order to continually affirm the importance of USF CARES in terms of shaping curriculum and assessing competencies, it is now advised that the administration discuss USF CARES during orientation and that course directors address this information during the introduction to their courses.
2. HSC faculty members have been sent USF CARES by e-mail, but faculty at the Moffitt may not have received it. Therefore, in addition to obtaining Moffitt e-mail addresses, the HSC information services is working to assure that Moffitt faculty receive e-mail from HSC accounts as well as from their Moffitt accounts.
ED-4. The program of medical education leading to the MD degree must include at least 130 weeks of instruction.
Committee Response: Provide the number of scheduled weeks of instruction in:
|Year One |40 |
|Year Two |34 |
|Year Three |50 |
|Year Four |36 |
ED-5. The medical faculty must design a curriculum that provides a general professional education, and fosters in students the ability to learn through self-directed, independent study throughout their professional lives.
Committee Response: The medical curriculum provides for a balanced and innovative professional education that fosters the development of self-directed learning throughout all four years. The hall-mark of these themes appears in the incoming medical student’s first course that features the State of the Art/Current Standard of Care student presentations, as well as an introduction to Evidence Based Medicine and medical science literature designed to question the standard of care. These themes are subsequently carried through all of the basic foundation courses in the first-year curriculum, including independent and group exercises and presentations designed to emphasize the importance of both independent thought and professional teamwork for successful problem solving/presentations.
Self-directed learning is fostered throughout the second year of the curriculum, with continuing emphasis on the importance of independent thought in a continuing emphasis on small group problem solving and research reports that included data analysis (Principles of Medical Immunology and Infectious Disease) and new developments in drug therapy (Medical Pharmacology). In this regard, laboratory activities and intranet-posted self-instruction are important components of lab-based courses such as pathology and laboratory medicine. In Physical Diagnosis a web-based format for studying, lectures and taking quizzes foster the student’s ability to develop self-direction, independence and time management by helping them prepare for hands-on skill sessions. These themes are echoed and further developed in the Clinical Diagnosis and Reasoning course, as well as the small groups of the Clinical Problem Solving course. Finally the Evidence Based Medicine course and Longitudinal Clinical Experience courses amplify and fine-tune the development of individual knowledge and confidence in problem-solving skills prior to the third year.
The third-year clerkships in both their prior, traditional, specialty organization and their new interdisciplinary themes build on the developed, independent, and group-learning skills that are emphasized in the preclinical years: evidence-based medicine in decision making and problem-solving in identified areas according to the clerkship; teamwork in the work-up of virtual and actual patients followed in the clinics or wards depending on the educational setting. Included are a continued offering of computer-based learning environments, as well as more traditional reading assignments followed by individual presentations and critiques.
The senior year Critical Care Clerkship includes both traditional journal club with self-directed, independent study, as well as the conversion of clinical problems into a several-part clinical questions that are addressed through literature searches, analysis, and finally, in written and oral critical appraisals of their findings.
ED-6. The curriculum must incorporate the fundamental principles of medicine and its underlying scientific concepts; allow students to acquire skills of critical judgment based on evidence and experience; and develop students’ ability to use principles and skills wisely in solving problems of health and disease.
Committee Response: [Incorporated into response to ED-7.]
ED-7. It must include current concepts in the basic and clinical sciences, including therapy and technology, changes in the understanding of disease, and the effect of social needs and demands on care.
Committee Response: The guiding principle for the development of the current curriculum has been to assure a thorough education in the scientific principles underpinning the modern practice of medicine while incorporating the acquisition and development of the skills necessary to apply that knowledge to patient care.
Each required course and clerkship in the educational program contributes to these two important educational objectives: the development of a sound foundation of knowledge and the ability to apply it in the care of patients. Clinical application of biomedical scientific knowledge is incorporated into teaching from the very beginning of curriculum. Emphasis is placed on the development of skills in the interpretation of results in the scientific and clinical literature. Diagnostic skills are taught in the context of the anatomic, physiologic, and pathologic principles underlying their validity. Students are given the opportunity to apply their knowledge and skills by interactions with patients beginning in the first year of the curriculum, and progressively increase their involvement in the diagnostic and treatment process with each stage of the educational program.
In order for this increased emphasis to be placed on the development of clinical decision-making skills and experiential learning, the number of lecture hours has been reduced, and the amount of time devoted to small group learning and clinical experience has been increased. Despite these changes, the amount of time devoted to lecture is still considerable. The faculty and administration are committed to working toward decreasing the number of lecture hours and increasing the amount of self-directed and small-group learning experiences for students.
ED-8. There must be comparable educational experiences and equivalent methods of evaluation across all alternative instructional sites within a given discipline.
Compliance with this standard requires that educational experiences given at alternative sites be designed to achieve the same educational objectives. Course duration or clerkship length should be identical, unless a compelling reason exists for varying the length of the experience. The instruments and criteria used for student evaluation, as well as policies for the determination of grades, should be the same at all alternative sites. The faculty who teach at various sites should be sufficiently knowledgeable in the subject matter to provide effective instruction, with a clear understanding of the objectives of the educational experience and the evaluation methods used to determine achievement of those objectives. Opportunities to enhance teaching and evaluation skills should be available for faculty at all instructional sites.
While the types and frequency of problems or clinical conditions seen at alternate sites may vary, each course or clerkship must identify any core experiences needed to achieve its objectives, and assure that students received sufficient exposure to such experiences. Likewise, the proportion of time spent in inpatient and ambulatory settings may vary according to local circumstance, but in such cases the course or clerkship director must assure that limitations in learning environments do not impede the accomplishment of objectives.
To facilitate comparability of educational experiences and equivalency of evaluation methods, the course or clerkship director should orient all participants, both teachers and learners, about the educational objectives and grading system used. This can be accomplished through regularly scheduled meetings between the director of the course or clerkship and the directors of the various sites that are used.
The course/clerkship leadership should review student evaluations of their experiences at alternative sites to identify any persistent variations in educational experiences or evaluation methods.
.
Committee Response: Each course and clerkship has a single course director who communicates to all faculty the course-specific objectives and grading policies for the course. Although some clerkships may be conducted at different sites, the overview and responsibility for each course is under a single course director.
A single evaluation system is used by all faculty in the course. The creation of a college-wide evaluation form will ensure linkage between the educational objectives and the evaluation of each student in both formative and summative evaluations.
All faculty in the College of Medicine have access to faculty development offerings at the university. Available resources include the Center for 21st Century Teaching Excellence, faculty enhancement workshops conducted through the COM’s Office of Educational Affairs, and course-specific faculty development activities utilizing resources from the various medical specialty academies and COM departmental conferences.
Faculty receive feedback via anonymous student evaluations as well as evaluation by the course director.
Evaluation forms contain program wide competency and objective ratings as well as clerkship-specific ratings. These forms are reviewed by individual clerkship directors as well as collectively by all clerkship directors and department chairs. Currently a centralized evaluation of sites on the evaluation forms in being instituted.
ED-9. The LCME must be notified of plans for major modification of the curriculum.
Notification should include the explicitly-defined goals of the change, the plans for implementation, and the methods that will be used evaluate the results. Planning for curriculum change should consider the incremental resources that will be required, including physical facilities and space, faculty/resident effort, demands on library facilities and operations, information management needs, and computer hardware.
In view of the increasing pace of discovery of new knowledge and technology in medicine, the LCME encourages experimentation that will increase the efficiency and effectiveness of medical education.
Committee Response: The most recent major revision to the curriculum occurred within the Years 3 and 4 programs beginning in June of 2005. A principal feature of that revision included an interdisciplinary/interdepartmental approach to the organization of the required clerkships and the addition of an outpatient continuity experience. The reasons for this change were recognition of existing deficiencies as well as broad national mandates for a multidisciplinary perspective in the approach to treating patients and promoting health. Multiple IOM (Institute of Medicine) reports call for health professionals to be prepared to deliver patient-centered care as members of an interdisciplinary team with an emphasis on evidence-based medicine and quality improvement. These internal and external factors dictated that the faculty of the College of Medicine modify the Years 3 and 4 program to better reflect these principles.
An overarching goal of this reform is to educate students in an environment similar to real-life settings they may encounter in the future. In addition, students should gain key knowledge, skills and attitudes which will be necessary to practice medicine in the 21st century.
Throughout the process of curricular renewal for all four years of the curriculum, increasing emphasis has been placed on the utilization of small group learning activities to promote and develop skills in clinical reasoning and decision-making. The need for increased availability of small conference rooms has increased substantially with the implementation of these curricular changes. While there is currently adequate classroom space, there has been a problem of inadequate mechanisms to schedule the space for the educational program. Policy changes have been recommended and are in progress to centralize the scheduling of all classroom and conference room facilities within the College of Medicine to meet the needs of the educational program.
ED-10. The curriculum must include behavioral and socioeconomic subjects, in addition to basic science and clinical disciplines.
Feedback should be provided by departmental leadership or, if relevant, other
institutional leadership.
Committee Response: In addition to the basic and clinical disciplines, the curriculum throughout the four years includes required behavioral and socioeconomic subjects. The following topics are considered to be important content areas and are covered through lectures, small-group discussion, lab activities, and through clinical experiences: alternative medicine, biostatistics, clinical pathology, communication skills, community health, diagnostic reasoning, end-of-life care, epidemiology, evidence-based medicine, family violence/abuse, medical genetics, geriatrics, health care systems, health care quality review, home health care, human development/life cycle, human sexuality, medical ethics, medical humanities, medical jurisprudence, medical socioeconomics, multicultural medicine, nutrition, occupational health/medicine, pain management, palliative care, patient health education, population-based medicine, preventive medicine, rehabilitation/care of the disabled, research methods, substance abuse and women’s health.
A significant problem with some content areas is that they are often “orphaned” by the fact that they may be germane to many disciplines yet no single discipline takes “ownership” of the content. This may be particularly true in the clinical disciplines. With the restructuring of the Year 3 and 4 programs, the Integrated Longitudinal Curriculum (ILC) was developed to make explicit (and provide a “home” for) a number of such topics. Each clerkship is asked to provide a contribution (where applicable) to the ILC. As such, each topic is provided in the context of a specific discipline and made more relevant. Although originally introduced in the Year 3 and 4 programs, the concept of the ILC has promoted a healthy dialogue across the entire four-year program.
ED-11. It must include the contemporary content of those disciplines that have been traditionally titled anatomy, biochemistry, genetics, physiology, microbiology and immunology, pathology, pharmacology and therapeutics, and preventive medicine.
Committee Response: While the first and second year curricula include named courses in anatomy, physiology, microbiology, pathology and pharmacology, the contemporary context of these disciplines is also included in the other required courses during the first two years, including the Professions of Medicine, ethics and humanities, molecular medicine, imaging for anatomy, medical neuroscience, Introduction to Behavioral Medicine, Physical Diagnosis I, Colloquium I, Longitudinal Clinical Experience I and II, Clinical Diagnosis and Reasoning, Physical Diagnosis II, Evidenced-Based Medicine, Clinical Problem Solving, and Colloquium II.
ED-12. Instruction within the basic sciences should include laboratory or other practical exercises that entail accurate observations of biomedical phenomena and critical analyses of data.
Committee Response: Laboratory and other practical exercises are included as part of the required learning throughout the basic sciences courses. The aim of laboratory exercises in the molecular medicine course is to apply knowledge gained from the course and textbook material to identify distinguishing histological features of basic tissue using a microscope. The class is split into small learning groups in the laboratory to emphasize use of the microscope and review of the material presented to the entire class. Laboratory exercises are interspersed throughout the 10 week course. In anatomy, the students participate in required labs in gross anatomy and histology. They collect the data and use and analyze material for identification of anatomical structures and histological features.
In each major section of the physiology course there is a computer simulation/exercise associated with it. Some of these exercises require the student to alter parameters, examine the outcomes and interpret the mechanism by which the changes induced the results. Other exercises require the student to select tests, and interpret the computer-generated results to determine the identity of the perturbing event.
The medical neuroscience course includes several clinical skills lab sessions during which students assess neurological function in small groups comprised of their classmates. During these sessions students learn about and practice clinical skills related to the neurological examination and have a chance to observe and become familiar with clinical findings suggestive of normal neurological function.
In the pathology and laboratory medicine course, there are approximately 22 hours of laboratory exercises that are designed as case presentations which are explored with students. At a certain point, students must observe glass slides in a systematic manner in order to answer questions they identified during the cases discussions. These observations are then formally correlated with the cases at the end of the exercises.
The pharmacology course uses 24 separate problem-solving sessions which require real or simulated laboratory exercises that oblige students to make observations of biomedical phenomena and collect or analyze data.
Medical Immunology and Infectious Diseases has switched from “wet lab” experiences in 2005 to computerized laboratory exercises. Students solve cases of medical significance and students’ progress is evaluated by multiple choice questions at the end of each case.
ED-13. Clinical instruction must cover all organ systems, and include the important aspects of preventive, acute, chronic, continuing, rehabilitative, and end-of-life care.
Committee Response: Clinical instruction during the third-year clerkships is organ system-based and aspects of preventive, acute, chronic, continuing, rehabilitative, and end-of-life care are covered throughout the clerkship rotations. End-of-life care, for instance, is covered through 36 structured sessions in 10 different courses and also clinically within Physical Diagnosis I and the clerkships in Primary Care and Special Populations, Inpatient Medicine and Pediatrics, and Surgical Care. Preventive medicine is covered in 48 structured sessions in nine different courses and clinically within Physical Diagnosis I and II and the clerkship rotations in Newborn and Maternal Health, Primary Care and Special Populations, and Surgical Care. Rehabilitative care and care of the disabled is covered in 18 structured sessions within 6 courses and clinically within Physical Diagnosis I and the clerkship rotations in Primary Care and Special Populations, Inpatient Medicine and Pediatrics, Neuropsychiatry, and Surgical Care.
ED-14. Clinical experience in primary care must be included as part of the curriculum.
Committee Response: Training in primary care takes place in the curriculum through our Longitudinal Clinical Experience I and II course (during years 1 and 2) and through four of the six third year clerkship rotations (Primary Care and Special Populations; Inpatient Medicine and Pediatrics; Newborn and Maternal Care; and Emergent and Urgent Care).
ED-15. The curriculum should include clinical experiences in family medicine, internal medicine, obstetrics and gynecology, pediatrics, psychiatry, and surgery.
Schools that do not require clinical experience in one or another of these disciplines must ensure that their students possess the knowledge and clinical abilities to enter any field of graduate medical education.
Committee Response: USF COM has a clerkship system that is integrated by design. Content and experiences from the traditional six core clerkship disciplines (family medicine, internal medicine, obstetrics and gynecology, pediatrics, psychiatry, and surgery) are included within the USF COM clerkship system. The table below demonstrates where the relevant knowledge and skills typically learned within a traditional clerkship system are learned within the USF COM clerkship system.
|Content |Primary Care and |Inpatient |Emergent |Newborn and |Neuro- |Surgical Care |
| |Special Populations|Medicine and |And |Maternal Health |psychiatry | |
| | |Pediatrics |Urgent Care | | | |
|Family Medicine |X |X |X |X |X |X |
|Internal |X |X |X | |X | |
|Medicine | | | | | | |
|Obstetrics & |X | |X |X | |X |
|Gynecology | | | | | | |
|Pediatrics |X |X |X |X | | |
|Psychiatry |X |X |X |X |X | |
|Surgery | |X |X | | |X |
ED-16. Students’ clinical experiences must utilize both outpatient and inpatient settings.
Committee Response: Clinical experiences begin for students during their first year as part of the Longitudinal Clinical Experience (LCE). Starting in November of their first year (LCE I) and continuing throughout the second year (LCE II), students spend one-half day per week in a clinical setting with a physician. Students are assigned to three separate physician preceptors for a longitudinal experience over the two years. Generally, each student has the opportunity to work with at least one primary care physician in an ambulatory practice setting and at least one specialist in an ambulatory or hospital setting. A combination of College of Medicine physician faculty as well as private physicians participate as preceptors for LCE I and II.
During the third year, the balance between inpatient and ambulatory teaching is equal. Students spend 50% of their time (24 weeks total) in ambulatory clinical sites and 50% (24 weeks total) in inpatient sites. Ambulatory clinical teaching sites include a combination of College of Medicine faculty practices, private physician practices, and federally qualified health centers (i.e., community/migrant health centers). Inpatient clinical sites include Tampa General Hospital, James A. Haley Veteran’s Administration Medical Center, Bay Pines Veteran’s Administration Medical Center, H. Lee Moffitt Cancer Center, All Children’s Hospital and Shriners Hospital. All of these inpatient facilities are academic teaching facilities of the College of Medicine and students assigned to these sites practice with and are supervised by College of Medicine faculty and residents.
ED-17. Educational opportunities must be available in multidisciplinary content areas, such as emergency medicine and geriatrics, and in the disciplines that support general medical practice, such as diagnostic imaging and clinical pathology.
Committee Response: Emergency medicine content is presented within a dedicated four-week clerkship in Emergent and Urgent Care. While this clerkship was developed to provide experience in dealing with the undifferentiated patient, students receive exposure to multidisciplinary content areas of emergent medicine. Electives are also available in emergent medicine during the fourth year.
Geriatric topics are included across the entire curriculum. In year one, geriatric topics such as aging, dementia, delirium, degenerative neurologic diseases, and ethics concerning advanced directives and death and dying, as well as aging in general are included within Medical Ethics and Humanities, medical neuroscience, and Introduction to Behavioral Medicine. In year two, geriatric issues are discussed broadly. The neurology block provides a concentrated opportunity for discussion of neurodegenerative diseases. The organ system blocks of Cardiology, Pulmonary Medicine, Gastroenterology, and Genitourinary Medicine also cover common geriatric diseases. The presentation of material is across most courses in the year two program.
At the beginning of the year three program, there is a week-long intensive program on geriatrics. The Primary Care and Special Populations Clerkship has a month-long geriatric component. This year, 35% of the patients hospitalized during the inpatient medicine month were geriatric. Topics related to dosing of medication related to lower GFR in the elderly, mobility limitations, delirium and dementia, are addressed as they arise within the context of hospitalized patients on the student’s ward team. Also during year three, the Neuropsychiatry Clerkship includes topics of geriatric depression, dementia, delirium, mental status changes and capacity for medical decision making. Geriatric electives are available during year four.
Diagnostic Imaging/Radiology topics are included across the entire curriculum. In year one, Imaging for anatomy is a course dedicated to imaging applications in medicine and correlates with the anatomy learned in the Human anatomy course and the Neuroscience block. This relationship is emphasized by testing imaging material during the anatomy block exams. The Professions of Medicine touches briefly on these topics in the context of breast cancer (mammograms) and stroke (CT and MRI of the brain).
In Year 2, Evidence-Based Medicine includes discussion of diagnostic tests: sensitivity, specificity, PPV, NPV, pretest and post test probabilities. The examples used include various diagnostic and screening tests including imaging studies. In Principles of Medical Immunology and Infectious Diseases we show images of the CNS and respiratory systems when teaching about related infectious diseases. In the Clinical Diagnosis and Reasoning course, UTI imaging is included to discern how diagnostic studies are used in the evaluative process of patients. In pathology and laboratory medicine there are 48 hours of instruction in Clinical Pathology throughout course including hematology, thyroid function tests, cytology, fluid analysis, etc.)
In our third year clerkships, diagnostic imaging is included within all clerkships.
• In Emergent and Urgent Care students review all images with the attending physician.
• In the Inpatient Medicine and Pediatrics clerkships, four sessions are taught by radiologists in the areas of chest, abdominal, and pediatric imaging.
• In our Newborn and Maternal Health clerkship, there is didactic and clinical experience with obstetric ultrasound.
• The Neuropsychiatry clerkship includes a one hour didactic on neuroradiology to review CNS anatomy, common imaging techniques and examples of neurological pathology
• The Primary Care and Special Populations clerkship has a didactic session on chest and abdominal x-rays; and power point presentations on sinus films.
• In the Surgical Care clerkship, diagnostic imaging is core to teaching conferences, tumor boards, and patient care.
Clinical pathology is also included across the curricular program. In the first year, a system has been instituted whereby abnormalities found in the gross lab are correlated with a pathologist who “consults” regarding the patient and biopsies the abnormality whenever possible. The Profession of Medicine course introduces discussion of the pathology of the topics presented. In anatomy, students work in small groups facilitated by pathologists to discuss apparent pathological findings in the cadavoric specimens.
In year two, Evidence-Based Medicine presents the proper use of diagnostic laboratory tests. The Principles of Medical Immunology and Infectious Diseases course presents diagnostic tests in immunology and medical microbiology. We have a clinical pathologist discuss the set-up and utilization of the clinical laboratory. The proper use of diagnostic tests is part of the Clinical Problem Solving course.
In our third year clerkships, students learn the proper use of laboratory medicine which forms the core of each clerkship. For example, in Inpatient Medicine and Pediatrics, evaluation of anemia, abnormal liver tests, ascitic fluid analysis, ABG analysis are examples of laboratory medicine in the clerkships.
See also information for standard ED-10.
ED-18. The curriculum must include elective courses to supplement required courses.
While electives permit students to gain exposure to and deepen their understanding of medical specialties reflecting their career interests, they should also provide opportunities for students to pursue individual academic interests.
Committee Response: No elective weeks are available to students during years one, two, and three. A total of 24 elective weeks are available to students during year four (this will change to 20 elective weeks starting in June 2006). Typically, students select electives that will allow them to pursue their individual academic interests or deepen their understanding of their selected medical specialty; however, students are limited to a maximum of four electives within a single department. Fourth year students are able to spend 12 weeks taking electives at other institutions. Students in the most recent graduating class (2005) spent an average of 3.2 weeks taking electives at other institutions.
ED-19. There must be specific instruction in communication skills as they relate to physician responsibilities, including communication with patients, families, colleagues, and other health professionals.
Committee Response: Instruction in communication skills occurs across all four years of the curriculum. Several preclinical classes offer didactic experiences in communication. Examples include presentations regarding communicating with the difficult patient in Behavioral Medicine and communicating about ethical issues in Medical Ethics. In the Longitudinal Clinical Experience (Years 1 and 2), students spend three hours per week shadowing a physician who delivers patient care, most often in a private office setting. The specific goal of this experience is to develop the skills necessary to appropriately communicate with patients and their families.
During year one, communicating with patients and families is covered through lecture and discussion, video, role modeling and patient care in the following courses: molecular medicine, Colloquium I, Longitudinal Clinical Experience (LCE) I, and Introduction to Behavioral Medicine. Communication with colleagues is covered via small group and lab exercises, small and large group discussion, and role modeling and patient care in: Molecular Medicine, physiology, and LCE. Communicating with other health professionals takes place via lecture, role modeling and patient care during Molecular Medicine and LCE. Courses in the first year including anatomy and physiology include students from our Physical Therapy school as well as students from our Master of Science in Medical Sciences program, creating an atmosphere for communication as a medical team.
In Year two, communicating with patients/families is covered via case-based and large group instruction, seminars and role-playing, patient care, and standardized patients during the following courses: Clinical Diagnosis and Reasoning, Physical Diagnosis II, Evidence Based Medicine, Principles of Medical Immunology and Infectious Diseases, Pharmacology, and Clinical Problem Solving. For example, during the Clinical Problem Solving course, faculty members role-play patients in different clinical settings, including the doctor’s office and the emergency room. One important focus of this course is to have the students interview these “patients,” elicit a history, perform a physical, and explain significance of laboratory test results and treatment plans. Furthermore, students learn to present the diagnosis to patients and to interact with them and their families about diagnostic concerns. Communication with colleagues and health professionals is covered through lecture, small groups and role play in Evidence-Based Medicine, Principles of Medical Immunology and Infectious Diseases, Pharmacology, and Clinical Problem Solving. Aspects of the Physical Diagnosis course are taught with medical students and nursing students, again fostering communication as a medical team.
Departments in the second year such as Pharmacology and PMIID have patients brought to class by the physician. Students learn from the presenting physician how a team approach is necessary for diagnosis and treatment. In Year 2, several lectures are given in the PMIID and Pathology course that clearly emphasize the relationship of the physician to the clinical laboratory. Similarly, in the Pharmacology course, communication with the pharmacist is stressed.
In the Years 3 and 4, communication with patients and patient families, colleagues and other health professionals is ongoing through each of the six clerkships. Students learn and practice their communication skills via role modeling, patient care, lecture, standardized patients, and consultation liaison services.
ED-20. The curriculum must prepare students for their role in addressing the medical consequences of common societal problems, for example, providing instruction in the diagnosis, prevention, appropriate reporting, and treatment of violence and abuse.
Committee Response: Students are prepared for their role in addressing the medical consequences of common societal problems, including the diagnosis, prevention, appropriate reporting, and treatment (if applicable) of such problems throughout the four years. The charts below indicate where these societal problems are covered:
What Courses/Clerkships Cover the Following Aspects of Various Common Societal Problems
|Societal Problem | |Required course(s) where |Required clerkship(s) where topic is addressed |
| |Content area |topic is addressed | |
|Substance Abuse | | | |
| |Diagnosis |-Pharmacology |-Newborn and Maternal Health |
| | |-Medical Neuroscience |-Primary Care and Special |
| | |-Introduction to Behavioral |Populations |
| | |Medicine |-Surgical Care |
| | |-Pathology |-Emergent and Urgent Care |
| | |-Physical Diagnosis II |-Inpatient Medicine and -Pediatrics |
| | |-Clinical Problem Solving |Neuropsychiatry |
| |Prevention |-Introduction to Behavioral |-Neuropsychiatry |
| | |Medicine |-Surgical Care |
| | | |-Newborn and Maternal Health |
| |Reporting |-Introduction to Behavioral |-Newborn and Maternal Health |
| | |Medicine |-Neuropsychiatry |
| |Treatment |-Introduction to Behavioral |-Primary Care and Special |
| | |Medicine |Populations |
| | |-Pharmacology |-Inpatient Medicine an |
| | | |Pediatrics |
| | | |-Neuropsychiatry |
|Nutrition | | | |
| |Diagnosis |-Molecular Medicine |-Primary Care and Special |
| | |-Introduction to Behavioral |Populations |
| | |Medicine |-Surgical Care |
| | |-Pathology |-Inpatient Medicine and |
| | |-Physical Diagnosis II |Pediatrics |
| | |-Clinical Problem Solving |-Neuropsychiatry |
| |Prevention |-Molecular Medicine |-Inpatient Medicine and |
| | |-Introduction to Behavioral |Pediatrics |
| | |Medicine |-Newborn and Maternal Health |
| | |-Colloquium I | |
| |Reporting |-Principles of Medical Immunology and |-Newborn and Maternal Health, |
| | |Infectious Diseases | |
| |Treatment |-Molecular Medicine |-Surgical Care |
| | |-Clinical Problem Solving |-Inpatient Medicine and |
| | |-Colloquium I |Pediatrics |
| | |-Clinical Diagnosis and |-Primary Care and Special |
| | |Reasoning |Populations |
| | | |-Neuropsychiatry |
|STDs including HIV | | | |
| |Diagnosis |-Ethics and Humanities |-Primary Care and Special |
| | |-Pharmacology |Populations |
| | |-Evidence Based Medicine |-Emergent and Urgent Care |
| | |-Pathology |-Neuropsychiatry |
| | |-Physical Diagnosis II |-Inpatient Medicine and |
| | |-Principles of Medical |Pediatrics |
| | |Immunology and Infectious | |
| | |Diseases | |
| |Prevention |-Ethics and Humanities |-Inpatient Medicine and |
| | |-Principles of Medical Immunology and |Pediatrics |
| | |Infectious Diseases | |
| | |-Longitudinal Clinical Experience I and II | |
| |Reporting |-Ethics and Humanities |-Inpatient Medicine and |
| | |-Principles of Medical |Pediatrics |
| | |Immunology and Infectious | |
| | |Disease | |
| |Treatment |-Ethics and Humanities |-Inpatient Medicine and |
| | |-Principles of Medical |Pediatrics |
| | |Immunology and Infectious |-Emergent and Urgent Care |
| | |Diseases | |
| | |-Pharmacology | |
Courses/Clerkships that Cover the Following Aspects of Domestic Violence and Abuse
| |Required course(s) where |Required clerkship(s) where topic is |
|Content area |topic is addressed |addressed |
|Diagnosis |-Introduction to Behavioral |-Newborn and Maternal |
| |Medicine |Health |
| |-Physical Diagnosis II |-Primary Care and Special |
| |-Clinical Problem Solving |Populations |
| |-Clinical Diagnosis and |-Surgical Care |
| |Reasoning |-Emergent and Urgent Care |
|Prevention |-Introduction to Behavioral |-Neuropsychiatry |
| |Medicine |-Emergent and Urgent Care |
| |-Evidence Based Medicine | |
| |-Clinical Diagnosis and | |
| |Reasoning | |
|Reporting |-Ethics and Humanities |-Newborn and Maternal |
| |-Introduction to Behavioral |Health |
| |Medicine |-Surgical Care |
| |-Clinical Diagnosis and |-Inpatient Medicine and |
| |Reasoning |Pediatrics |
|Treatment |-Clinical Diagnosis and |-Emergent and Urgent Care |
| |Reasoning | |
| |-Introduction to Behavioral | |
| |Medicine | |
Beyond these examples, our Colloquium I and II courses are specifically designed to give students the opportunity to learn about the epidemiologic significance and medical consequences common societal problems. Other examples of topics covered include the following: environmental threat to the environment, living with chronic disability, obesity, and pain management and controlled substances, abuse and the law.
ED-21. The faculty and students must demonstrate an understanding of the manner in which people of diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments.
All instruction should stress the need for students to be concerned with the total medical needs of their patients and the effects that social and cultural circumstances have on their health. To demonstrate compliance with this standard, schools should be able to document objectives relating to the development of skills in cultural competence, indicate where in the curriculum students are exposed to such material, and demonstrate the extent to which the objectives are being achieved.
Committee Response: The goals and objectives for the medical education program and also the core clinical competencies address the issues of cultural competence and the care of diverse populations. Our three week Profession of Medicine course, which serves as an introduction for students to medical school, has four hours dedicated specifically to “cultural competency” and recently incorporated the use of a self-assessment tool on this topic as well. Cultural competence issues are also covered in several other courses/clerkships throughout the four years.
ED-22. Medical students must learn to recognize and appropriately address gender and cultural biases in themselves and others, and in the process of health care delivery.
The objectives for clinical instruction should include student understanding of demographic influences on health care quality and effectiveness, such as racial and ethnic disparities in the diagnosis and treatment of diseases. The objectives should also address the need for self-awareness among students regarding any personal biases in their approach to health care delivery.
Committee Response: Cultural content is covered throughout the four years of the medical school curriculum. While there is still room for enhancement and further integration of cultural content into the curriculum, it is interesting to note that, from the most recent AAMC Medical School Graduation Questionnaire for USF graduates (2005), on the topic of multicultural medicine, 15.3% of USF students reported an “excessive” amount of time was spent (compared to 5.9% of all students nationally).
During the first three weeks of medical school, in the Professions of Medicine course, four hours are dedicated specifically to “cultural competency.” Students explore attitudes about cultural differences and inequities through the use of video clips followed by small and large group discussion. Students are also assigned to research and present on different cultures. Faculty and senior students, identified as “cultural student leaders,” facilitate these sessions. In Medical Ethics and Humanities, students learn about cultural differences as they relate to medical issues by using assigned films. The course also addresses racial and gender disparities. Significant time is given to the racial bias in research with reference to the study conducted by the US Public Health Service on men in Tuskegee, Alabama. In the humanities component, emphasis is given to both racial and gender issues, but the latter is developed more, with a fair number of the readings being authored by women and focused of women’s issues and perspectives. Specific objectives of this course include the importance of civil discourse, improved interpersonal and intercultural understandings, and tolerant attitudes toward others who are like us or not like us, including classmates. During their Longitudinal Clinical Experience, students are required to present a small group case and the presentation is to discuss important psychological, sociologic, or economic factors that have a bearing on the case.
The Clinical Diagnosis and Reasoning course in the second year uses four to five dedicated cases with a variety of these issues as part of the cases presented throughout the year. In Clinical Problem Solving students research and discuss in small groups issues involving Haitian health care issues and attitudes, dealing with a homosexual patient and the rights of homosexual partners to patient information, and Chinese-American attitudes relative to health care and use of traditional remedies including acupuncture. Evidence-Based Medicine stresses the importance of applying evidence to the patient, taking into consideration the patient’s individuality, cultural and/or religious preferences, and unique socioeconomic situation throughout the course. The course also has a formal objective to “Integrate the knowledge of the best available evidence with patient-centered care that includes an understanding of their diverse values, cultures, spiritual beliefs, systems of care, preferences, and needs.” Instruction occurs through formal didactic teaching and the use of case-based scenarios that include patient preferences for a particular approach to care. In pharmacology, the use of BiDil in African-Americans and the differences in metabolism of alcohol metabolism are addressed where appropriate. In addition, during Physical Diagnosis II all students attend the Judeo Christian and/or Brandon Outreach Clinics, free clinics in town that have large minority and immigrant populations. Students interact with these patients and also have the experience of working with trained medical interpreters. In Principles of Medical Immunology and Infectious Diseases the students learn about epidemiologic considerations, global medicine issues and compliance issues.
During the Introduction to the Clerkships course in year three, students complete an on-line cultural competency assessment instrument. This assessment forms the foundation for a two-hour block on cultural competency led by the Associate Dean for Academic Enrichment. In addition to highlighting the importance of understanding the socio-cultural dimensions surrounding the patient/physician relationship and the impact of this relationship on patient satisfaction and adherence to a prescribed course of action, students are divided into small groups for further discussion and proficiency building.
The required clerkships, simply by their clinical setting, provide the students an opportunity to learn about cultural proficiency issues every day. More specifically, within the Inpatient Medicine and Pediatrics clerkship, the students are exposed to patients from all socioeconomic and cultural backgrounds at all three hospital sites. All exposure to cultural competence within this clerkship is delivered by direct “real-time” exposure to patients within the clinical setting. While there is no formal instruction in cultural competency in the Neuropsychiatry clerkship, there is an emphasis on allowing the patient to tell his or her story and to respect diverse backgrounds and lifestyles. Students see patients from a broad range of ethnic backgrounds at the clinical sites. There is an emphasis on partnering with the patient and providing supports for the patient in the specific community. During the Primary Care and Special Populations clerkship, students have a longitudinal experience within a community/migrant health center (AHEC clinic), where they encounter specific issues related to different cultures constantly. They also work at a free clinic similar to AHEC sites while on the women’s health month. During this experience, faculty spend time discussing cultural issues related to these patients at each session. There are also three didactics focused on cultural issues in health care presented by faculty and AHEC physicians; these include a discussion on racial and ethnic health disparities, health literacy, health-care financing and safety-net programs, as well as actual patient cases from a migrant health center. In the Emergent and Urgent Care clerkship, cultural and gender competence and the recognition of biases is included in each student’s four patient presentations. Each presentation includes modifying factors such as age, gender, ethnicity, and barriers to communication, socioeconomic status, underlying disease and other factors that may affect patient management. During the Surgical Care Clerkship, students spend time counseling patients with a variety of cultural and belief systems on the topics of fertility and contraception..
Several electives in the fourth year focus on issues of cultural diversity and physical and emotional disabilities, including elective in Rural Medicine, elective in Rural Family Medicine, Social Problems in Medicine, Rural Women’s Health, Primary Care Community-Based Women’s Health, Pediatric Rural or Migrant Health, Public Sector Medicine and Medical Spanish. The electives emphasize the importance of understanding and appreciating difference in ourselves and others.
ED-23. A medical school must teach medical ethics and human values, and require its students to exhibit scrupulous ethical principles in caring for patients, and in relating to patients’ families and to others involved in patient care.
Each school should assure that students receive instruction in appropriate medical ethics, human values, and communication skills before engaging in patient care activities. As students take on increasingly more active roles in patient care during their progression through the curriculum, adherence to ethical principles should be observed and evaluated, and reinforced through formal instructional efforts.
In student-patient interactions there should be a means for identifying possible breaches of ethics in patient care, either through faculty/resident observation of the encounter, patient reporting, or some other appropriate method.
“Scrupulous ethical principles” imply characteristics like honesty, integrity, maintenance of confidentiality, and respect for patients, patients’ families, other students, and other health professionals. The school’s educational objectives may identify additional dimensions of ethical behavior to be exhibited in patient care settings.
Committee Response: All courses have developed course-specific objectives based on the college-wide objectives for the educational program for the MD. These program-wide and course-specific objectives are tied to the USF CARES competencies and objectives. As such, all objectives explicitly cover the program-wide general competency: “Ethics: utilization of principles of medical ethics governing medical practice” and the associated program-wide objective that states: “Demonstrates knowledge of principles of medical ethics and consistently applies these principles in the care of patients.”
During the first year, in our Professions of Medicine course, there is a section on “Ethics and Professionalism” totaling eight hours over three individual sessions. It is divided roughly in thirds between Ethics, Humanities, and Jurisprudence. In addition, we have an entire course called Ethics and Humanities that is devoted to helping students understand and explore ethical issues and human values. It brings ethics and humanities and medical school teaching face-to-face. All of our explicit educational objectives are related to this overarching task. Specific classes schedule clinicians and non-clinicians into class discussions of assigned materials. In addition, students examine fiction, essays, history, art, poetry, theater, and film to consider more fully the elusive qualities that characterize and define not just the patient, but also the physician and the society they share. These tools focus on the medical setting, aspects of the human journey, and various voices or perspectives; they are intended to complement information and skills learned in basic science courses and texts and to underscore the value of professional attitude as it relates to personal responsibilities and patient care. The materials assigned and presented in class, reveal the complexities, nuances, and ambiguities of patients--and ourselves - the elements of medical encounters.
During the second year, in our Physical Diagnosis II course, all students have clinical experience at Judeo Christian or Brandon Outreach Clinics, free clinics in town that serve the medically needy. This experience demonstrates the proper ethics of treating those who cannot access and afford health care. Communication skills classes focus on “human values.”
Our Evidence-Based Medicine course addresses ethical issues and human values at various levels. First, it discusses study designs for various types of studies, noting that some designs, despite being more rigorous than others, might not be practical or ethical particularly when studying harm and prognosis. Second, the course covers institutional review board, protection of human subjects, and human values as well as research principles of honesty, and integrity. Third, the block on “Prognosis” might be driven by a patient question on disease prognosis. If so, ethical issues related to management of disease, withholding therapy, and decision-making are discussed as part of the clinical examples given.
In Principles of Medical Immunology and Infectious Diseases there is a small group conference (problem-solving session) dealing with a physician’s error in diagnosis. The students discuss the openness of this physician and discuss what they would do in this situation. In addition, the concept of human values is practiced and addressed with real patients who are brought to class as well as with student-actors role playing as patients.
All end of term evaluations in the clinical years incorporate the USF CARES competencies and objectives. As such, all students are evaluated on a scale of 1 = Unsatisfactory to 5 = Exceptional on the general competency of “Ethics: utilization of principles of medical ethics governing medical practice.” The associated program-wide objective is as follows: “Demonstrates knowledge of principles of medical ethics and consistently applies these principles in the care of patients.
ED-24. Residents who supervise or teach medical students, as well as graduate students and postdoctoral fellows in the biomedical sciences who serve as teachers or teaching assistants, must be familiar with the educational objectives of the course or clerkship and be prepared for their roles in teaching and evaluation.
The minimum expectations for achieving compliance with this standard are that: (a) residents and other instructors who do not hold faculty ranks (such as graduate students and postdoctoral fellows) receive a written copy of the course/clerkship objectives and clear guidance from the course/clerkship director about their roles in teaching and evaluating medical students; and (b) the institution and/or relevant departments provide resources such as written materials and/or workshops to enhance the teaching and evaluation skills of all residents and other non-faculty instructors.
There should be central monitoring of the level of resident/other instructor participation in activities to enhance their teaching/evaluation skills. The LCME encourages formal assessment of the teaching and evaluation skills of residents and other non-faculty instructors, with opportunities provided for remediation if their performance is inadequate. Assessment methods could include direct observation by faculty, feedback from students through course/clerkship evaluations or focus groups, or any other suitable method.
Committee Response: Residents are acknowledged as an integral part of the teaching team for our students on clinical rotations. To assure that the residents are prepared for this role , the following is in place:
• During the formal orientation of all PGY-1 residents and residents beginning training at USF after PGY-1, the Office of GME presents a program on how to teach and evaluate medical students. This has been in place for the last three orientation cycles dating back to 2003 so that 90%+ of all residents have experienced the program.
• The same office presents a half-day program to all residents entering their final year of training on the same topic. This program is interactive whereas the program at the general orientation is more didactic.
• Clinical departments are expected to give all residents a copy of the student learning objectives.
• Selected departments sponsor additional programs annually for the purpose of enhancing the resident’s teaching and evaluation skills.
• Clerkship directors regularly distribute educational materials pertaining to the clerkship to residents as well as faculty.
• Formal student evaluation of students includes residents in selected departments, but that is left to the discretion of the department and/or clerkship director.
• In the neuropsychiatry clerkship, students evaluate their resident teachers and residents meet with the clerkship director to review this evaluation.
Students as educators:
In selected situations, including teaching physical diagnosis skills and evaluation of OSCE performance, fourth-year medical students are utilized as teacher. In all of these circumstances, the students are fully briefed in the objectives and methodology of the exercise at hand.
ED-25. Supervision of student learning experiences must be provided throughout required clerkships by members of the medical school’s faculty.
Committee Response: Faculty supervision of student learning experiences is assured at several levels. At the highest level, a faculty committee is responsible for the development and implementation of each clerkship in collaboration with the clerkship director. The curriculum committee regularly reviews each clerkship to assure it is meeting the objectives of the educational program. Only core faculty serve as clerkship directors. In turn, clerkship directors communicate with all faculty through the electronic logbook system. This electronic logbook system contains the data regarding individual student learning experiences (including numbers and type of patients seen), that populates a report sent to clerkship directors each week.
All faculty involved in the clerkship educational process are expected to personally oversee all aspects of the student’s clerkship experience and meet with the student regularly for both educational and feedback purposes. This clerkship includes some direct observation of the student’s patient encounters, review of clinical notes, and discussing of significant clinical teaching points from the patient at hand. As in ED-24 above, residents participate in this process, but the ultimate responsibility for the student rests with the faculty.
Required clerkships are almost exclusively staffed by core faculty; however, many of the clerkships supplement the faculty with voluntary faculty for specific purposes. This staffing most commonly generates a clinical experience for students that is unique and enhances their experience in our own USF clinical venues. For example, a student might be assigned to a voluntary faculty for the purpose of a rural experience.
All faculty who participate in a required clerkship program are required to apply for and be granted voluntary clinical faculty appointments. At the assistant professor rank, such applications are reviewed by the clinical department chair. At higher ranks, a voluntary faculty appointment and promotion committee reviews the applicant’s credentials.
Such voluntary faculty are provided the educational objectives of the clerkship and are provided appropriate and necessary educational materials to support their involvement in the clerkship. Such voluntary faculty evaluate the students at the end of each rotation and are in turn, evaluated by the student.
ED-26. The medical school faculty must establish a system for the evaluation of student achievement throughout medical school that employs a variety of measures of knowledge, skills, behaviors, and attitudes.
Evaluation of student performance should measure not only retention of factual knowledge, but also development of the skills, behaviors, and attitudes needed in subsequent medical training and practice, and the ability to use data appropriately for solving problems commonly encountered in medical practice.
Schools are urged to develop a system of evaluation that fosters self-initiated learning by students. The system of evaluation, including the format and frequency of examinations, should support the goals, objectives, processes, and expected outcomes of the curriculum.
Committee Response: Students are evaluated through multiple modalities to assure achievement in all domains including knowledge, skills and attitudes. The knowledge domain is measured by formal testing and faculty observation. Skills and attitudes are evaluated through the program, and are focused on particularly in clinical settings.
USF COM has developed institutional and course-specific objectives and outcome measures for the overall educational program as well as for every course and clerkship. These are regularly reviewed to assure alignment with USF COM Educational Program Objectives. To assist in this effort, the Office of Educational Affairs hired a PhD educator to work with each course and clerkship director to develop appropriate measures. At the curriculum committee level, all course-specific objectives and outcome measures are reviewed annually to ensure the appropriate portfolio of measures. In addition, at the annual curriculum committee retreat, summative reports of knowledge, skills and attitudes are reviewed. Recommendations for changes are forwarded to the vice dean and course/clerkship directors as appropriate.
See Appendix for common USF CARES clerkship evaluation form.
ED-27. There must be ongoing assessment that assures students have acquired and can demonstrate on direct observation the core clinical skills, behaviors, and attitudes that have been specified in the school’s educational objectives.
Committee Response:
• End of year 2 - OSCE
• End of year 3 - CPX
• Year 4 - videotaped history and physical
See Appendix 3 - Core Skills
ED-28. There must be evaluation of problem solving, clinical reasoning, and communication skills.
Provide a representative sample of the materials (written or oral exam questions, research paper assignments, problem-based learning cases, etc.) specifically designed to assess student skills in problem solving, clinical reasoning, and communication. Indicate the courses or clerkships that employ such materials.
Committee Response: Representative samples have been provided in the database for this question. Examples are mainly from Years 1 and 2 but clinical reasoning scenarios are used in Years 3 and 4 as well.
Many of the courses and all of the clerkships assess student skills in problem solving, clinical reasoning, and communication. Below is a representative sampling of such assessments from various courses and clerkships:
In year one, in Profession of Medicine, students are given specific graded, group assignments to help them develop communications skills. More specifically, students are assessed on their ability to discuss the sensitivity and specificity of various approaches to testing, including medical history and physical examination, electrocardiographic techniques, and enzymatic diagnostic technique as they related to an acute myocardial infarction. In addition, the student must demonstrate the following: understand and describe in detail the development of EMS and chest pain centers and their crucial role in the management of acute MI; describe thrombolysis as an intervention management technique for acute MI; describe percutaneous coronary intervention (PCI) as an intervention management technique for acute MI; describe the psychological, sociological, and economic implications of acute MI for patients and their families; describe the role of primary and secondary prevention in the management of acute MI; and describe impairment(s) and or functional limitation(s) that may result following a myocardial infarction and how these are evaluated and ameliorated.
In our Introduction to Behavioral Medicine course, there are a variety of ways that students’ skills in problem solving, clinical reasoning and communication are assessed. These courses include a series of seminars in which the students discuss topics and review questions with a moderator. These questions are assigned to the students to research prior to the seminar. There are also a series of small-group case discussions in which students are required to assess the needs of the patient and how to ascertain the patient’s diagnosis. This assessment is done with the guidance of the course directors of the block three courses. Students are also required to interview a patient and discuss their experiences in the health care system. Students are instructed to discuss their responses to their patient’s experiences. Finally, the students’ performances are evaluated in a series of examinations given throughout the course. Specific examples are provided in the database.
In our Molecular Medicine course, there are many ways that students’ skills in problem solving, clinical reasoning and communication are assessed. For example, student must give a group presentation that is not only graded, but also contributes to the exam materials. In addition, several clinical correlations are held where the class is provided with the case in advance to promote questions and discussion with both patients and physicians.
In our Medical Neuroscience course, problem solving and clinical reasoning are assessed on a number of exams. A sample of these questions are below:
A 36 y/o man was seen in the emergency room following the sudden onset earlier that day of numbness involving his right arm and hand. He denied any sensory changes involving his face or lower limbs. On clinical examination you note intact perception of light touch and pinprick in the right upper limb, but he is unable to distinguish among different coins when asked to retrieve a particular one from a small container. He is able to perform this task easily and without error when he uses his left hand. These clinical findings are suggestive of an abnormality involving the
A. medial parietal lobe on the left side
B. lateral parietal lobe in the left side
C. medial parietal lobe on the right side
D. lateral parietal lobe on the right side
In year two, our Clinical Diagnosis and Reasoning course uses a variety of exam items to assess problem solving, and clinical reasoning. Examples of exam questions are below:
A 32-year-old woman presented to the emergency department complaining of bruising over her body and bleeding gums for the past two days. She denies any previous history of bruisability, bleeding into the joints, epistaxis, or gum bleeding. Denies any previous problems with her menses. Denies any family history of bleeding disorders. Physical exam revealed small hemorrhagic bullae on the buccal mucosa , oozing of the gingivae, and multiple ecchymoses on both lower extremities. PT, PTT, hematocrit, and hemoglobin are all within normal limits. Platelets were 9000/ul (range 150,000-450,000/ul). A bone marrow aspiration and biopsy revealed normal cellularity and an increased number of megakaryocytes. The patient was diagnosed with autoimmune thrombocytopenia.
Which of the following factors can be excluded as an etiology?
a) Hemophilia *
b) Human immunodeficiency virus
c) Pregnancy
d) Penicillin
e) Systemic Lupus Erythematosus
In our Principles of Medical Immunology and Infectious Diseases course, students must write an abstract and give an oral presentation on a topic such as epidemiological issues of infectious disease, vaccine development, laboratory testing development, recent findings in immunology as related to medical issues etc., using primary sources.
In addition, in this course, students are also evaluated on case-based learning in small group conferences.
In Physical Diagnosis II , students’ skills in problem solving, clinical reasoning and communication are assessed by the methods listed below:
• Faculty critique complete videotaped H(istory) and P(hysical)
• Student provide a “writeup” of the complete videotaped H and P
• Student turn in teo “writeups” from the “Free Clinic” attendance
• Students have one-on-one videotaped communication assessment by a faculty member ---Topic “Difficult Patient”
• Students are presented unknown cases to test their clinical reasoning skills in the first hour of the Skills Session for each organ system.
In the third year, our Emergent and Urgent Care clerkship utilizes “student portfolios”. These portfolios assess skills in problem solving, clinical reasoning and communication.
Our Inpatient Medicine and Pediatrics clerkship assess problem solving and clinical reasoning by having students “Evaluate a Study of Diagnostics Tests.”
Evaluating a Study of Diagnostic Tests
(Adapted from University of Alberta EBM Toolkit)
Are the results valid?
1. Was the test compared to an appropriate reference standard?
a. Was the comparison blind and did every subject have both the study test and the reference standard?
2. Was the patient sample appropriate?
3. Were the tests described in sufficient detail, including interpretation of results?
What were the results?
1. What was the magnitude of the effect?
a. Can the results be applied to my patients?
2. Will the test be reproducible and well interpreted in my practice setting?
3. Are my patients similar to the study’s patient sample?
4. Will the test results change my management?
5. Will my patients be better off because of the test?
a. Is the condition harmful and treatment beneficial?
6. Is the test risk acceptable?
In addition, during the same clerkship, problem solving and clinical reasoning as assessed via various cases studies. See database for specific examples.
ED-29. The faculty of each discipline should set the standards of achievement in that discipline.
Refer to the responses for standard MS-33 in Section III of the database relating to evaluation of student performance. If there are no institutional policies regarding evaluation of student performance, describe how standards of achievement are determined for required courses and clerkships.
Committee Response: The faculty and director of each course/clerkship define the criteria for acceptable academic performance in that course.
Institutional standards are found in the Student Handbook:
Specifically, the policy states:
3. Grade Determination
The generally accepted standards for grade levels are:
H = 90% or above
PC = 80%-89%
P = 70%-79%
F = 69% or lower
I = all course requirements have not been successfully completed
Any alteration to this policy will be listed in a course syllabus available to students no later
than the 1st day of class.
4. Clerkship Grading, Evaluation and Scheduling
a. Grading Standards – Year III
For all clerkships minimum standards for NBME Shelf examination performance
have been set as follows:
Passing = 17th percentile or greater
PC = 45th percentile or greater
H = 70th percentile or greater
Regardless of course average as delineated for each course below, the Clerkship Directors have agreed upon these minimum standards. Students may receive a grade that is above these minimum standards in extraordinary cases where there has been superior clinical performance and a justification is written explaining the policy exception.
For determination of class rank purposes only, grades will be assigned using a plus (+)/minus (-) system. Only a full letter grade will be reported on transcripts.
In addition, all course syllabuses also provide such information. List below is an example from our Molecular Medicine course:
V. COURSE GRADE:
Exams I, II, III will each count 20%, and the Comprehensive Exam will count 20% of the final grade.
An overall average of 70% on Exams must be achieved without adjustment from the Group Exams in order to Pass the course. The average of the Laboratory Practical Exams will count 10%, and Small Group Presentations will count 10% of the final grade. An overall average of 70% or above is required for a passing course grade.
ED-30. The directors of all courses and clerkships must design and implement a system of formative and summative evaluation of student achievement in each course and clerkship.
Those directly responsible for the evaluation of student performance should understand the uses and limitations of various test formats, the purposes and benefits of criterion-referenced vs. norm-referenced grading, reliability and validity issues, formative vs. summative assessment, etc.
In addition, the chief academic officer, curriculum leaders, and faculty should understand, or have access to individuals who are knowledgeable about, methods for measuring student performance. The school should provide opportunities for faculty members to develop their skills in such methods.
An important element of the system of evaluation should be to ensure the timeliness with which students are informed about their final performance in the course/clerkship. In general, final grades should be available within four to six weeks of the end of the course/clerkship.
Committee Response: The Office of Educational Affairs at the COM is staffed by individuals who have expertise in student assessment. The vice dean for educational affairs has extensive experience in the development of student assessment tools both for written examinations and in standardized patient programs. He also has extensive experience in the development of other evaluation tools. The associate dean for undergraduate medical education has skills and experience in assessment methodologies. Further, the office employs two educators who have doctoral degrees and a staff who administer the clinical skills center. There is also a designated individual who runs computerized administration of examinations and their evaluation.
All faculty at USF have access to campus education resources. The Center for 21st Century Teaching Excellence at the University of South Florida was established to promote personal reflection and scholarly dialogue on the art, science and craft of university teaching. The Center sponsors publications, workshops, and research which critically examine and promote instructional excellence, including various assessment methodologies. All faculty are kept abreast of these workshops by e-mail from the Office of Educational Affairs.
Dr. David Swanson directed an item writing workshop each of the last three academic years. In addition, the Education and Design and Technology team works individually with course/clerkship directors on course development. A PhD educator is available for outcome measures and objectives. The College is invited to participate in the multitude of educational workshop presented on main campus. The Office of Educational Affairs is developing a web-based resource for faculty development. In addition, this office sponsors attendance at AAMC workshops concerning student evaluations (about five faculty members including the curriculum committee chair).
Course directors are encouraged to participate in their discipline related course training and course directors work with their departmental faculty to review examination questions. For each block examination in years one and two, the course directors, and faculty who participated during that block meet to review and edit the exam, item by item. The Associate Dean for UME attends these exam review sessions as well and critiques the writing of test items.
For courses, performances on block examinations are released within 48 hours after the day of the examination. Final course grades are submitted to the registrar within three weeks of the end of the course. For clerkships, administrative policy states that all grades must be in within 4 weeks of the ending of clerkships. Submission of all grades and distribution of grades to students are closely monitored and enforced by the registrar’s office, the associate dean for student affairs and the associate dean for undergraduate medical education.
ED-31. Each student should be evaluated early enough during a unit of study to allow time for remediation.
It is expected that courses and clerkships provide students with formal feedback during the experience so that they may understand and remediate their deficiencies. Courses or clerkships that are short in duration (less than 4 weeks) may not have sufficient time to provide structured formative evaluation, but should provide alternate means (such as self-testing or teacher consultation) that will allow students to measure their progress in learning.
Committee Response: Students are examined and receive the results so that they may review, and if necessary adapt their performance during a course. Every clerkship has a mid-term assessment using a centralized form. All other courses in the program that are over four weeks provide multiple assessments with feedback for each. (The only course that is less than four weeks in duration, "The Professions of Medicine," includes a quiz that provides feedback to students on performance). Course and clerkship specifics concerning evaluations are included in all syllabi. Students certainly receive this feedback in sufficient time so that remediation may occur. Students who perform beneath the standard are offered remediation.
ED-32. Narrative descriptions of student performance and of non-cognitive achievement should be included as part of evaluations in all required courses and clerkships where teacher-student interaction permits this form of assessment.
Committee Response: A summative evaluation of academic performance and behavior and non-academic character including interaction with peers and professionalism is provided in a narrative that is written by the course director and faculty at the end of a particular course/clerkship. This evaluation is conducted on a common form that may be found in the Teaching and Evaluation database.
ED-33. There must be integrated institutional responsibility for the overall design, management, and evaluation of a coherent and coordinated curriculum.
The phrase “integrated institutional responsibility” implies that an institutional body (commonly a curriculum committee) will oversee the educational program as a whole. An effective central curriculum authority will exhibit:
- Faculty, student, and administrative participation.
- Expertise in curricular design, pedagogy, and evaluation methods.
- Empowerment, through bylaws or decanal mandate, to work in the best interests of the institution without regard for parochial or political influences, or departmental pressures.
The phrase “coherent and coordinated curriculum” implies that the program as a whole will be designed to achieve the school’s overall educational objectives. Evidence of coherence and coordination includes:
- Logical sequencing of the various segments of the curriculum.
- Content that is coordinated and integrated within and across the academic periods of study (horizontal and vertical integration).
- Methods of pedagogy and student evaluation that are appropriate for the achievement of the school’s educational objectives.
Curriculum management signifies leading, directing, coordinating, controlling, planning, evaluating, and reporting. Evidence of effective curriculum management includes:
- Evaluation of program effectiveness by outcomes analysis, using national norms of accomplishment as a frame of reference.
- Monitoring of content and workload in each discipline, including the identification of omissions and unwanted redundancies.
- Review of the stated objectives of individual courses and clerkships, as well as methods of pedagogy and student evaluation, to assure congruence with institutional educational objectives.
Minutes of the curriculum committee meetings and reports to the faculty governance and deans should document that such activities take place and should show the committee’s findings and recommendations
Committee Response: An excellent relationship exists between the academic administration, the Committee on Curriculum, and the student leadership. All parties have worked together as a team toward the common objective of providing the best possible educational experience. The members of the Committee on Curriculum take a global view of the educational process rather than a departmental one and thus ensure balanced and carefully thought out decision making. When problems are encountered, they are resolved in an objective, collegial manner.
The overall curriculum is reviewed during the annual or semi-annual curriculum retreats. These retreats provide a detailed review of the college curriculum evaluations, normative test scores, student responses to the AAMC Graduation Questionnaire, all college performance-based examinations and any other information relevant to curricular assessment. Areas of concern are noted and discussed and corrective plans are formulated. Particular attention is given to content, coordination, and outcome measures.
The Committee on Curriculum conducts a formal, highly detailed review of each component every two years or more frequently when problems arise. This process includes the review of all outcome measures, course materials such as the course syllabus, assessments of overall faculty effectiveness, course directors’ responses to previous reviews and recommendations, etc. The reviewer interviews the course director privately as part of the review process and the course director meets with the entire Committee on Curriculum when the course review is presented and discussed. The student members of the Committee on Curriculum provide valuable input, insight and perspective during these reviews.
Members try to match methods of pedagogy to the college’s goals and to the LCME expectations. The continued focus on the extensive use of the lecture format, particularly during the first year, is inconsistent with the goal of developing independent learners. Modifications are underway to reduce the use of the lecture format and replace it with methods more attuned to the needs of adult learners.
The course reviews described above provide one method of monitoring curriculum content and effectiveness. The USMLE sub-score analyses also provide information on the adequacy of the course content as does the performance based assessments of clinical skills including OSCE and CPX. The Year Two Course Directors work together to provide a detailed yearly curriculum plan and hourly schematic. This planning process has served well to assure coordination, integration, completeness and relevance. It has been especially helpful to have the significant involvement of a number of both basic science and clinical faculty in the process. Efforts are underway to increase the level of integration in Year One to mirror that of Year Two. The faculty and clerkship directors in Year Three have an excellent perspective of the content of each of the specialty areas covered as a result of the integrated, multi-disciplinary planning that occurred during the PACE process. During the restructuring of the third and fourth years, careful attention was paid to the content, relevance and integration of the course material.
An Annual Report is sent to the Faculty Council which outlines what the committee has accomplished over the past year, including which courses have been reviewed.
ED-34. The program’s faculty must be responsible for the detailed design and implementation of the components of the curriculum.
Such responsibilities include, at a minimum, the development of specific course or clerkship objectives, selection of pedagogical and evaluation methods appropriate for the achievement of those objectives, ongoing review and updating of content, and assessment of course and teacher quality.
Committee Response: Faculty members, under the leadership of the course director, are responsible for the course content, method of delivery, and student assessment. Each course must have clear and detailed course objectives developed by the course faculty. These objectives are to be in congruence with the overall objectives delineated in USF CARES. The course director formally surveys the involved faculty regarding all significant aspects of the course at its conclusion. Students evaluate each course and its faculty. The student evaluations and the faculty review of the course provide valued input for the course modifications by the faculty and for oversight by the Committee on Curriculum.
ED-35. The objectives, content, and pedagogy of each segment of the curriculum, as well as for the curriculum as a whole, must be subject to periodic review and revision by the faculty.
The curriculum committee, working in conjunction with the chief academic officer, should assure that each academic period of the curriculum maintains common standards for content. Such standards should address the depth and breadth of knowledge required for a general professional education, currency and relevance of content, and the extent of redundancy needed to reinforce learning of complex topics. The final year should complement and supplement the curriculum so that each student will acquire appropriate competence in general medical care regardless of subsequent career specialty.
Committee Response: In addition to the review processes delineated about in the discussions on the retreat process and the formal course reviews by the Committee on Curriculum, individual components of the curriculum are evaluated several ways. At the conclusion of each component, the involved faculty and students complete online course evaluations administered by the Office of Educational Affairs staff. Each course director also completes a Course Director’s Evaluation which provides a detailed update of the course including successes, problems, concerns and future needs.
ED-36. The chief academic officer must have sufficient resources and authority to fulfill the responsibility for the management and evaluation of the curriculum.
The dean often serves as the chief academic officer, with ultimate individual responsibility for the design and management of the educational program as a whole. He or she may, however, delegate operational responsibility for curriculum oversight to a vice dean or associate dean.
The kinds of resources needed by the chief academic officer to assure effective delivery of the educational program include:
- Adequate numbers of teachers who have the time and training necessary to achieve the program’s objectives.
Committee Response: In the past, it has been time-consuming and sometimes challenging to recruit faculty to adequately staff the interdisciplinary courses. Since no one department has direct responsibility for a given course, there is often a reluctance to commit faculty resources to these courses. Even when an individual faculty member is willing to participate, the departmental chair has not always been willing to balance other commitments in order to make participation possible or to appropriately reward faculty for participating in such educational activities. Under the soon-to-be implemented AIMS program, all faculty will be required to devote a certain percentage of effort to stipulated types of educational activities as part of the overall faculty compensation plan. By making educational activities a required component for compensation, participation by sufficient faculty will be assured.
- Appropriate teaching space for the methods of pedagogy employed in the educational program.
Committee Response: While in the aggregate sufficient rooms for small group sessions exist, the control and scheduling of these rooms has not been centralized thus necessitating multiple contacts in order to locate and schedule the necessary conference rooms. An associated problem has been that a given room when available may not have been appropriately equipped. These problems are being resolved by centralizing the scheduling of educational facilities under the vice dean for educational affairs and by uniformly equipping similar rooms to meet the educational needs.
- Appropriate educational infrastructure (computers, audiovisual aids, laboratories, etc.).
- Educational support services, such as examination grading, classroom scheduling, and faculty training in methods of teaching and evaluation.
- Support and services for the efforts of the curriculum management body and for any interdisciplinary teaching efforts that are not supported at a departmental level.
The chief academic officer must have explicit authority to ensure the implementation and management of the educational program, and to facilitate change when modifications to the curriculum are determined to be necessary.
Committee Response: The issue of authority, as it relates to the implementation of the findings of the curriculum committee, has been stated above.
ED-37. The faculty committee responsible for the curriculum must monitor the content provided in each discipline so that the school’s educational objectives will be achieved.
Committee Response: See the discussion above under ED-33
ED-38. The committee responsible for the curriculum, along with medical school administration and educational program leadership must develop and implement policies regarding the amount of time student spend in required activities, including the total required hours spent in clinical and educational activities during clinical clerkships.
Attention should be paid to the time commitment required of medical students specially during the clinical years. Students’ hours should be set taking into account the effects of fatigue and sleep deprivation on learning and patient care. In general, medical students should not be required to work longer hours than residents.
Committee Response: As noted above, the time commitment issue has been addressed for Year 3 through the PACE program. Years 1 and 2 are limited to 28 hours a week. While the contact hours in Year 2 approaches the national average, year 1 hours currently exceed the average and these contact hours are under review in order to align them with the national average.
NOTE: Questions for standards ED-39 through ED-45 should be completed only by schools that operate geographically separate campuses, as defined in the instructions for completing the database.
ED-46. To guide program improvement, medical schools must evaluate the effectiveness of the educational program by documenting the extent to which its objectives have been met.
ED-47. In assessing program quality, schools must consider student evaluations of their courses and teachers, and an appropriate variety of outcome measures.
Among the kinds of outcome measures that serve this purpose are data on student performance, academic progress and program completion rates, acceptance into residency programs, postgraduate performance, and practice characteristics of graduates.
Committee Response: In guiding program improvement and assessing program quality, the COM does utilize a number of indicators of effectiveness including:
|Results of USMLE and NBME subject examinations |
|Student scores on internally developed examinations |
|Performance-based assessment of clinical skills including OSCE and CPX exams |
|Student responses on AAMC Medical School Graduation Questionnaire |
|Student evaluation of courses and clerkships |
|Student advancement and graduation rates |
|NRMP results |
|Specialty choice of graduates |
|Program director surveys of PGY 1 performance |
These data are reviewed by a number of groups and individuals including but not limited to the Committee on Curriculum, the Offices of Educational and Student Affairs, Course and Clerkship Directors, Department Chairs and departmental education committees.
This review process has resulted in curricular reform (albeit slow at times) at both the program wide as well as course/clerkship level.
ED-48. Medical schools must evaluate the performance of their students and graduates in the framework of national norms of accomplishment.
Committee Response: Students must take and pass Step 1 and Step 2 CK/CS USLME exams in order to graduate. In addition, many of the courses and clerkships utilize NBME subject examinations (with minimum) passing scores as a component of the course/clerkship evaluation schema.
8 Recommendations, Possible Solutions and Strategies
The planned implementation of USF CARES will continue. These competencies and core objectives will be reinforced at every appropriate opportunity. The students, faculty and course evaluation instruments based on USF CARES will continue to be tested and refined. The detailed course objectives also will continue to be reviewed and refined. To further emphasize USF CARES, the ongoing campaign will continue to reinforce the awareness of the College of Medicine community of USF CARES.
The self-study committee has found that year one of the curriculum has more contact hours and less self-directed learning than is considered optimal. As a result, an effort is underway to reduce the contact hours and to increase the self-directed learning during the new academic year. However, given the constraints imposed by the timing, the desired corrections cannot be completed in the academic year beginning in August 2006 and will require additional changes in the 2007 academic Year one curriculum.
The AAMC Medical School Graduation Questionnaire revealed that two “orphan topics,” medical socio-economical issues and nutrition, would benefit from more attention in the curriculum. It is anticipated that in the revised curriculum, these deficits will be corrected. For instance, the faculty leading the new scholarly concentration in the business of medicine have been given the following charge: “Evaluate the current content in the curriculum for all medical students in the area of the business of medicine and propose modifications where appropriate.” The program will be monitored over the coming year to determine that the corrections have occurred.
Scheduling conference rooms for small-group sessions has been difficult because of limited centralized scheduling capability rather than a room shortage. The dean has approved additional resources to staff the centralized scheduling and to purchase the appropriate software to facilitate the process. In addition, funding has been allocated to uniformly equip similar rooms in order to expand the use of the existing rooms.
The issue of effectiveness of residents and fellows in teaching medical students during two of the clerkships is anticipated to be resolved as a result of the revised curriculum. The situation will be carefully monitored to assure that the changes are effective.
9 Issues of Concern Relevant to Other Committees
• Scheduling of Classroom and small-group-conference room facilities, committee 9
• Student lounge and study room space, committee 9
• Effectiveness of teaching of medical students by residents and fellows in two of six required Year three clerkships (2005 Graduation Questionnaire), committee 3
11 Attachments
Attachment 1 - Year 1 & 2 student evaluation form
Attachment 2 - USF CARES
Attachment 3 - Core Clinical Skills/Behaviors
12 Narrative of Process
The committee (and its subcommittees on Educational Objectives, Structure of the Educational Program, Teaching and Evaluation, Curriculum Management, and Evaluation of Program Effectiveness) met often during a seven-month period. While subcommittees were utilized, the full committee discussed and developed the final responses for each section of the report, submitted queries to administrative liaisons, and reviewed and edited each section of the preliminary and final reports during meetings and by e-mail. Highlights of the full committee’s work will be shared at a scheduled faculty meeting and later posted to the USFCOM LCME website.
13 Database Accuracy
Database sections included the required LCME database elements. The committee reviewed the sections appropriate to our deliberations. The accuracy of the database was confirmed through committee discussions.
14 Committee Membership
Greg Nicolosi, PhD, Self-Study Committee Co-Chair
Associate Professor, Molecular Pharmacology & Physiology
Chair, Committee on Curriculum
Marion B. Ridley, MD, Self-Study Committee Co-Chair
Professor, Otolaryngology
Faculty Council, Past President
Lori Bowers, MD
Assistant Professor, Pediatrics
Sophie Dessureault, MD, PhD
Assistant Professor, Interdisciplinary Oncology/GI Tumor Program
Surgical Oncologist
Paul Gottschall, PhD
Professor, Pharmacology
Richard P. Hoffmann, MD
Associate Professor, Internal Medicine
Associate Dean, Clinical Outreach
David L. Keefe, MD
Professor, Obstetrics/Gynecology
James M. Ingram Chair, Obstetrics/Gynecology
Christopher Phelps, PhD
Professor, Pathology & Cell Biology
Susan Pross, PhD
Associate Professor, Molecular Medicine
W.S. Quillen, PT, PhD, SCS, FACSM
Professor & Director, School of Physical Therapy
Associate Dean
Deborah Roth, DO
Associate Professor, Psychiatry & Behavioral Medicine
Cynthia Selleck, ARNP, DSN
Director, Area Health Education Center
Kira Swygart, MD
Assistant Professor, Family Medicine
Jonathan Keshishian
Medical Student 1
Alexis Harrison
Medical Student 2
Jenny Beckman
Medical Student 3
Guraman Bhullar
Medical Student 3
David Wilson
Medical Student 4
Bryan Bognar, MD, Administrative Liaison
Professor, Internal Medicine
Associate Dean, Undergraduate Medical Education
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