The College of Medicine is in the process of developing a new curriculum for the medical school. We invite you to familiarize yourself with the rationale behind our decision to revise the medical school curriculum. This memo provides the rationale behind our decision to revise the medical school curriculum , presents an overview of our goals for curriculum change and encourages you to add your thoughts to the process.
The Ohio State University College of Medicine has a long history of preparing students to take on the rigors of a wide variety of post graduate training opportunities in institiutions within Ohio and across the nation. We believe that to meet the needs of our students, faculty and community, we must strive to continuously improve our curriculum. We will need to focus on the environment of learning, the content we emphasize and the methods we use to teach and assess our learners. While we have much to be proud of, we believe that dramatic societal forces and internal performance metrics suggest that we must be willing to innovate to insure that we are training the types of physicians who will positively impact health care in the future.
What are our current strengths?
- We have a dedicated group of faculty who have developed strategies to meet the different learning styles of our medical students.
- We have developed a successful strategy for training physician scientists.
- We have an award winning curriculum in doctor patient relationship skills.
- We were one of the first institutions to disseminate hand held devices to students and residents and one of the first to upgrade those devices as technology has developed.
- We have a strong simulation center that allows students to practice skills ranging from effective communication and physical diagnosis to laparascopy and critical care resuscitation techniques.
- We have over 600 residents and fellows in graduate education who also contribute time and effort to the education of our students.
Why change? Society demands it.
Medical education in the United States is undergoing a period of unprecedented change; some might characterize the changes as revolutionary. It has been fully 100 years since Abraham Flexner proposed the current 2+2 system of medical education. Since that time:
- The nature of disease has shifted from predominantly acute infectious diseases and nutritional deficiencies to chronic multisystem disease. This shift requires a different set of physician competencies, including teamwork, interdisciplinary care, coordination of care, and participatory decision making.
- Our understanding of disease mechanisms, therapeutics and predictors has grown exponentially in the last quarter century and promises to continue to expand. This mandates the development of a physician who has a strong foundation of basic science knowledge and critical thinking that continues throughout the clinical years of their training and into whatever field of medicine they eventually practice. A USMLE study of fourth year medical students educated under the Flexnerian 2+2 model shows that retention of the basic science knowledge tested in Step 1 is suboptimal.
- The locus of care has shifted from the inpatient to the outpatient arena. Hospital stays, once virtually limitless in their length and ideal for teaching the natural history of disease and intervention as well as facilitating relationship building, are now intense, short stays. Trainees may spend more time on admission and discharge paperwork than on interviewing patients and analyzing their cases. We need to develop a system of education that facilitates the establishment of longterm relationships between students and patients and that allows them to see the results of their diagnostic and therapeutic strategies.
- The US health care system is too expensive, too fragmented and insufficiently focused on quality and safety. Despite spending 50% of the world’s health care resources on 5% of the world’s population, we rank only 37th in the world in terms of preventable disease morbidity and mortality. We need to prepare physicians to practice effective, efficient, safe and equitably distributed medicine. This requires expanded skills in leadership, collaboration, social justice and stewardship of scarce resources.
- There has been recognition that there may be significant gaps in the care we intend to deliver and the care the patient receives. The fields of continuous quality improvement and patient safety need actively involved physicians and physician leaders. This requires that students learn about the science of quality improvement and patient safety.
- The US public has been increasingly intolerant of errors committed in the process of education. This requires new training methods that provide students with the opportunity to practice high risk skills in low risk environments until they reach a certain threshold of competency. In addition, we are increasingly called upon to document that competency has been truly measured, rather than assumed based on time on task.
- There has been increasing recognition of the negative affects of sleep deprivation on performance in the clinical environment. We need to learn how to train physicians who spend fewer hours in the hospital setting. Physicians need to learn how to engage and manage teams to provide continuous care and to transition care safely.
- The American Board of Medical Specialties has realized the importance of continuous professional development. No longer is board certification a sanction to life long practice supported only by CME lectures. Physicians are required to critically analyze their own performance and the care they deliver to support their continued certification. We need to prepare physicians to embrace the role of personal performance assessment based on outcomes and the associated continuing education.
Why Change? Internal performance metrics support the need for curricular enhancement.
While we have much to be proud of, it is clear that we could target a higher level of performance for our school and our graduates.
- We had not changed our institutional objectives since 1996. Since that time, the world of medical education has recognized the importance of six, non compensatory competencies (meaning that students must demonstrate a threshold level of competency in every domain, regardless of their performance in other domains.) These six competencies include medical knowledge, patient care, professionalism, interpersonal skills and communication, systems based practice and practice based learning and improvement and are the foundation for our new general learning objectives, developed by an interprofessional task force in the 2007-2008 academic year. To review these objectives, please see the associated document: Core Educational Objectives of the Medical Curriculum. We need to design a new curriculum that is aligned with our new institutional objectives.
- The 2008 graduate questionnaire still identifies areas that we could improve. 20% of our students finish one of their clerkships without observation by a faculty member. It is hard to assure the competence of our students with patients if they are not directly observed.
- 62% of the program directors surveyed about their experience with our graduates rated our graduates as much or slightly better than the graduates of other medical schools. We would like this number to be > 80%. We need to focus our attention on guaranteeing that our graduates not only meet but exceed the expectations of receiving program directors.
- One year after graduation, 78% of our graduates rate their medical school training as much or slightly better than peers from other medical schools. We strive for > 85% in this metric.
- We have a significant number of students who perform in an outstanding fashion on USMLE exams 1, 2CK, and 2CS. Our 2008 average score for step I is 223 with a US average of 222. We fair slightly better on step 2CK with a mean score of 235 compared with a national average of 226. Our institution has set a goal to rank in the top 20 of institutions. Our test scores should reflect this.
- Despite efforts to shore up professionalism, we, like other medical centers, still struggle with the “hidden curriculum”. At times, the way in which we treat our patients, our peers and our interdisciplinary colleagues is not compatible with our institution’s values of teamwork, excellence and innovation or our profession’s values of altruism, respect, accountability, integrity and patient centeredness. We need to identify methods to insure that every member of our medical center community continously exhibits the positive values we hold dear. Students need to learn from positive role models in our educational environments how to reason through ethically challenging situations and deal with strong emotions amidst uncertainty and stress. Our curriculum should prepare them for the inevitability of challenges to professionalism.
Why change? We should lead the way, rather than follow.
Ohio State has all of the resources and people needed to be leaders in medical education. We owe it to the profession and to our patients to continuously seek to improve medical education to meet the needs of our public. Curricular change must be grounded in educational theory, supported by faculty talent and vetted by our community. We ask for your assistance as we take on this journey. Please visit https://communities.osumc.edu/sites/com to take a survey on curricular issues. Watch your email for the dates and times of faculty town hall meetings about this important topic. We look forward to hearing your thoughts, concerns, hopes, and vision for a world where the OSUMC leads the way in developing the ideal 21st century physician.
FAQ regarding Curriculum Change
What about the MSP students?
We are committed to maintaining and enhancing the training of physician scientists. The value of the MSP program is that the scientists are physicians and the physicians are scientists. Both aspects of development must be considered equally important. We will involve all program directors, including the MSP program directors to make sure that the unique needs of different populations of students are met. We will expect all to be adaptable as we consider the type of structure needed to achieve our institutional objectives.
What does curricular integration mean?
Curricular integration includes the tight linkage of basis science with clinical science across the four year curriculum and the integration competency teaching and assessment across the clinical disciplines. Faculty will work to identify what basic science concepts are taught prior to substantial clinical exposure, what are best taught in the clinical setting and what do not need to be mastered by physicians at all. Similarly, they will identify the patient care experiences that facilitate the development of the necessary skills and expose students to a variety of career options.
What steps will you take to make sure the faculty supports the curriculum?
Faculty support and participation are vitally important. We have commissioned working groups to do the legwork of literature review, institutional benchmarking and critical thinking about curricular structure. These redesign groups will provide written documents on the web for your input and will lead a series of town hall meetings to hear your thoughts and views. Traditional forums for communication, like the Executive Curriculum Committee, Faculty Council and the Council of Chairs will provide additional opportunities for review and comment. If you have other thoughts on optimal community involvement, please let us know.
What is the timeline for the change?
We plan to have an implementation team working during the 2009-2010 academic year with pilots planned for the 2011-2012 year. The full curriculum will be rolled out in 2012 at the latest.
I want to participate. What can I do?
We welcome additional help. Please contact me directly if you are interested in innovating and implementing. I can be reached most easily via email: daniel.clinchot@osumc.edu.