The College of Human Medicine stands at the forefront of national efforts to improve the medical school experience in response to changes in the landscape of health care, advances in medical knowledge and new understandings about lifelong learning and competency-based assessment. Our is truly an innovative approach to medical education that is both student-centered and patient-centered, making the patient the focus of our entire educational enterprise. The embraces change. Its delivery employs technology where it is most useful and the human touch where it is most needed. It reaches for both the attainable and the aspirational goals of our learners and our faculty. Its creation represents hundreds of hours of the best kind of work: shared discovery in service of the hopes and dreams of the college to serve our patients and to make their lives better. Upon its launch in August 2016, the Michigan State University College of Human Medicine will be the product of five years of literature review and synthesis, expert consultation and advice, stakeholder input, faculty discourse and consensus. It will have involved unique planning and implementation strategies along with rigorous quantitative and qualitative data analysis. Based on guiding principles endorsed by the college faculty, it has been constructed to include early and ongoing longitudinal clinical experiences, robust integration of basic and clinical sciences throughout four years of the curriculum, alignment of evaluations with curricular content and real-world performance. It promises flexibility for student advancement, and opportunities for students to pursue excellence and demonstrate mastery. At the same time, the has maintained the values the College of Human Medicine has espoused since its founding a commitment to diversity, belief in the biopsychosocial model of care, and caring for patients in the communities in which they live. Now, as it was at the birth of the College, our ultimate goal is to serve our patients and make their lives better.
THE SHARED DISCOVERY CURRICULUM: Context and Vision The Michigan State University College of Human Medicine is a community-based medical school with a history of responding to educational imperatives with innovation. The college was among the first in the nation to train students within communities, and at present, educates our learners on eight campuses that span the state. We pioneered development of focal problems (a precursor of problem-based learning) as a guiding educational strategy. The college has been cited as a leader in the social mission of medical schools which reflects its contribution to physician workforce diversity, the percentage of graduates who practice primary care, and the percentage who work in underserved areas. Our health care system is in the midst of significant improvement efforts. New knowledge and skills are now required for students, residents and practicing physicians to enable them to contribute to those advances. Prevailing educational structures and strategies (the 2+2 model of preclinical and clinical education, for instance) must similarly undergo change to respond to best evidence about how physicians attain and maintain excellence in the provision of patient care. The (SDC) represents a radical departure from present educational models, emphasizing usefulness and experience as a framework for adult education. Featuring the blending of curriculum and action, and in explicit distinction to the traditional medical education of the last 80 years, we create a community-focused medical school experience responsive to the health care needs of Michigan and the country and in the educational best interests of diverse learners. The guiding mission of our is to nurture, educate and graduate students who are ready, willing and able to be exemplary new residents and practicing physicians. We will complete our mission by putting the patient at the center of the educational enterprise, focusing on the following Shared Discovery strategies: Early and ongoing clinical experience for students Integrated basic and clinical sciences throughout the curriculum Collaborative learning for faculty and students Flexible programming Alignment of evaluations with curricular content and real-world performance Assuring competence and striving for excellence College of Human Medicine Page 2
Foundations of the The is planned around the patient and takes place where patients receive care, placing clinical experiences at the center of the curricular design. It rapidly immerses students in real clinical environments, providing an authentic trajectory of training and progressively increased responsibility. It represents a complete transformation of our undergraduate educational enterprise, and involves all four years of the curriculum. In 2005, the college organized its curriculum around a core group of competencies based on the residency competencies adopted by the Accreditation Council for Graduate Medical Education (ACGME). The college did not simply adopt the ACGME competencies but made them MSU Green by adding additional competencies (for example, service) and re-organizing other competencies to better fit the college s mission. CHM s educational competencies are referred to as the SCRIPT Competencies: Service Care of Patients Rationality Integration Professionalism Transformation No ACGME related Competency Patient Care and Interpersonal and Communication Skills Practice Based Learning and Improvement Systems Based Practice Professionalism Medical Knowledge Five innovations are incorporated into the SDC. They are: The Chief Complaints and Concerns: define the end-competencies of the educational program utilizing an integrative framework centered on what happens in the workplace Just In Time Medicine: curricular/assessment software drives the curriculum Early, Middle and Late Clinical Experiences: are longitudinal and take place in authentic patient care environments where students are useful members of the healthcare team The Academy and Learning Societies: provide structure for small group learning, educator development, and support in a challenging environment while strengthening the learner/educator dynamic The Progress Suite of Assessments: ensures assessment across all 4 years with more formative feedback and more robust, less frequent summative assessment Chief Complaints and Concerns The novel structure and organization of the required a new system of identifying and presenting the content and objectives for the college. College faculty identified a group of Chief Complaints and Concerns (C3) based on international lists of core objectives and diagnoses. Rather than the disciplinary (biochemistry, immunology) or organ system (cardiovascular or neurologic) classifications typically employed in medical education, the Chief Complaints and Concerns documents are focused on patients complaints or physicians concerns (shortness of breath or elevated blood sugar). End-competency objectives for each of the Chief Complaints and Concerns define, for each topic, what an exemplary new resident should know and be able to do for a patient with that chief complaint or concern. College of Human Medicine Page 3
Just In Time Medicine (JIT): Powering the Curriculum The requires staff, student and educators access to schedules, content, assessments and data that is rapid, reliable and responsive to each stakeholder s needs. Originally developed and used within our Internal Medicine clerkship, Just In Time Medicine (JIT) accomplishes these critical functions by leveraging cloud based technology and functioning on all internet enabled devices. Built to be a self-service interface that facilitates the authoring of customized content and criterion-based assessment tools that are easily accessed and displayed on internet-enabled devices JIT makes possible the capturing and reporting of learner progress through the curriculum. JIT provides easy access to and use of tools and data by students and educators to accomplish both learner instruction and educator development and creates permanent records and dashboards of learner competencies for student assessment and curricular evaluation. Robust assessment reporting enables and simplifies meeting the goals of criterion-based assessment, as well as licensing and accreditation reporting requirements. To have maximal functionality, assessment reports are displayable for users to visualize them in different ways and for different purposes. Additionally a customizable method for calculating the contribution that an individual assessment makes toward achieving a successful outcome is embedded. A major feature of the JIT system is the capacity to map user-generated hierarchical taxonomic structures with applied grading schema, enabling dynamic reporting. Importantly, this system allows for multiple, overlapping taxonomies such that student performance can be reported and displayed by any number of paradigms including SCRIPT competencies, EPA s, milestones and other specific competency frameworks. A reporting interface which functions much like a disease registry, the curricular registry, allows students, faculty and administrators to see color coded tables of students progress to date, enabling the use of this data in determining if students are on an acceptable educational trajectory. This registry also simultaneously allows drill-down functionality to view the details of each assessment. College of Human Medicine Page 4
The Clinical Experiences and Intersessions The curriculum is organized around three major clinical experiences: the Early Clinical Experience (ECE), the Middle Clinical Experience (MCE), and the Late Clinical Experience (LCE). The ECE places students in ambulatory settings learning with medical assistants, nurses, and physicians. The MCE places students in ambulatory and inpatient environments with an Interprofessional team which includes residents and attending physicians, and also respiratory therapists, social workers, nutritionists, physical therapists, pharmacists, and other health care team members who will deliver portions of the curriculum. The LCE places students who are now equipped to take on more responsibility in ambulatory and inpatient settings on disciplinary services where they are able to realistically prepare for the first day of residency training. Between the ECE and the MCE, and between the MCE and the USMLE Step 1 examination, there is a series of four-week focused topic study courses, or Intersessions, which provide an opportunity for students to focus on particular areas of required by the curriculum as well as areas of particular strength. College of Human Medicine Page 5
The Academy Students and educators are organized in the curriculum through the creation of four learning societies spanning the geographic campuses and medical student years in the curriculum. The Learning Societies are the site of academic coordination of student learning plans as well as the home of post clinic groups that integrate and contextualize students experiences in clinic with the programed content of the curriculum. The Academy is the intellectual and professional home of our learners and the medical education home of its Faculty Fellows. Organized into four Learning Societies that include small groups of students, clinical faculty, basic and social scientists, it is designed to provide the organization and delivery of several components of the curriculum, including post-clinic debriefing, problembased learning and other small group learning experiences, student portfolio review and individual learning plan formulation and tracking. The Academy enables the organization of and delivery of specialized, educator development to promote both excellence in teaching and coaching, as well as ongoing support of scholarly endeavors. The Academy, with its composition of students, basic and social scientists, and physicians, anchors our educational enterprise. This structure enables students to interact with educators in a variety of settings over multiple years. Each week, Learning Society educators debrief students clinical experiences, lead small groups and teach clinical and necessary science, observe clinical skills performance in simulation or in patient care environments, and hold informal office hours. On a regular basis, they review the contents of their students educational portfolios and guide the development of students individualized learning plans. Behind the scenes, Learning Society Fellows create curricular offerings and engage in specific educator development to build their skills in curriculum design and delivery, small group teaching and facilitation, as well as learner coaching and assessment. The Learning Societies enable the development of longitudinal, trusting relationships for students with each other and with educators to provide a rich collegial environment for educators that facilitates ongoing mentoring and scholarly collaboration. College of Human Medicine Page 6
Progress Suite of Assessments From the first days of the medical school, and at regular intervals throughout the curriculum, a suite of progress assessments enables students and their faculty to verify learners achievement of competence and readiness to advance. Progress testing is a longitudinal competency assessment that facilitates adult learning. Students take the Progress Suite of Assessments and move through the curriculum as they demonstrate competency. The takes the concept of progress assessment and applies it to patient care performance and necessary science knowledge, bioethics and the social context of clinical decision making. The components of the Progress Assessment are carefully aligned with our SCRIPT competencies, testing medical knowledge, skills and real world behaviors and are aligned with our SCRIPT competency goals as represented in the table below: Our progress assessments include the nationally normed multiple-choice examinations associated with a professional education but do not stop at the determination of what our learners know. A novel core assessment, the Progress Clinical Skills Examination, requires students to demonstrate the ability to integrate knowledge and skills during actual performance with standardized patients. Other assessments in the suite include the ratings of their educators, peers, health care team members and actual patients. This enables the college to understand what College of Human Medicine students do. Portfolios of evidence containing essays, videos, reflections, scholarly products and projects are reviewed by Learning Society Fellows at regular intervals to assure that acquisition of the necessary knowledge, skills and attitudes is taking place, and that learners receive anticipatory guidance to achieve not only competence, but excellence. Ongoing data flow from these multiple types of assessments assures that students, educators, and administration know how to improve. Students with particular strengths (perhaps a strong basic science or clinical background) and weaknesses (perhaps a time away from formal schooling or an atypical college major) will be guided to focus on particular areas of challenge and opportunity. Progress Suite Assessments are offered twice a semester and are available to students of all levels of the curriculum. Students must pass the Progress Suite of Assessments in order to move through the curriculum. The combination of progress testing and experience-based education fuels individual learning planning so that every student can achieve their fullest potential. College of Human Medicine Page 7
A Closer Look at the Early Clinical Experience (ECE) HM 552 Medical School I HM 553 Medical School II Middle Clinical Experience (MCE) HM 554 Medical School III HM 555 Medical School IV HM 556 Medical School V Late Clinical Experience (LCE) HM 661 Adv. Skills & Knowledge in Medical School I HM 662 Adv. Skills & Knowledge in Medical School II HM 663 Adv. Skills & Knowledge in Medical School III HM 664 Adv. Skills & Knowledge in Medical School IV Departmental courses Intersessions (HM 553 Medical School II, HM 554 Medical School III, HM 665 Advanced Skills & Knowledge in Medical School V) College of Human Medicine Page 8
The Early Clinical Experience (ECE) The 24 week Early Clinical Experience (ECE) places students in ambulatory settings learning with medical assistants, nurses, and physicians. Preparation for clinical work which emphasizes and enables student and patient safety in clinical settings begins immediately. Students are oriented to their ambulatory clinic site and then begin learning the clinics processes. Students participate in patient care activities along with medical assistants after demonstrating the knowledge and skills necessary to safely enter a patient care environment. They then participate in the care management and population health activities of the practice as well as beginning to perform more focused data gathering on patients with common presenting conditions. Students apply learnings about basic communication and clinical skills, ethics, the social context of clinical decisions, and the biological science behind clinical findings to their clinical work throughout the ECE. Learning objectives for each week are delivered using a combination of methodologies that take place in large and small groups as well as via guided independent learning. Simulation forms a backbone of our curriculum, enabling learners to practice, receive feedback, and hone knowledge and skills in a realistic environment. This replaces the see one, do one, teach one model to enable learners to experience psychological safety and patients to receive safe care. A typical Week in the Life of an Early Clinical Experience student might look like this: The ECE students meet twice a week with their Learning Society Fellows in Post Clinic Groups (PCGs). This curricular experience has three core functions: 1) integration of curricular content and clinical experience, 2) preparation for weekly simulations and large group learning experiences and 3) individualized learning plan development and coaching. The college successfully piloted the ECE in the summer of 2013 and found that matriculating students were able to meet the intermediate clinical goals of the ECE in six weeks. The pilot validated the core function of the post clinic groups, finding that faculty skill in debriefing the clinical experience and teaching the necessary science within the PCG structure steadily improved over time. Although the delivery of the pilot was not intentionally organized using Learning Society principles, faculty and students strongly embraced the structure. This shared discovery has been of fundamental importance to all subsequent curricular visioning.
Intersessions Late in the ECE students will take the Progress Suite of Assessments and create a personal learning plan with the help of their Learning Society Fellows. Each student s performance on the Progress Suite of Assessments is used to create the students learning plan for enrollment in specific Intersessions, which are focused-topic study courses between the ECE and the Middle Clinical Experience (MCE). There are three main types of Intersessions: 1) Core Intersessions, required by every student; 2) Foundation Intersessions, designed to help students enhance understanding and performance; 3) Advanced Intersessions, focused on the interests and strengths of the individual student. A typical Week in the Life of an Intersession student might look like this: College of Human Medicine Page 10
The Middle Clinical Experience (MCE) The Middle Clinical Experience (MCE) places students in ambulatory and inpatient environments with an interprofessional team which includes residents and attending physicians, and also respiratory therapists, social workers, nutritionists, physical therapists, pharmacists, and other health care team members who will deliver portions of the curriculum. The MCE consists of substantive ambulatory and inpatient rotations which stress strong integration of clinical work and the underlying necessary science required to care for patients and work within the health care system. Middle Clinical Experience students will continue to have one Post-Clinic Group session to debrief and discuss the Chief Complaint and Concern of the week (chest pain or cyanosis, for instance), and will also meet in Rotational small groups to discuss Topics of the Week relevant to their specific rotation (such as vaginal bleeding, if they are doing ambulatory obstetrics and gynecology). Specific goals of the MCE are to: 1. Expand skills in interviewing, physical examination, diagnostic reasoning, communication, and documentation in authentic care settings 2. Begin to perform hypothesis-driven histories and physicals 3. Gain further understanding of the necessary biological and social science knowledge required to understand and interpret the clinical data gathered in evaluation of common complaints 4. Develop further understanding of the health care system and the patient experience 5. Expand skills as a member of interprofessional teams 6. Prepare for national licensing examinations Middle Clinical Experience rotations include physical therapy, emergency medicine, nutrition consultation service, ambulatory obstetrics and gynecology, adult wards, pharmacy service, pediatric wards, newborn nursery, respiratory therapy, social work and palliative care. A sample schedule for a student on the inpatient wards would look like this: College of Human Medicine Page 11
The Late Clinical Experience (LCE) During the Late Clinical Experience (LCE), students engage in disciplinary clerkships, in both inpatient and outpatient settings, spending four weeks on rotations in Internal Medicine, Family Medicine, Pediatrics, Obstetrics and Gynecology, Surgery, Psychiatry, and Intensive Care and eight weeks on rotation in Surgery. These rotations enable students to bring their considerable patient care experience to a specialty-driven population of patients and their problems. Students are enrolled in a College course each semester alongside their clerkships. Elective clerkships are available early in the LCE. Students are required to do 5 electives across the LCE, with additional time available to pursue their interests or to complete research projects or certificate programs begun earlier in the curriculum. The Learning Society continues to engage during the LCE focusing on longitudinal clinical, scientific and social topics as part of Advanced Skills and Knowledge (ASK), a semester long course. The Learning Society small groups meet less frequently than during the ECE and LCE and require students to provide more intellectual leadership than in previous clinical experiences. The ASK course also includes necessary science and simulation. The : A complete transformation of our undergraduate educational enterprise involving all four years of the curriculum blending learning with action. Planned around the patient, taking place where patients receive care, placing clinical experiences at the center of the curricular design. Rapidly immersing students in real clinical environments, providing an authentic trajectory of training, and progressively increasing responsibility. Based on the SCRIPT competency framework which defines the outcomes of the curriculum, provides the curricular framework and defines graduation requirements. College of Human Medicine Page 12