reciprocal integration: medical curriculum model university of iowa carver college of medicine...

RECIPROCAL RECIPROCAL INTEGRATIONINTEGRATION::

Medical Curriculum Model Medical Curriculum Model

University of IowaUniversity of IowaCarver College of MedicineCarver College of Medicine

Curriculum Renewal Modeling Curriculum Renewal Modeling Committee ReportCommittee Report

September 27, 2010September 27, 2010

Team MembersTeam Members

• Anderson, JasonAnderson, Jason• Axelson, Rick DAxelson, Rick D• Brown, DonaldBrown, Donald• Christine, Paul JChristine, Paul J• England, Sarah KEngland, Sarah K• Fox, Daniel KFox, Daniel K• Haugsdal, Michael LHaugsdal, Michael L• Hoffmann, Darren SHoffmann, Darren S• Khaja, SobiaKhaja, Sobia• Lenoch, SusanLenoch, Susan• Liu, VincentLiu, Vincent

• Longley, Thomas WLongley, Thomas W• Murray, JeffMurray, Jeff• Rahhal, AmalRahhal, Amal• Rowat, JaneRowat, Jane• Smith, Mark CSmith, Mark C• Sugg, SoniaSugg, Sonia• Takacs, Elizabeth BTakacs, Elizabeth B• Wickham, Gerald PWickham, Gerald P• Willemsen-Dunlap, Willemsen-Dunlap,

AnnAnn• Zeitler, William AZeitler, William A

OverviewOverview

• I. StrategyI. Strategy

• II. Permeating ThemesII. Permeating Themes

• III. Pedagogical ConsiderationsIII. Pedagogical Considerations

• IV. Reciprocal Integration ModelIV. Reciprocal Integration Model

• V. Model AnalysisV. Model Analysis

• VI. ConclusionsVI. Conclusions

StrategyStrategy

• ChargeCharge

• ApproachApproach

ChargeCharge• Provide flexibility to accommodate new knowledgeProvide flexibility to accommodate new knowledge

• Improve Improve integration of basic, clinical, social of basic, clinical, social sciencessciences

• Address patient & societal needsAddress patient & societal needs

• Provide Provide earlier clinical experience clinical experience

• Encompass competenciesEncompass competencies

• Promote Promote student-centered learning learning

• Maximize use of educational & informational Maximize use of educational & informational technologiestechnologies

• Enable individualized progress Enable individualized progress

ApproachApproach

• Create ideal Iowa medical graduateCreate ideal Iowa medical graduate

• Propose original curricular elementsPropose original curricular elements

• Review literatureReview literature

• Draft original curriculaDraft original curricula

• Consider curricula at other medical Consider curricula at other medical schoolsschools

• Integrate into one model Integrate into one model

OverviewOverview







Permeating ThemesPermeating Themes

• IntegrateIntegrate basic and clinical sciences, both basic and clinical sciences, both vertically and horizontallyvertically and horizontally

• Optimize opportunity for Optimize opportunity for careercareer exploration exploration• Ensure exposure to Ensure exposure to spectrumspectrum of conditions of conditions

encountered in primary careencountered in primary care• Optimize Optimize pedagogicalpedagogical aspects of curriculum aspects of curriculum• Provide “Provide “corecore” and “” and “dynamicdynamic” components ” components

to curriculum to accommodate changing to curriculum to accommodate changing medical knowledge and to accommodate medical knowledge and to accommodate different learning stylesdifferent learning styles

• Attend to Attend to personalpersonal as well as professional as well as professional needs of studentsneeds of students

OverviewOverview







Pedagogical ConsiderationsPedagogical Considerations

• Curricular oversight critical=> Curricular oversight critical=> Curriculum Oversight CommitteeCurriculum Oversight Committee

• Evaluation of process and goals of Evaluation of process and goals of student evaluationsstudent evaluations

• Eclectic combination of various Eclectic combination of various curricular modelscurricular models– Organ-basedOrgan-based– Case-basedCase-based– Presenting-complaint basedPresenting-complaint based

OverviewOverview







““Reciprocal Integration”Reciprocal Integration”

• Mutual integrationMutual integration– Interweaving of Interweaving of basic and clinical sciencesbasic and clinical sciences

throughout the four years of medical schoolthroughout the four years of medical school– CollaborationCollaboration across medical specialties/fields across medical specialties/fields

as well as across the health care teamas well as across the health care team

• GoalGoal: : to prepare a versatile, complete to prepare a versatile, complete physician who is equipped to act in the physician who is equipped to act in the best interest of the patient and society best interest of the patient and society through teamwork and an ability to stay through teamwork and an ability to stay current with medical knowledgecurrent with medical knowledge

1st year (M1)—

Basic Science PrimerBasic Science Primer

• DescriptionDescription: Course providing fundamental basic : Course providing fundamental basic science science

• DurationDuration: 2 weeks: 2 weeks• GoalGoal: Ensure all students of : Ensure all students of diversediverse backgrounds backgrounds

equipped with tools for successful mastery of equipped with tools for successful mastery of basic sciencebasic science

• ComponentsComponents– Molecular/cell biologyMolecular/cell biology– BiochemistryBiochemistry– ImmunologyImmunology– BiostatisticsBiostatistics– Introduction to evidence-based medicineIntroduction to evidence-based medicine– Introduction to ethicsIntroduction to ethics

Personal Wellness Personal Wellness ExplorationExploration

• DescriptionDescription: Longitudinal care experience utilizing : Longitudinal care experience utilizing one’s own one’s own personalpersonal health and wellness as a venue for health and wellness as a venue for learning the application of basic science to clinical carelearning the application of basic science to clinical care

• DurationDuration: over 4 years : over 4 years • GoalGoal: To expose students to the principles of public : To expose students to the principles of public

health, wellness (including nutrition, diet, exercise, and health, wellness (including nutrition, diet, exercise, and other identifiable environmental components, as well other identifiable environmental components, as well as genetic predisposition) at the personal level.as genetic predisposition) at the personal level.

• ComponentsComponents– A series of short lectures A series of short lectures – Coupled to small groups Coupled to small groups – Incorporate wellness aspects such as nutrition, exercise, public Incorporate wellness aspects such as nutrition, exercise, public

health, and geneticshealth, and genetics– Opportunity for self-reflection Opportunity for self-reflection

Continuity of Care ClerkshipContinuity of Care Clerkship

• DescriptionDescription: Longitudinal care experience: Longitudinal care experience• DurationDuration: 4 years x ½ day/week : 4 years x ½ day/week • GoalGoal: To progressively develop clinical : To progressively develop clinical

skills in a closely monitored fashion, skills in a closely monitored fashion, thereby offering early clinical exposure, thereby offering early clinical exposure, mentorshipmentorship, and development of , and development of independence.independence.

• ComponentsComponents– Pairing with a “Master Clinician” mentorPairing with a “Master Clinician” mentor– Weekly 1/2-day clinical sessionsWeekly 1/2-day clinical sessions– May utilize rotating schedule of 2-3 mentorsMay utilize rotating schedule of 2-3 mentors

Foundations of Basic Foundations of Basic ScienceScience• DescriptionDescription: Course on : Course on corecore basic sciences that basic sciences that

serve as the basis for clinical practiceserve as the basis for clinical practice• DurationDuration: 16 weeks: 16 weeks• Lectures and complementary small group Lectures and complementary small group

interactioninteraction• GoalGoal: Provides the tools required for learning in an : Provides the tools required for learning in an

organ-based approach.organ-based approach.• ComponentsComponents

– BiochemistryBiochemistry– Cell biologyCell biology– Anatomy/neuroanatomy/embryology/histologyAnatomy/neuroanatomy/embryology/histology– GeneticsGenetics

Human Organ Systems & Human Organ Systems & DiseaseDisease• DescriptionDescription: : Organ-systemsOrgan-systems approach to approach to

the normal and abnormal human condition the normal and abnormal human condition • DurationDuration: 38 weeks: 38 weeks• GoalGoal: Provides understanding of how : Provides understanding of how

disease states represent disturbances of disease states represent disturbances of the normal human condition on a the normal human condition on a molecular, cellular, and organ level molecular, cellular, and organ level

• ComponentsComponents– Encompasses current HOS curriculum Encompasses current HOS curriculum – Plus integration of microbiology and Plus integration of microbiology and

immunologyimmunology

Foundations of Basic Science:BiochemistryCell biologyAnatomy/neuroanatomy/embryology/histologyGenetics

Systems and Disease:HOS (normal): physiology, histology, anatomy

Path (abnormal): pathology, pharmacology

Cellular:Histology, Immunology, Microbiology

Integration: Small groups, Continuity of Care clerkship etc…

1st year (M1)—

Foundations of Clinical Foundations of Clinical PracticePractice• DescriptionDescription: Course providing the : Course providing the

practicalpractical skills and knowledge for the skills and knowledge for the practice of clinical medicinepractice of clinical medicine

• DurationDuration: 66 weeks: 66 weeks• GoalGoal: To train medical students to : To train medical students to thinkthink

and and actact like physicians, with emphasis on like physicians, with emphasis on basic science applicationbasic science application

• ComponentsComponents– Expansion of current FCP curriculumExpansion of current FCP curriculum– Specific adoption of presenting complaints Specific adoption of presenting complaints

learning paradigmlearning paradigm

Integrated Small Group Integrated Small Group Bridge Bridge

• DescriptionDescription: Course bridging Human Organ Systems & : Course bridging Human Organ Systems & Disease with Foundations of Clinical Practice Disease with Foundations of Clinical Practice

• DurationDuration: 38 weeks: 38 weeks• GoalGoal: Provides explicit platform for integration of clinical : Provides explicit platform for integration of clinical

context to basic science instructioncontext to basic science instruction• ComponentsComponents

– ““Patient-centered Vertical Vignette”Patient-centered Vertical Vignette”– hypothetical patient cases that serve as curricular vehicles that hypothetical patient cases that serve as curricular vehicles that

move with the students as they progress through the move with the students as they progress through the chronological curriculum sequence chronological curriculum sequence

– serve as educational strands that unify the curriculum serve as educational strands that unify the curriculum longitudinally longitudinally

– e.g. autoimmunity topic addressed in HOS-D is illustrated in e.g. autoimmunity topic addressed in HOS-D is illustrated in hypothetical patient with lupus erythematosus, whose clinical hypothetical patient with lupus erythematosus, whose clinical findings are mastered in FCP, and re-addressed later in findings are mastered in FCP, and re-addressed later in discussion of renal pathophysiology, etc. discussion of renal pathophysiology, etc.

– Case-presentation and presenting complaint-based series of Case-presentation and presenting complaint-based series of casescases

2nd year (M2)—

IntersessionsIntersessions• DescriptionDescription: Periodic week-long intervening sessions at : Periodic week-long intervening sessions at

the start of each clinical clerkship and between basic the start of each clinical clerkship and between basic science coursesscience courses

• DurationDuration: 1 week : 1 week • GoalGoal: To provide dedicated time to basic science : To provide dedicated time to basic science

integrationintegration into the clinical years, and for explicit into the clinical years, and for explicit incorporation of other health-related issues (e.g. ethics, incorporation of other health-related issues (e.g. ethics, safety/quality, etc) into the basic science yearssafety/quality, etc) into the basic science years

• ComponentsComponents– Basic science review and application during clinical clerkships to Basic science review and application during clinical clerkships to

provide the basic science groundings for the subsequent clinical provide the basic science groundings for the subsequent clinical experienceexperience

– Allied health issues incorporated into basic science yearsAllied health issues incorporated into basic science years– Potential time for addressing remediation issuesPotential time for addressing remediation issues– DynamicDynamic curriculum curriculum

3rd year (M3)—

Required Clinical Required Clinical Blocks/ClerkshipsBlocks/Clerkships

• DescriptionDescription: Core clinical experiences deemed necessary for all : Core clinical experiences deemed necessary for all medical graduatesmedical graduates

• DurationDuration: 5 blocks x 12 weeks/block = 60 weeks : 5 blocks x 12 weeks/block = 60 weeks • GoalGoal: To provide spectrum of clinical experiences required of : To provide spectrum of clinical experiences required of

primary care and to offer career exploration primary care and to offer career exploration • Components:Components:

– Cerkships grouped into integrated blocks to facilitate interdisciplinary Cerkships grouped into integrated blocks to facilitate interdisciplinary integrationintegration• Internal medicineInternal medicine (inpatient + outpatient) (inpatient + outpatient)• SurgerySurgery (general surgery + surgical subspecialties) (general surgery + surgical subspecialties)• Family medicineFamily medicine + + Cognitive/behavioral medicineCognitive/behavioral medicine (neurology + psychiatry) (neurology + psychiatry)• OB/GynOB/Gyn + + PediatricsPediatrics• Critical careCritical care (emergency medicine + critical care unit + anesthesia + (emergency medicine + critical care unit + anesthesia +

radiology) (M4)radiology) (M4)– M3: IM + Surg + either FM/CBM or Ob/Gyn/PedsM3: IM + Surg + either FM/CBM or Ob/Gyn/Peds– Within the integrated block, different sequences/tracks of Within the integrated block, different sequences/tracks of

experiences may be offered experiences may be offered – Sub-internshipSub-internship (4 weeks) (4 weeks)

4th year (M4)—

Clinical ElectivesClinical Electives

• DescriptionDescription: Non-required, : Non-required, multidisciplinary, clinical experiences multidisciplinary, clinical experiences

• DurationDuration: 32 weeks: 32 weeks• GoalGoal: To offer a breadth and depth of : To offer a breadth and depth of

clinical experiences to enable students to clinical experiences to enable students to make informed career decisions and to make informed career decisions and to enhance their clinical knowledge and skillsenhance their clinical knowledge and skills

• ComponentsComponents– Emphasis on multidisciplinary approachEmphasis on multidisciplinary approach– e.g. cutaneous oncology=onc, derm, surg, etc. e.g. cutaneous oncology=onc, derm, surg, etc.

OverviewOverview







Model AnalysisModel Analysis

•Charge

•Resource implications


• Improve Improve integration of basic, clinical, social of basic, clinical, social sciencessciences

• Address patient & societal needsAddress patient & societal needs

• Provide Provide earlier clinical experience clinical experience

• Encompass competenciesEncompass competencies

• Promote Promote student-centered learning learning




– ““Core-dynamic” concept- intersessionsCore-dynamic” concept- intersessions– Clinical experience blocksClinical experience blocks– Attention to pedagogyAttention to pedagogy– Curriculum Oversight CommitteeCurriculum Oversight Committee– Increased and earlier elective timeIncreased and earlier elective time

• Improve Improve integration of basic, clinical, social sciences of basic, clinical, social sciences• Address patient & societal needsAddress patient & societal needs• Provide Provide earlier clinical experience clinical experience• Encompass competenciesEncompass competencies• Promote Promote student-centered learning learning• Maximize use of educational & informational Maximize use of educational & informational

technologiestechnologies• Enable individualized progress Enable individualized progress

ChargeCharge• Provide flexibility to accommodate new knowledgeProvide flexibility to accommodate new knowledge• Improve Improve integration of basic, clinical, social sciences of basic, clinical, social sciences

– IntersessionsIntersessions– Curriculum Oversight CommitteeCurriculum Oversight Committee– Personal Wellness ExplorationPersonal Wellness Exploration– Integrated Small GroupIntegrated Small Group– Clinical experience blocksClinical experience blocks– Multidisciplinary electivesMultidisciplinary electives

• Address patient & societal needsAddress patient & societal needs• Provide Provide earlier clinical experience clinical experience• Encompass competenciesEncompass competencies• Promote Promote student-centered learning learning• Maximize use of educational & informational technologiesMaximize use of educational & informational technologies• Enable individualized progress Enable individualized progress

ChargeCharge• Provide flexibility to accommodate new knowledgeProvide flexibility to accommodate new knowledge• Improve Improve integration of basic, clinical, social sciences of basic, clinical, social sciences• Address patient & societal needsAddress patient & societal needs

– IntersessionsIntersessions– Focus on primary care issues in curricular designFocus on primary care issues in curricular design– Personal wellness explorationPersonal wellness exploration– Preservation of service distinction tractsPreservation of service distinction tracts– Preservation of learning commuitiesPreservation of learning commuities

• Provide Provide earlier clinical experience clinical experience• Encompass competenciesEncompass competencies• Promote Promote student-centered learning learning• Maximize use of educational & informational Maximize use of educational & informational


ChargeCharge• Provide flexibility to accommodate new knowledgeProvide flexibility to accommodate new knowledge• Improve Improve integration of basic, clinical, social of basic, clinical, social

sciencessciences• Address patient & societal needsAddress patient & societal needs• Provide Provide earlier clinical experience clinical experience

– Continuity of Care clerkshipContinuity of Care clerkship– Earlier formal entrance to clinical clerkships (April, 2Earlier formal entrance to clinical clerkships (April, 2ndnd

year)year)• Encompass competenciesEncompass competencies• Promote Promote student-centered learning learning• Maximize use of educational & informational Maximize use of educational & informational


ChargeCharge• Provide flexibility to accommodate new knowledgeProvide flexibility to accommodate new knowledge• Improve Improve integration of basic, clinical, social of basic, clinical, social

sciencessciences• Address patient & societal needsAddress patient & societal needs• Provide Provide earlier clinical experience clinical experience• Encompass competenciesEncompass competencies

– Call to re-evaluate evaluation methodsCall to re-evaluate evaluation methods– Curricular Oversight CommitteeCurricular Oversight Committee

• Promote Promote student-centered learning learning• Maximize use of educational & informational Maximize use of educational & informational


ChargeCharge• Provide flexibility to accommodate new knowledgeProvide flexibility to accommodate new knowledge• Improve Improve integration of basic, clinical, social sciences of basic, clinical, social sciences• Address patient & societal needsAddress patient & societal needs• Provide Provide earlier clinical experience clinical experience• Encompass competenciesEncompass competencies• Promote Promote student-centered learning learning

– Personal wellness explorationPersonal wellness exploration– Continuity of care clerkship (mentorship)Continuity of care clerkship (mentorship)– Greater schedule flexibilityGreater schedule flexibility– Call to re-evaluate evaluation methodsCall to re-evaluate evaluation methods



ChargeCharge• Provide flexibility to accommodate new knowledgeProvide flexibility to accommodate new knowledge• Improve Improve integration of basic, clinical, social sciences of basic, clinical, social sciences• Address patient & societal needsAddress patient & societal needs• Provide Provide earlier clinical experience clinical experience• Encompass competenciesEncompass competencies• Promote Promote student-centered learning learning• Maximize use of educational & informational Maximize use of educational & informational

technologiestechnologies– Personal Wellness explorationPersonal Wellness exploration– Attention to safety and quality (explicitly during intersessions)Attention to safety and quality (explicitly during intersessions)


ChargeCharge• Provide flexibility to accommodate new knowledgeProvide flexibility to accommodate new knowledge• Improve Improve integration of basic, clinical, social sciences of basic, clinical, social sciences• Address patient & societal needsAddress patient & societal needs• Provide Provide earlier clinical experience clinical experience• Encompass competenciesEncompass competencies• Promote Promote student-centered learning learning• Maximize use of educational & informational Maximize use of educational & informational

technologiestechnologies• Enable individualized progressEnable individualized progress

– Greater flexibility in schedulingGreater flexibility in scheduling– Continuity of care clerkship for longitudinal evaluationContinuity of care clerkship for longitudinal evaluation– IntersessionsIntersessions

Resource ImplicationsResource Implications

• Creation of Curriculum Oversight Creation of Curriculum Oversight CommitteeCommittee

• Continuity of Care clerkshipContinuity of Care clerkship

• Intersessions scheduling requirementsIntersessions scheduling requirements

OverviewOverview







ConclusionsConclusions: Key Features of : Key Features of ““Reciprocal IntegrationReciprocal Integration” Model” Model

• Earlier clinical exposureEarlier clinical exposure (e.g. through Continuity of Care clerkship, (e.g. through Continuity of Care clerkship, earlier entrance into the formal clinical clerkships [by April of 2nd earlier entrance into the formal clinical clerkships [by April of 2nd year], etc.) emphasizing relevance of basic science to clinical year], etc.) emphasizing relevance of basic science to clinical medicine and allowing for achievement of more advanced clinical skill medicine and allowing for achievement of more advanced clinical skill level by graduationlevel by graduation

• Conscious attention to Conscious attention to integrationintegration of basic and clinical sciences (e.g. of basic and clinical sciences (e.g. through Intersessions, Personal wellness course, etc) and to pedagogy through Intersessions, Personal wellness course, etc) and to pedagogy (through curricular oversight, etc) fosters conceptual connections to (through curricular oversight, etc) fosters conceptual connections to be made by the student and facilitates broader and deeper learning be made by the student and facilitates broader and deeper learning (‘spiral model’)(‘spiral model’)

• Increased (8 months) and earlier (as soon as April of second year) Increased (8 months) and earlier (as soon as April of second year) elective timeelective time opportunities that allow for individualized learning and opportunities that allow for individualized learning and greater opportunities for exploration of career goalsgreater opportunities for exploration of career goals

• Provision of longitudinal Provision of longitudinal mentorshipmentorship opportunities (e.g. through opportunities (e.g. through Continuity of Care clerkship, etc.) to cultivate personal and Continuity of Care clerkship, etc.) to cultivate personal and professional developmentprofessional development

reciprocal integration: medical curriculum model university of iowa carver college of medicine...

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