Portal de Periódicos da CAPES

The Ohio State University College of Medicine and Public Health

2000; Lippincott Williams & Wilkins; Volume: 75; Issue: Supplement Linguagem: Inglês

10.1097/00001888-200009001-00086

1938-808X

Ronald C. Comer, Judith A. Westman, JAMES HOERSTRA,

Health Sciences Research and Education

Curriculum Management and Governance Structure ♦ The Executive Curriculum Committee (ECC) is responsible for the planning, design, implementation, evaluation, and oversight of the curriculum leading to the MD degree. ♦ Leadership and management of a coherent and coordinated curriculum are vested in the associate deans for medical education administration and for clinical education. ♦ Eight academic program directors, each chairing a faculty committee, are responsible to the ECC for organizing, implementing, and monitoring their portions of the curriculum. ♦ All academic program directors sit on the ECC, in addition to five at-large faculty, a basic science department chair, a clinical department chair, the academic review board chair, the associate deans for medical education administration and for clinical education, the director of academic services, and two students. ♦ Recommendations for major curricular change are submitted by the ECC to Faculty Council for approval with the concurrence of the Council of Chairs. Office of Education ♦ The Office of Medical Education was established over 30 years ago. ♦ For many years the associate dean for medical education was responsible for educational leadership and direction of the curricular programs. ♦ Recently, two associate deans, the associate dean for student affairs and medical education administration and the associate dean for clinical education and outreach, share responsibility for the office of medical education. ♦ Staff support to the academic program directors and budget support for implementation of the curriculum are administered through this office. Budget to Support Educational Programs ♦ The Office of Medical Education has an annual budget allocated by the dean of the College of Medicine and Public Health. ♦ The budget consists of a combination of state funds, student tuition funds, and “dean's tax” funds resulting from clinical practice income. ♦ The budget is further allocated to each of the eight academic programs, the Office of Academic Services, and Admissions and Student Affairs. ♦ Increasingly, some limited funds for building renovation and refurnishing are also being allocated to the Office of Medical Education to improve the physical infrastructure necessary for a high-quality medical education program. Valuing Teaching ♦ Teaching awards are presented annually. Students elect faculty winners. Plaques are presented at convocation. ♦ Excellence in Medical Education Awards (including cash awards) are presented annually. Nominations are collected from chairs, affiliated hospitals, and faculty. Winners are elected by a faculty committee. Plaques are presented at an Annual Community Preceptor Banquet and at departmental faculty meetings. Acknowledgements are included on a “Wall of Excellence” (under construction). CURRICULUM RENEWAL PROCESS Learning Outcomes ♦ The clinical curricular reform initiative, fully implemented during 1999-00, defined ten goals for the MD curriculum and several hundred learning objectives for clinical education. ♦ The basic science lecture/discussion curriculum is currently in the process of reform. ♦ Preclinical curricular options have defined learning objectives as follows. The Independent Study Pathway curriculum option (preclinical) includes detailed learning objectives for each module. The problem-based learning curriculum option (pre-clinical) uses student-defined learning objectives. The lecture/discussion curriculum is currently being reformulated. ♦ The new clinical curriculum is in its first year of full implementation. Changes in Pedagogy ♦ Preclinical students have a choice of three curricular tracks, independent study (ISP), problem-based learning (PBL), and lecture/discussion. ISP students have a time-variable curriculum. ISP students take exams when they feel they have mastered the modular learning objectives. They do not participate in classroom instruction. The ISP curriculum uses some cases and a considerable number of computer-based tutorial programs. PBL students meet regularly in small groups of seven students and two faculty over the first two years of medical education. The PBL curriculum is entirely case-based. PBL students take scheduled examinations customized to accommodate the variability in topics covered across groups. Lecture/discussion students attend classroom presentations, often in large-group settings. The lecture/discussion curriculum is currently being redesigned to increase the use of small-group discussions, some of which will be case-based. ♦ Standardized patients are used intermittently with all students during the Doctor-Patient Relationship course, during the physical examination course, and for the third-year OSCE. Application of Computer Technology ♦ At this time, students are not required to have their own computers, but are encouraged to do so. ♦ Class surveys indicate that almost 75% of the class have access to computers at home. ♦ Nearly 90 computer workstations conveniently located on the medical school campus provide students with upto-date computer technologies and Web accessibility. ♦ Computer technology is used throughout the four-year educational program. ♦ All students have e-mail addresses. Much of the administrative communication with students is via electronic mail. ♦ The Independent Study Pathway uses a series of tutorial programs for students to self-evaluate their knowledge prior to taking module examinations. ♦ During the first year, computer-based programs are used extensively in gross anatomy, neuroscience, and histology. ♦ Annotated gross and histopathologic images are available in a Web-delivered format for students in the second year. ♦ Computer-based resources are used in cardiology, neurology, and ophthalmology during the second and fourth years. ♦ A new initiative is under way to develop Web-based physical examination educational materials. ♦ Students use Web-based course registration. ♦ Third- and fourth-year clerkship scheduling is completed via the Web. Changes in Assessment ♦ Faculty observation of student history and physical exam skills has historically been required during the Doctor-Patient Relationship (DPR) course, the physical examination course, and the general clerkship. ♦ Obtaining faculty compliance has not been a problem in the DPR course, but has been a challenge during the physical exam course and the general clerkship. ♦ Faculty development and orientation workshops, sensitizing clerkship directors and hospital representatives to the need for compliance, and requiring students to obtain their evaluation forms for the witnessed history and physical have all been somewhat successful in improving this process. ♦ The use of student logs of clinical activity has increased over the past several years. ♦ Most recently, the ambulatory clerkship is using student logs to document the range of patient problems encountered on the family medicine and internal medicine rotations. ♦ The logs are used both to monitor student clinical activity and for ongoing evaluation of the ambulatory experience. ♦ The use of an OSCE following third-year clerkships in pediatrics, internal medicine, and psychiatry/neurology was implemented during academic year 1999-00. ♦ The ten-station OSCE is designed to examine a sampling of critical clinical skills spanning these clinical domains. Currently this project is considered a pilot to determine feasibility and viability. Clinical Experiences ♦ Students are matched with preceptors in hospitals and in clinical offices throughout the four years of medical education. ♦ First year—all students complete a clinical preceptorship that includes, at minimum, eight three-hour ambulatory office experiences that provide opportunities to practice interviewing and history-taking skills. ♦ PBL students take their physical examination course during this year, which also includes outpatient history and physical exam experiences. ♦ Second year—lecture/discussion and ISP students complete their physical examination course, which includes learning experiences in hospital and in ambulatory clinical environments. ♦ Third and fourth years: ♦ Third-year students take a required 12-week ambulatory clerkship with 4.5 days each week in ambulatory clinic environments. ♦ Several other clerkships during the third year involve both ambulatory clinic and hospital ward settings. ♦ Fourth-year selectives and electives are both clinic-and ward-based. Curriculum Review Process ♦ A major curricular reform effort was initiated in 1996 to redesign the clinical curriculum and to be followed by a reformulation of the basic science curriculum. ♦ The dean charged a curriculum committee: to develop new learning objectives for clinical education; starting with a zero base, to define core clinical learning experiences, including first-, second-, third-, and fourth-year experiences and any longitudinal experiences; and to define emphasis programs in primary care and other specialties. ♦ A comprehensive review of the literature was conducted, existing objectives (available at Ohio State and from elsewhere) were analyzed, and academic leaders, faculty, and students were interviewed. ♦ Progress was regularly reported to standing committees and during general faculty meetings. Curriculum committee meeting minutes and draft reports were kept upto-date on the Web for all faculty and students to access. ♦ After the final committee report was approved by the ECC, clerkship task forces were appointed to plan the details of implementation and evaluation. A year of transition and then the current year of full implementation followed this process. ♦ Reform of the preclinical curriculum is currently under way. ♦ Program review is an ongoing process. ♦ Each of the curricular tracks and academic programs has substantial program-evaluation systems to monitor the educational program. ♦ Regular evaluation reports are generated based on student feedback. ♦ Faculty and student representatives on the academic program committees and module directors provide ongoing review. ♦ Each academic program is required to provide an annual report to the ECC documenting the previous year's achievements and presenting planned change for the coming year. Future Goals and Challenges ♦ Providing clinical education in the midst of economic change ♦ Funding faculty to teach, as their primary responsibility ♦ Curriculum reform of the basic science years ♦ Implementation of additional clinical education in the preclinical curriculum ♦ Definition and development of a clinical skills training facility