Portal de Periódicos da CAPES

Sidney Kimmel Medical College at Thomas Jefferson University

2020; Lippincott Williams & Wilkins; Volume: 95; Issue: 9S Linguagem: Inglês

10.1097/acm.0000000000003326

1938-808X

Deborah Ziring, Katherine M. Berg, Nina Mingioni, Dimitrios Papanagnou, Urvashi Vaid, Steven K. Herrine,

Health Sciences Research and Education

Medical Education Program Highlights Established in 1824, the Sidney Kimmel Medical College (SKMC) of Thomas Jefferson University (originally Jefferson Medical College) is a large, private medical college in Philadelphia. The first U.S. medical school to incorporate bedside teaching, SKMC has long held the reputation for producing superior clinical graduates. The school is distinguished in the quantity and depth of student community engagement. SKMC recently underwent a significant curricular redesign (JeffMD), transitioning from a 2 + 2 paradigm to a 3-phase program integrating fundamental science, clinical science, and health systems science (HSS) throughout all 4 years. Highlights: Varied pedagogical approaches with tight integration of clinical and scientific concepts in small groups and limited lecture hours Utilization of frequent low-stakes assessments Robust scholarly inquiry requirement for all students in one of several tracks: clinical and translational research, design, digital health, health policy and systems, humanities, medical education, population health Competency-based final curricular phase with pathways to teach and assess general and specialty competencies linked to graduate medical education milestones Home of the Jefferson Longitudinal Study of Medical Education Curriculum Curriculum description The JeffMD Curriculum consists of a preclerkship phase (Phase 1), core clerkship phase (Phase 2), and specialization phase (Phase 3). See Supplemental Digital Appendix 1—Curriculum Overview—at https://links.lww.com/ACADMED/A849. See Supplemental Digital Appendix 2—Curriculum Schematic With Structure and Sequencing—at https://links.lww.com/ACADMED/A849. Curriculum changes since 2010 JeffMD curriculum successfully launched in 2017 with complete implementation in 2021 Increased use of active learning techniques with > 40% reduction of lectures Customization opportunities via scholarly inquiry tracks and specialty pathways Centralization of curricular development, administration, assessment, and quality control Future changes: Expand assured admission programs to increase student body diversity Optimize application of HSS concepts through early clinical experiences Adopt competency-based assessment and learner advancement Class size changes since 2010 While class size has increased from approximately 260 to 270 students, JeffMD offers more opportunities for small-group active learning compared with our legacy curriculum. SKMC introduced a regional campus in 2017 that includes a 6-student longitudinal integrated clerkship (LIC). Medical education program objectives Developed and adopted in 2000 with reference to AAMC Medical School Objectives Project Guidelines (2000), SKMC graduation competencies and linked medical education program objectives were revised in 2016 referencing AAMC core competencies and Entrustable Professional Activities (EPAs) and ACGME transitional year milestones. See Table 1—Medical Education Program Objectives and Assessment Methods.Table 1: Medical Education Program Objectives and Assessment MethodsIn 2017, the SKMC Student Assessment Office was created to provide oversight of all student assessments. With launch of the JeffMD curriculum, SKMC developed the Jefferson Competency Assessment Tool (JeffCAT), a secure online platform that aggregates student assessment data from multiple modalities, providing an integrated portrait of student performance throughout the curriculum. JeffCAT benchmarks student performance to SKMC graduation competencies, EPAs, and ACGME milestones. Administrators and students can track progress longitudinally to identify areas of strength and opportunities for improvement. For Phases 2 and 3, SKMC instituted the Jefferson Direct Observation Tool (JeffDOT), a mobile phone-based application for bedside use, to encourage frequent microassessments and track student progress. JeffDOT uses checklists that, in aggregate, are designed to stratify learners' skill level and provide evidence of progress toward workplace competence. Additional JeffMD assessment changes by phase are described below. Phase 1: Computer-based administration of assessments (quizzes, exams, case-based learning [CBL] peer assessments) through educational technology Weekly low-stakes quizzes to assess mastery of information Rubric grading for CBL, including peer and facilitator assessments Longitudinal tracking of student performance on the NBME Comprehensive Basic Science Self-Assessment over 3 administrations End-of-block, end-of-year 1, and end-of-Phase 1 OSCEs Phase 2: Work-based structured assessment of clinical skills longitudinally Project-based assessments in scholarly inquiry Additional end-of-clerkship OSCEs Integration of NBME subject exams into clerkship assessment structure End-of-clerkship evaluation mapped to SKMC competencies End-of-Phase 2 OSCE Phase 3: End-of-course evaluations mapped to SKMC competencies Project-based assessments in scholarly inquiry and advanced basic science courses Group simulation experiences Implementation of an end-of-Phase 3 OSCE Work-based structured assessment of clinical skills in required Phase 3 courses Parallel curriculum or tracks In 2017, SKMC launched the LIC at the Atlantic Health System, which emphasizes outpatient care, integration between disciplines, and longitudinal relationships with faculty and patients. SKMC plans to offer a 3-year graduation option for 8–12 students, linked with graduate programs at Thomas Jefferson University Hospital (TJUH), beginning in 2021. Pedagogy Various pedagogical approaches are used throughout the 4-year curriculum. Simulation, standardized patients, lectures, and small- and large-group discussion are employed during all phases. Students have in-patient and ambulatory experiences in all phases. Peer teaching occurs during CBL and team-based learning (TBL) in Phase 1 and continues during patient rounds in Phases 2 and 3. Self-directed learning is specifically incorporated into CBL during the preclerkship phase and occurs routinely during the clinical curricular phases. Some pedagogical approaches are limited to specific phases. In Phase 1, the cornerstone of the curriculum is small-group CBL using a guided inquiry approach. TBL is extensively incorporated as well. The Phase 1 communication skills curriculum uses role plays and a preceptorship. Gross anatomy dissection and virtual microscopy labs occur in Phase 1 as well as during advanced basic science courses in Phase 3. SKMC moved from a predominantly lecture-based curriculum to a longitudinally integrated, case-based organ system curriculum requiring close collaboration between basic and clinical scientists. SKMC now uses more active learning approaches including CBL, TBL, audience response, flipped classrooms, and patient panels. A longitudinal scholarly inquiry track was added to teach and foster research principles; humanities selectives were expanded. Clinical experiences All required clinical experiences occur at either TJUH or one of several affiliated community-based academic medical centers. Each offers exposure to a diverse patient population and an opportunity to see medicine practiced in a variety of settings. Students can participate in one of our branch campus programs, which focus most clinical rotations at a particular community site. Christiana Care Health System in Delaware serves as a regional medical campus, providing students in the Delaware Branch Campus program with clinical experiences. Students enrolled at Main Line Health Branch Campus do most clinical rotations at the hospitals of the Main Line Health Systems. Students enrolled in the LIC complete their clinical requirements at the Atlantic Health System in New Jersey. However, most students will complete core clerkships at both TJUH and community-based academic affiliates. Required longitudinal experiences Students in the LIC receive longitudinal clinical exposure with a small host of dedicated preceptors in major specialties. All students have a 4-year scholarly inquiry longitudinal experience incorporating research projects and mentoring. Clinical experience first encounter SKMC students' first clinical exposure is 4 months into the first year, when they partner with community health workers at outpatient sites for first-hand exposure to the challenges patients face and ways social determinants affect patient care and health care delivery. Required and elective community-based rotations SKMC does not require any community-based rotations. However, most students complete at least part of their required core clerkships or fourth-year rotations at an affiliated community-based academic medical center. Challenges in designing and implementing clinical experiences for medical students Considerable effort is invested to maintain the number and quality of clinical sites for students to ensure they receive outstanding clinical teaching within the geographic area despite the high demand for clinical placements. Curricular Governance Decentralized curricular governance There is granular departmental involvement in core clerkships through the clerkship directors and coordinators, although there is central oversight of Phase 2. The LIC, due to significant administrative need and its location remote from the main campus, has considerable autonomy in its functions. Most of the educational budget is administered centrally, although a portion is within control of the departments. See Figure 1—Office of the Dean administrative organizational chart.Figure 1: Office of the Dean administrative organizational chart.Education Staff The office staff includes 1 vice dean, 1 senior associate dean, 3 associate deans including 1 dean of professionalism, 1 business manager, 2 administrative assistants, and 5 educational coordinators. A curriculum technology specialist performs curricular mapping, technologic tools training, and building/problem-solving with the learning management system. An assistant dean of assessment, director of student assessment, senior psychometrician, and 2 data analysts comprise the Undergraduate Medical Education Student Assessment Office. The Office of Academic Affairs works closely with the SKMC Center for Research in Medical Education and Health Care, particularly on the Jefferson Longitudinal Study of Medical Education. A faculty member is supported part time as phase director for each of the 3 phases of the curriculum, ensuring longitudinal integration and spiraling of content. The office is responsible for medical student curriculum planning and evaluation, student promotion and remediation processes, accreditation activities, and affiliate collaborations. The administrative faculty and staff in the office are responsible for undergraduate and graduate medical education. It is not responsible for areas outside of educational programming. See Figure 2—Curricular governance committees.Figure 2: Curricular governance committees.Faculty Development and Support in Education Professional development for faculty as educators The Office of Faculty Affairs and Faculty Development (OFAFD) provides a multifaceted faculty development program offered continuously across the academic year and features content across 3 thematic domains to assist faculty with their career advancement: effective teaching, research skills, and leadership and management. Curricular content is curated by an interdisciplinary, interprofessional cadre of faculty members across the 10 schools of the university. Content represents domains of expressed need for faculty skills, with a particular focus on pedagogy. The program includes a series of in-person workshops, with remote access for affiliate faculty. Sessions are recorded and archived, and remain available for asynchronous access. Faculty are eligible to earn continuing medical education credits for participation. In addition, a series of interactive modules in pedagogy are developed and made available for faculty. The OFAFD sponsors its annual signature Faculty Days Program, a full-day interprofessional multidisciplinary event consisting of presentations by and for Jefferson faculty who share their knowledge and strategies to improve teaching and learning for learners across the continuum. Most recently, to equip faculty with skills to facilitate CBL sessions in the setting of the revised curriculum, the OFAFD developed an immersive 4-part multimodal training program. Part 1 offered faculty a series of asynchronous modules covering principles of facilitation, including peer-vetted resources. Part 2 provided faculty with video recordings of actual CBL sessions modeled by seasoned faculty facilitators with medical students. Part 3, an in-person workshop, immersed faculty in a simulated CBL session, followed by a large-group debriefing. An optional Part 4, offered to faculty weeks before their first session (just-in-time), was executed through co-facilitation with expert facilitators. Role of teaching in promotion and tenure Faculty contributions to the educational mission of SKMC are heavily weighted in promotion and tenure decisions. Contributions to teaching are evaluated through faculty members' education and teaching portfolios, which are reviewed during appointment and promotion procedures. Excellence in teaching remains a critical criterion for promotion across all tracks at SKMC. Furthermore, educational scholarship can be leveraged for promotion and tenure decisions in scholarship-based tracks in the medical school. Regional Medical Campuses The Delaware Branch Campus offers all core clerkships, as well as required fourth-year rotations such as subinternships, to 6–8 students each academic year. The Atlantic Health System Branch Campus is the site for the LIC, enrolling 6 students each academic year; expansion up to 12 students per year is under consideration. Educational experiences across sites The Delaware Branch Campus Program and the LIC program are relatively local, allowing participating students to commute to the SKMC campus for required educational activities and assessments. Each clerkship has a single set of educational objectives that are reviewed annually with the branch campus clerkship site directors, who are accountable to the main clerkship directors. The LIC Program was designed to meet SKMC educational goals and objectives. Patient logs, with identical targets as those for the rest of the student body, are used to monitor clinical experiences. All students submit standard end-of-clerkship questionnaires after every clerkship and, at each site, the results of which are used to compare student experiences across sites and assure comparability of educational experiences. Finally, a student-run clerkship liaison program regularly queries the student body about their clinical experiences and reports their findings to the core clerkship phase director.