Portal de Periódicos da CAPES

Albany Medical College

2010; Lippincott Williams & Wilkins; Volume: 85; Linguagem: Inglês

10.1097/acm.0b013e3181e95aa7

1938-808X

Henry Pohl,

Curriculum Management and Governance Structure (Figure 1)FIGURE 1:: Undergraduate Curriculum Planning, Management, Policy, and Quality Improvement ♦ The Undergraduate Medical Education (UME) Council is a subcommittee of the Academic Governing Council. The Council is responsible for the planning, implementation, oversight, and policies of the UME program. The Council represents education committees of each Clinical Department and the basic science Interdisciplinary Research Centers (IRC). The Chairs of each Department and the Directors of each IRC are official members. Membership includes a student from each class, the OSR representative, and the Director of the Library. There are four working groups, one for each year of the curriculum, managed by two Assistant Deans, one for Years 1 and 2 and one for Years 3 and 4, who report to the Council. Office of Education ♦ An Office of Medical Education was established in 1987 to support curricular change. The Office manages the academic logistics of the curriculum including course scheduling, syllabus development, faculty development support, examination administration, and student–faculty evaluation meetings. ♦ In November 2005, a Department of Medical Education was established to harbor the Sosa Academy of Medical Sciences, the Office of Medical Education, and faculty with education as a career priority. Four support staff and one full-time and one part-time (0.5 FTE) education specialist work with the Chair and other Department faculty to fulfill the responsibilities of the Department. ♦ Formal faculty development sessions and faculty curriculum development support are provided by the Sosa Academy of Medical Sciences and the Office of Medical Education. Financial Management of Educational Programs ♦ The Administration is committed to maintaining the funding of all of the educational programs. Philanthropic dollars from the Dean's discretionary funds and the Sosa Academy supplement hard dollars for the UME program. ♦ All of the academic programs are managed by the Vice Dean for Academic Administration in order to assure that institutional resources support the needs of all of the academic programs. Valuing Teaching ♦ The Sosa Academy of Medical Sciences, established in 2005 through philanthropic donations, provides advocacy and support for faculty educators, stimulates curriculum development and reform across the continuum of medical education, offers a variety of faculty development activities, emphasizes the patient–doctor relationship, encourages extramural funding for educational activities, and promotes educational scholarship in the form of presentations and publications. The Academy presents awards (a sizeable stipend and a plaque) during the Graduation Ceremony to recognize outstanding teaching, mentoring of students and faculty, and educational contributions throughout the continuum of undergraduate, graduate, and continuing medical education. ♦ Teaching is an important criteria used for appointment and promotion. Curriculum Renewal Process ♦ The curriculum revision complete in the 1990s was predicated on ongoing continuous improvement to enhance the curriculum over time. The school will begin a process to better integrate the third- and fourth-year curriculum and encourage iterative learning over the entire four years. Learning Outcomes/Competencies When the “new” curriculum was instituted in 1993, outcome objectives developed by the faculty at Albany Medical College, SUNY Buffalo, and SUNY Syracuse as part of the Josiah Macy Foundation Grant to establish the clinical competency center were adapted by the faculty to anchor the curriculum. In December 1998 and February 1999, the Undergraduate Medical Education Council reviewed and revised the expectations to more comprehensively reflect the school's goals. The following served as the cornerstone of the curriculum: ♦ Combining knowledge and skills with an understanding of the relationship between the needs of the society and the needs of individuals, students graduating from Albany Medical College should have the ability to (1) identify clinical problems; (2) accumulate data; (3) interpret data; (4) assess the urgency of clinical situations; (5) develop diagnostic strategies; (6) develop management plans; (7) document data, assessment, and plans in the record; (8) appreciate the cost of caring for patients; (9) counsel patients; (10) educate patients; (11) promote wellness and preventive strategies; (12) use the scientific method to initiate and evaluate research; (13) teach others; (14) demonstrate professional attitudes; (15) demonstrate ethical imperatives; (16) demonstrate an understanding and respect for cultural differences; (17) function as a health care member; and (18) become a lifelong learner. The goals had correlated with the MSOP objectives. ♦ At the time of the 2003 LCME site visit, the outcome objectives served as the basis for initiating a competency-based approach to curriculum monitoring and development. ♦ In 2007, the clerkship directors gathered to consider changes in the third- and fourth-year curriculum. The Clerkship Directors determined that although the 18 objectives reflected planning and monitoring, they did not offer sufficient guidance to anchor a truly competency-based approach. After reviewing many possible formats, the working group elected to adopt competency-based objectives that were patterned after the ACGME Competencies but reflected the intent of the school's original outcome objectives. ♦ The Undergraduate Medical Education Committee discussed, edited, and added to the original proposal. In 2008, the objectives were reviewed again, resulting in some changes. In 2009, the objectives were reviewed as part of a Faculty Development workshop, gaps were noted, and additions were proposed. The UME Council reviewed and approved the revised objectives. They were also approved at the Academic Governing Council and are represented by the current objectives. The major objectives are included here. Albany Medical College Graduation Objectives Graduates who achieve the MD degree from Albany Medical College are expected to demonstrate the knowledge and skills to practice patient-centered, culturally sensitive care while respecting the relationship between the needs of society and the needs of the individual. With this foundation for the practice of medicine, Albany Medical College requires that each graduating student demonstrate the following abilities in order to be deemed competent to undertake further training in graduate medical education programs ♦ Medical knowledge: Students must demonstrate knowledge about established and evolving biomedical, clinical, and associated sciences (e.g., epidemiological and social–behavioral) and application of this knowledge to the practice of medicine throughout the life cycle. ♦ Patient care: Students must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of illness and the promotion of health. ♦ Interpersonal and communication skills: Students must display interpersonal and communication skills that foster effective information exchange and build rapport with patients, their families, and professional associates. ♦ Practice-based learning and improvement: Students must be able to examine and evaluate their patient care practices, appraise, and assimilate scientific evidence, and use this information to improve their abilities while developing strategies to use these skills to continuously improve their care of patients. ♦ Systems-based practice: Students must demonstrate knowledge of and responsiveness to the larger context of health care and the ability to effectively call on system resources to provide care that is of optimal value to the health of the individual and of the community. ♦ Professionalism: Students must demonstrate a commitment to the highest standards of professional responsibility; adherence to ethical principles; and sensitivity in all interactions with patients, families, colleagues, and others with whom physicians must interact in their professional lives. New Topics in the Curriculum Since 2000 ♦ Addiction Medicine ♦ Chronic Disease ♦ Geriatrics ♦ Emergency Preparedness: All third-year students are brought together to spend a day focused on each of these topics. This helps assure that students have an overall awareness of the topic areas to complement what they have covered in clerkships or basic science themes. All sessions are interactive large group, small group, or a combination. ♦ Interprofessional Team Learning: This year we are initiating joint learning experiences with our Physician Assistant Program to explore the role of Physicians and Physician Assistants as relates to the care of acute, chronic, and health maintenance care. We are focusing on the team approach to each level of care. Changes in Pedagogy ♦ Using SAKAI, a Web-content management system, students can be required to review material before interactive sessions documented with pre and posttests and/or engage in interactive online discussions. ♦ Team-based learning using interactive small groups with groups being responsible for learning outcomes has become the primary pedagogic tool in one course. ♦ Standardized patient families have been developed to be used in interactive large or small groups to help students explore family meetings, ethics consults, autopsy requests, giving bad news, and making medical errors. ♦ Utility of these methods has been tracked with student performance on MCQ, Clinical Skills examinations, and USMLE Step examinations. Changes in Assessment ♦ NBME customized examinations have been added in the first two years. Sometimes they are used in conjunction with home-grown examinations. ♦ The Graduation Clinical Skills Examinations has become more comprehensive and sophisticated to better test the school's competency-based outcome objectives. ♦ Self-assessment exercises have become universal. Clinical Experiences ♦ The sites for clinical education are Albany Medical Center Hospital, Veterans Administration Hospital, Multiple Community Hospitals, Albany Medical College Practice Ambulatory Clinic sites, Community Practitioner practice sites, AHEC-related rural and inner city sites, and locations across the country for Family Practice outpatient experiences. ♦ Clinical Education Challenges: The pressure of clinical productivity both at the Medical College and in the Private Practices is ever present. The use of EMR as it relates to student participation and training needs to be dealt with. Regional Campus ♦ The Bassett Health System in Cooperstown, New York is currently our regional campus for the third year. This relationship will end in 2011. We are exploring options for the future. The Cooperstown program is innovative in that it was developed as a longitudinal experience following brief intense traditional clerkship rotations. The student fulfills the objectives of each traditional clerkship with supervision and monitoring of their ongoing clinical interactions in ambulatory sites. The students follow patients to surgery, to diagnostic tests, and to related care that provides the longitudinal care experiences for the students. Highlights of the Program/School ♦ One of the more innovative aspects of the Albany Medical College undergraduate medical education curriculum are the longitudinal themes that promote iterative and experiential learning linked to ongoing professional responsibilities: Health, Care, and Society: A four-year course that explores ethics, law, humanism, and aspects of social anthropology. Evidenced-Based Health Care: A four-year course designed to teach the principles of evidenced-based medicine, the fundamentals of the systems of health care, and aspects of epidemiology. Nutrition: A three-year course that details the foundations of nutrition, the basis of clinical nutritional analysis, and the role of nutrition in health and disease. Lagrange Medical Informatics: A three-year course that requires the students to demonstrate the ability to use electronic databases to satisfy course and clerkship assignments. Clinical Skills: Over the four years of medical school this course requires students to demonstrate the ability to do a history and physical and communicate with patients in the context of clinical problem solving. ♦ Standardized patients and families are used throughout the curriculum to trigger discussions, enhance clinical reasoning strategies, and explore complicated communication dilemmas. ♦ All fourth-year students are required to take a course entitled “Learning to Teach, Teaching to Learn (LTTL).” The students learn the principles of teaching, assessing learning and giving feedback. The required course refines fourth-year students' clinical skills while they get experience teaching clinical skills to first- and second-year students.