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• W3080428666 abstract "Medical Education Program Highlights Oregon Health & Science University (OHSU), founded in 1887, is the only academic health center in the state of Oregon. OHSU is committed to graduating physicians with demonstrated skills in lifelong learning and improvement—leaders who can adapt to and develop future innovations in the health system, leading to better outcomes for patients and communities. In addition to transferring information and skills, OHSU School of Medicine strives to prepare the student for lifelong learning and scholarship; synthesis of information, critical reasoning, and problem solving; self-assessment and reflection; and collaborative clinical practice. The curriculum explicitly integrates the scientific basis of medicine with relevant clinical experiences within and across each phase of learning. It offers students progressive patient care responsibilities, fosters independent learning, and allows individualization of educational experiences. Students learn in an integrated curricular model, in which scientific principles of normal and abnormal human structure and function are woven throughout and incorporated as threads. The goal of the OHSU School of Medicine curriculum, YourMD, is to effectively prepare the MD graduate for residency training and professional practice to best serve and meet the needs of society in the 21st century. Key aspects include: Competency-based education and assessment: Students are taught and assessed on their progress in attaining competencies linked to courses, clinical experiences, and other curricular elements that span the 6 domains of competence aligned with the ACGME framework. Frequent formative and summative assessments provide students with timely feedback to support their continued learning. Faculty portfolio coaches help students identify areas of academic strengths and challenges, and they offer resources and advice to overcome identified academic problems. Two assistant deans for student affairs who are dedicated to medical students, along with course directors, other UME educational leaders, peer tutors, and faculty-led review and tutoring sessions, are all available to support students. Integration of curriculum: Integration and spiraling of basic, clinical, and health system sciences promotes comprehension and retention. Lifelong learning: Students have opportunities to develop this critical skill through their mentored scholarly project, narrative medicine, written reflections, and meeting with their faculty portfolio coach to develop individualized goals. Learner-centered pedagogical approaches foster development of critical reasoning and independent problem-solving skills. Individualization of curriculum: Opportunities for curricular flexibility and customization are provided throughout the curriculum and start in year 1 with clinical preceptorships, enrichment activities, electives, and service learning. Curriculum Curriculum description See Supplemental Digital Appendix 1—Curriculum Template (Without Acceleration)—at https://links.lww.com/ACADMED/A913. See Figure 1—Curriculum threads.Figure 1: Curriculum threads.Curriculum changes since 2010 In 2012, OHSU embarked upon a radical curriculum transformation. The innovative YourMD competency-based, integrated, and learner-centered curriculum replaced the previous traditional 2 + 2 discipline-based curriculum and was launched with the entering class of 2014. YourMD includes 2 phases and 3 transition courses that bridge the progression from premedical to the foundations of medicine phase, from the foundations of medicine phase to the clinical experience phase, and from the clinical experience phase to postgraduate residency training. Starting in 2014, the class size gradually phase increased from 139 to 160 per year to address projected workforce shortages. The faculty responsibilities and availability of institutional resources were taken into account before final decisions regarding class expansion. The expansion of class size was successfully accommodated by the opening of a new education facility, hiring of new staff positions, and newly recruited clinical sites. Assessment OHSU School of Medicine UME program competencies were compiled and devised using the AAMC Physician Competency Reference Set, the ACGME 6 core competency domains, clinical informatics competencies, and OHSU interprofessional core competencies. See Supplemental Digital Appendix 2—Program Objectives and Assessment Methods—at https://links.lww.com/ACADMED/A913. OHSU School of Medicine uses competency-based assessments in both simulated and authentic clinical environments. Using standardized assessment instruments, trained faculty who are qualified assessors determine students’ milestone level along each competency. All required courses in the preclerkship curriculum phase have common assessment components, including weekly quizzes on both knowledge and skills attainment to provide frequent and low-stakes feedback. In addition, all required courses in the clerkship phase have a standardized assessment structure. A workplace-based assessment platform provides students a mechanism to receive ongoing, immediate, and formative feedback on the 13 Core Entrustable Professional Activities (Core EPAs) for Entering Residency. Pedagogy OHSU School of Medicine uses a multimodal pedagogical approach. In particular, case-based learning, peer teaching, lecture, preceptorship, simulation, self-directed learning/tutorial, standardized patients, video, virtual patient, lecture, lab, workshops, group discussions, narrative medicine, and both inpatient and ambulatory clinical experiences are all used to achieve the medical education program objectives. Clinical experiences OHSU students complete clinical rotations at a variety of clinical sites. This includes OHSU Hospital, the Portland Veterans Affairs Medical Center (VAMC), and many community-based hospitals and outpatient facilities throughout Oregon and Southwest Washington, including rural sites across Oregon. All students are required to complete a continuity clinical experience, which is typically an 8-week full-time core or elective clinical experience offered in a variety of clinical disciplines allowing students to maintain continuity in at least 2 of the following 3 ways: continuity with the same patient population, continuity with the same health system, and continuity with the same preceptor(s). OHSU students are exposed to clinical experiences through their preceptorship course in year 1. Students can choose from multiple disciplines with curricular emphasis on system-based practice, practice-based learning and improvement, and interpersonal communication competencies. OHSU students are required to complete a rural rotation. Students can choose from various disciplines including but not limited to family medicine, internal medicine, pediatrics, surgery, neurology, psychiatry, cardiology, anesthesiology, and otolaryngology. In addition, many students complete required and elective clinical rotations at community sites and the Portland VAMC. Challenges faced in designing and implementing clinical experiences include: Providing clinical experiences across a large geographical area. The large area creates the challenge of ensuring that each site has adequate support such as housing and clinical space as well as ensuring that the rotations provide appropriate instruction across disciplines. Creating objective rubrics for assessment of the medical education program objectives, as well as training faculty, residents, and others who assess medical students on the rubrics. Curricular Governance See Figure 2—Curricular governance committees.Figure 2: Curricular governance committees.Education Staff The Office of Undergraduate Medical Education (UME) provides administrative and academic support for all aspects of UME in the School of Medicine. The Office of UME is led by the associate dean for UME and a team of 2 assistant deans for student affairs, an assistant dean for admissions, 4 directors, and 25 additional professional and administrative support staff whose responsibilities include admissions, assessment, evaluation, course coordination, registration and scheduling, curriculum data, technical support, scholarships, wellness, student affairs, outreach, and accreditation/continuous quality improvement. The Office of UME provides administrative support to the UME Curriculum Committee (UMECC) and its 5 subcommittees: Foundations of Medicine, Core Clinical Experience Directors, Curriculum Development, Curriculum Evaluation, and Curriculum Resources. UMECC is responsible for reviewing and revising the overall goals and objectives of the UME curriculum, as well as assuring that these goals and objectives are achieved. See Figure 3—Dean chart.Figure 3: Dean chart.Faculty Development and Support in Education Faculty in the School of Medicine have access to a plethora of knowledgeable individuals and resources to help them improve their skills in teaching and assessment. The school’s assistant dean for continuing professional development and assistant dean for faculty development help coordinate workshops, seminars, and lectures in a wide variety of education topics for teachers at our institution in both clinical and basic science departments, as well as for teachers at our regional clinical partner sites. The Office of UME has a full-time doctoral-level director of UME assessment, and the Office of Graduate Medical Education supports a part-time doctoral-level faculty member, both of whom assist and train faculty members for learner assessment as well as course and program evaluation. The School of Medicine supports the faculty-driven Educators’ Collaborative, which hosts monthly faculty development and education grand rounds as well as the annual Symposium on Educational Excellence daylong conference that includes small-group discussion on topics of interest such as academic writing, curriculum design, and best practices for improving teaching and assessment skills for learners across the educational continuum. The School of Medicine supports the Education Scholar Program, a 9-month longitudinal cohort program where participants learn both education theory and methods. Program activities include sessions about effective education strategies for small- and large-group teaching, flipped classrooms, asynchronous learning, and mentoring for participants related to their application of educational concepts to current educational projects. The Teaching and Learning Center is a centrally located resource accessible to faculty across the institution. Its main focus is to assist faculty in skill development on a variety of topics such as how to perform formative and summative assessments of student learning and how to develop, implement, and improve best practices in teaching and course design. The Provost’s Office of Educational Improvement and Innovation is tasked with leading institution-level faculty development initiatives such as professional development series workshops aimed at new/junior faculty. Efforts include coordinating faculty leadership and professional development grants, cosponsoring education mini-grant opportunities with School of Medicine, and creating new resources such as the Fostering Respectful and Equitable Education website for faculty to reference as they make their courses more inclusive. Initiatives in Progress YourMD curriculum transformation initiative: The UME curriculum was radically transformed beginning in 2012, and the first cohort of the new curriculum launched with the entering class of 2014. Since that time, the curriculum has continued to evolve and adapt so that graduates are optimally prepared to practice in the highly complex and everchanging health care delivery environment of today. The School of Medicine has partnered with and received support from national organizations such as the American Medical Association’s Accelerating Change in Medical Education and Reimagining Residency consortia, and the AAMC’s Core EPAs for Entering Residency pilot, which has provided rare opportunities to advance innovative ideas that promise to transform medical education on a national and international scale. Being a part of the community of forward-thinking change agents from across the nation has been vital to the success of our transformation initiatives at OHSU. We believe our bold and courageous spirit of continual improvement toward “better”—better processes and enhanced outcomes—will benefit our students, staff, faculty, institution, and most important, our patients. In 2019, OHSU, in conjunction with the University of California, Davis, was awarded an American Medical Association grant to establish a robust graduate medical education collaborative known as COMPADRE, short for the California Oregon Medical Partnership to Address Disparities in Rural Education and Health. COMPADRE will place hundreds of medical students and resident physicians to train under faculty and community physicians at 10 health care systems, 16 hospitals, and a network of federally qualified health center partners throughout Northern California and Oregon. COMPADRE’s main goals are to address health care workforce shortages in rural, tribal, urban, and other communities that lack resources; increase access to health care providers; and improve the health of patients from ethnic and racial minority groups who are disproportionately affected by certain conditions. As part of the Core EPA pilot, OHSU is working toward ensuring every student is entrustable in the 13 Core EPAs. This includes forming an Entrustment Group whose focus is to make summative decisions, based on defined criteria, on whether a student has achieved a level of skill that will result in “badges” symbolizing that they are residency ready. Our goal is to find students who are behind and require extra support, as well as those who may accelerate through the curriculum. In the future, this will allow students to have a time-variable education and advance to residency when they are ready, not when a certain amount of time has passed, thus helping to address the growing physician shortage as well as reduce debt." @default.
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