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• W3080877690 abstract "Medical Education Program Highlights Johns Hopkins University School of Medicine (JHUSOM) launched the Genes to Society (GTS) curriculum in 2009 to address a paradigm shift in medicine, acknowledging variation in individual health and illness resulting from multiple societal, genetic, and physiologic factors. See Figure 1—Genes to Society paradigm.Figure 1: Genes to Society paradigm.The GTS curriculum includes novel features that have been continued at JHUSOM and have become standard components of medical school curricula elsewhere. These include horizontal strands (scientific, social, or clinical themes covered across the 4 years)and transition courses that assist with matriculation, entry into clinical care, and passage to internship. The integrated curriculum was built on a framework allowing the curriculum to evolve as students, medical knowledge, the practice of medicine, and societal needs evolve. Specific features include: Rich experience in understanding social determinants of health: communication skills, health behaviors, wellness and pathology, and collaboration with interprofessional teams at institutional and community levels. This experience takes advantage of our location in a culturally diverse urban setting that, with the institution’s global network, provides opportunities to care for a largely underserved population. Personalization and individualization of educational pathways through: Primary care leadership track (PCLT) or global health leadership track (GHLT) Scholarly concentrations in basic science, clinical research, history of medicine, public health research, and HEART (humanism, ethics, education, the arts of medicine) Selectives within Foundations of Public Health and during some core clerkships Choice of ambulatory or critical care for advanced clerkship requirement Selections among Translational Science courses each quarter Multiple local subinternship and electives opportunities (domestic and international) Additional degrees (MD–PhD program, and master’s degrees offered in public health, medical informatics, biomedical engineering, business or health care administration, history of medicine, bioethics, and medical education) The Colleges Advisory Program (CAP) assigns students to 1 of 4 colleges at matriculation (5 students/advisor/class). Advisors teach basic communication and clinical skills, emphasizing patient-centered care. CAP provides longitudinal guidance for academic success and career planning. Intentional connections between basic sciences and clinical medicine with Topics in Interdisciplinary Medicine (TIME, 4-day courses interspersed in years 1 and 2) and Translational Science courses (4-day courses following each core clerkship designed to reenergize students in considering clinical applications of basic science research as they reflect on clerkship experiences). Curriculum Curriculum description The GTS curriculum is organized around the GTS paradigm, with additional details at https://www.hopkinsmedicine.org/som/curriculum/genes_to_society/curriculum-overview.html. See Supplemental Digital Appendix 1—Curriculum Map—at https://links.lww.com/ACADMED/A969. Curriculum changes since 2010 On top of our CQI process, a formal curriculum review in AY 2014–2015 identified opportunities to enhance the GTS curriculum: prioritizing actions in competency-based education, content, and further integration; use of content-appropriate pedagogy; inclusion of new topics in medicine; and additional student assessment and program evaluation tools. Changes since implementation of the GTS curriculum include: Identifying emerging topic gaps in interdisciplinary and translational medicine—high-value care, health informatics, regenerative medicine, and genomic medicine—for which new TIME and Translational Science courses were developed Identifying a need to enhance clinical experiences in ambulatory medicine, leading to development of a new advanced clerkship in adult ambulatory medicine and increased ambulatory experiences in core clerkships Recognition that 8 of 20 original horizontal strands were well-integrated into the standard curriculum, and reorganization of remaining strands into 3 overlapping content areas: biomedical sciences, health systems sciences, and culture of medicine Assessment The Physician Competency Reference Set forms the basis for medical education program objectives. We have increased use of formative assessments in years 1 and 2 through formative questions embedded in e-lectures and live lectures, pre-small-group-session knowledge checks, and narrative feedback from small-group faculty. The Office of Curriculum (OOC) and Office of Assessment and Evaluation (OAE) provide coaching to faculty in item writing to enhance validity and reliability of written and standardized patient assessments. All internally written examination items are tagged for multiple domains (Bloom’s taxonomy level, USMLE content outline topic, and horizontal strand), to provide each student with an individualized report and provide programmatic reports to educational leaders. See Supplemental Digital Appendix 2—Program Objectives and Assessment Methods—at https://links.lww.com/ACADMED/A969. Parallel curriculum or tracks The PCLT and GHLT provide longitudinal educational experiences and mentorship with selected faculty. The PCLT prepares selected students to be compassionate, skilled primary care physicians, innovators, team leaders, and advocates for patients and communities. The GHLT prepares future leaders in global health by leveraging principles of public health, cultural humility, health equity, health justice, and interdisciplinary teamwork to improve care and advocate for patients and communities, locally and abroad. Interested first-year students apply the fall of year 1 and begin longitudinal experiences in January of year 1. Students in the PCLT continue working with longitudinal ambulatory clerkship (LAC) primary care preceptor, spending 1 half day per month during years 3 and 4, allowing a more advanced role in the ambulatory setting with growing clinical experience. Some PCLT educational sessions such as workshops are open to all students. Pedagogy Adult learning theory and strategies to promote lifelong learning are employed, with emphasis on interactive learning methods over lecture. Active learning modalities in years 1 and 2 build upon new content from lectures, e-lectures, and/or reading, to achieve advanced learning objectives such as application, synthesis, and analysis. Methods include discussion, case-based learning, laboratory, team-based learning, journal club, and virtual microscopy. GTS workshops: Students contribute on a rotating basis to weekly workshop presentations in the GTS course, using self-directed learning to prepare a topic they teach to their peers, which is assessed on the summative examination. Clinical courses and clerkships use a variety of content- and skills-appropriate pedagogical methods including role play, simulation, videos, clinical experience, small-group discussion, and peer teaching (Clinical Foundations of Medicine [CFM] course); workshops and case-based learning (LAC); and small-group, workshop, role-play, and simulation activities (preclerkship education exercises). PCLT: Preceptorship and ambulatory clinical experience are supplemented by workshops, role play, team-based learning, video/podcast, journal club, book club, case-based learning, discussion (large and small group), lecture, and peer teaching. GHLT: Students participate in case-based learning, clinical experience, lectures, self-directed learning, role play, and simulation. Changes in pedagogy since 2010 To mitigate unintended differences in outcomes among small groups with different facilitators, the OOC promotes in-person, just-in-time faculty development and provides a template to guide small-group facilitators including learning objectives, student preparation, session timelines, and discussion questions. Active learning sessions increasingly use formative or low-stakes knowledge questions at the beginning, to check and reinforce basic concepts from the required student preparation for the session. Faculty are shifting from lecture to e-lecture format, where new content is delivered in briefer modules with incorporation of formative knowledge assessments and embedded links for optional foundational or enhancement material. Clinical experiences Students’ first clinical experience occurs in fall of year 1 with CFM, where they learn basic communication and physical exam skills in the simulation center with standardized patients, and in the hospital setting. The LAC is a yearlong, weekly experience that provides a longitudinal relationship with a community-based preceptor and their office practice, with opportunities to practice skills learned in CFM, and integrated with the organ systems course in years 1 and 2. TIME courses incorporate simulated patient experiences or patient panels to share patient stories, allowing students to engage in history taking. Transition to the Wards is a 3-week course in year 2 where students prepare for core clinical clerkships in sessions including didactics, small-group clinical reasoning, procedural skills and simulations, and brief experiences on inpatient services. The core clerkships use Johns Hopkins Medicine affiliates including those in urban and suburban settings, and inpatient and ambulatory facilities in Baltimore and the surrounding community. Students may choose to do a portion of the pediatrics rotation at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida. The PCLT and GHLT use the clinical practices of Johns Hopkins Community Physicians and other community preceptors, as well as practices specifically serving immigrant populations. Several popular electives use specialty practice settings supervised by Johns Hopkins faculty—longitudinal health coaching, rural medicine, austere medicine, year 1 interprofessional practice, Latino health pathway, and subspecialty electives in various disciplines. Challenges faced in an effort to increase core clerkship capacity and increase ambulatory medicine skills include providing faculty development, recognizing the need to maintain clinical productivity while teaching students, ensuring uniform quality across sites, and identifying new ambulatory settings and implementing faculty and staff development. Curricular Governance The Educational Policy and Curriculum Committee (EPCC) provides central oversight and guidance for the curriculum. Voting members include directors of required courses and clerkships; representatives from horizontal strands, TIME courses, and CAP; 2 department directors; and at-large members selected by student leaders. EPCC subcommittees and their roles include: GTS Integration Committee: oversees implementation and evaluation of the 4-year curriculum Clerkship Directors and Clinical Skills Committee: oversees and manages clinical portions of the curriculum Student Assessment and Program Evaluation Committee: verifies that medical education program objectives are implemented and assessed effectively; facilitates curricular CQI by recommending actions to course leaders via EPCC in response to evaluation data See Figure 2—Organizational chart.Figure 2: Organizational chart.Education Staff The vice dean for education oversees UME, GME, graduate biomedical education, postdoctoral education, and CME. The following offices support medical student education at JHUSOM: OOC: The associate and assistant deans for undergraduate medical education, with 3 program administrators and 1 instructional designer, oversee implementation and monitoring of the curriculum and assist course and clerkship leaders in ongoing quality improvement. OAE: The assistant dean for assessment and evaluation and the director of the OAE, with a psychometrician, research data analyst, and program evaluation specialist, assist with designing and interpreting results of reliable assessments and program evaluation. Office of Academic Computing (OAC): The assistant dean and director of the OAC, an instructional designer, a programmer, and an audiovisual technician facilitate technologic solutions for delivery of educational sessions and online assessments for medical students. Office of Information Technology (OIT): The director of OIT leads a team of software engineers and program analysts to provide online applications supporting data collection and reporting in support of medical education broadly at JHUSOM. Office of Medical Student Affairs: The associate dean and 3 assistant deans for medical student affairs support students in many aspects of adapting to the medical education environment and navigating ongoing personal and professional matters. One assistant dean also serves as the director of medical student diversity. CAP: The director, associate director, academic program administrator, and 22 faculty create a learning community dedicated to supporting medical students’ professional growth, career development, and well-being. Faculty Development and Support in Education JHUSOM offers a broad range of faculty development opportunities through the Office of Faculty Development (OFD) and Institute for Excellence in Education (IEE), as well as the Master of Education in the Health Professions degree program, a collaboration of the Johns Hopkins Schools of Business, Education, Medicine, Nursing, and Public Health. The mission of the IEE is to promote, value, and advance the educational mission of JHUSOM, and aligns its programs in 4 pillars: improving teaching; inspiring and supporting research, scholarship, and innovation in education; valuing and recognizing teaching and education; and fostering a community of educators. Longitudinal programs and workshops are offered multiple times annually in teaching skills and curriculum development. Faculty may participate in programs offered by the OFD and in a variety of regularly scheduled educational programs and individual coaching programs offered by the IEE. The IEE also offers online modules on its Improve Your Teaching Skills website (https://www.hopkinsmedicine.org/institute_excellence_education/Pillar_1/improve_teaching.html). Faculty can apply for small educational project grants through the IEE. JHUSOM has a number of annual faculty teaching awards presented each year at our convocation ceremony. Additionally, the IEE offers a number of outstanding educator awards and mentors a student-run Distinguished Teaching Society recognizing faculty and residents who demonstrate the highest standards of excellence in clinical teaching. Initiatives in Progress Detailed content review of year 1 and 2 courses to determine whether information taught is foundational (prerequisite), core, or enhancement material for interested students Implementation of a standard teacher evaluation tool to provide evidence of teaching excellence for faculty annual assessments and promotion Implementation of competencies for medical educators Piloting new clinical performance assessment tool for the clinical courses based on Entrustable Professional Activities (EPAs), a mobile platform for collection of assessment data in real time, and a dashboard for student and faculty use to monitor individual and class progress Creation of UME to GME handoff with EPA data to inform interns’ first individualized learning plans" @default.
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