Curriculum Management and Governance Structure ♦ The Curriculum Oversight Committee is the standing committee responsible for the overall curriculum. ♦ Four other curriculum committees (First Year, Second Year, Required Clerkship, Elective Clerkship), composed of course directors, clerkship directors, administrators, and students, provide year-specific discussion and advice on the curriculum (Figure 1).FIGURE 1:: Management of the Curriculum Office of Education ♦ The Curriculum Office within Academic Affairs has primary responsibility for overseeing and managing the curriculum. ♦ The Division of Medical Education and Evaluation within the Department of Medical Education and Biomedical Informatics (MEBI) supports the medical education program in a number of ways. MEBI was founded in 1967 as a division to help medical school faculty improve the teaching and learning process. The division achieved departmental status in 1989. ♦ The department's Division of Medical Education and Evaluation employs nine full-time faculty members and two part-time faculty; many clinician–educators have affiliate appointments in the department. MEBI faculty hold many leadership roles in the School of Medicine. These include representatives on every curriculum committee, Year 1 Curriculum Committee chair, School of Medicine Director of Evaluation, Teaching Scholars Program codirectors, OSCE program codirector, Medical Information for Decision Making course chair, and Institute for Simulation and Interprofessional Studies codirector. ♦ The department's mandate has broadened to provide instruction to faculty and students, conduct faculty development workshops, assist with and implement performance-based teaching and evaluation, and train medical education researchers and educators through the Teaching Scholars Program conduct research into teaching and learning in a variety of settings provide professional services for health sciences faculty, including course evaluation and test design and scoring develop innovations in biomedical and health informatics Financial Management of Educational Programs ♦ The diversity in the revenue base of the School of Medicine has helped the School respond to the current global financial crisis. ♦ The School's sources of revenue remain stable. However, the relative proportion of total revenue derived from each source is changing over time: Although state revenues and spending will continue to be constrained and the School of Medicine's state funds were cut in Fiscal Year 2010, the state revenue in support of a recent medical school class expansion will continue to be phased in until fully funded in 2013. The University and the School of Medicine completed a seven-year capital campaign in FY 2008. UW Medicine exceeded its capital campaign goal of $1 billion; the pledges of endowment and gifts supporting faculty, students, and programs will be realized over the next few years. The School is in a good position to continue to realize above-average growth in research programs that are integral to its educational programs. The hiring of faculty who are leaders in biomedical sciences and clinical practice and who are active in biomedical research is an important source of the School's success and high quality. The clinical programs recorded continued growth and positive financial performance in Fiscal Year 2009. Rapid systemwide process improvements to reduce costs, eliminate redundant services, and improve overall efficiency in conjunction with effective strategic planning increased key patient volumes and revenues. Revenues are transferred from the practice plans and hospitals to support the teaching, research, and patient care activities of the School of Medicine. ♦ Both the University and the School of Medicine provided bridge funding to support the academic programs. ♦ UW Medicine, the health system in which the School of Medicine is one of seven entities, is executing a comprehensive strategic plan to improve performance, implement new programs, consolidate programs to reduce costs and increase efficiency, and develop business plans around the larger strategic initiatives. The implementation of the strategic plan will achieve desired growth in the system and inform future decisions around resource allocation in the face of ongoing financial turmoil. Valuing Teaching ♦ The Colleges program, although technically not a teaching academy, has created an effective learning community of medical school teachers: Started in 2001, the Colleges' program consists of 37 faculty educators who function as a cohesive learning community, administrative unit, and cadre of teachers and mentors within the School of Medicine. The Colleges oversee a four-year integrated curriculum of clinical skills and professionalism; teach the Introduction of Clinical Medicine II course throughout the second year through weekly bedside teaching sessions with consistent, small student groups; and provide a consistent faculty mentor for all students throughout their medical school career. Faculty from diverse specialties are selected through a competitive process and devote a minimum of 0.25 FTE to the Colleges; selection criteria include clinical, teaching, and mentoring excellence. Faculty conduct and receive considerable faculty development in addition to direct involvement in curriculum development, teaching, and mentoring activities. ♦ The Teaching Scholars, a nine-month faculty development program, has developed a cadre of faculty educators who continue to work together on educational projects, workshops, and curriculum development after they have completed the formal program. To date, 168 faculty from more than 20 clinical specialties, including nursing, physician assistants, pharmacy, and dentistry, have participated in the program. Many have been promoted and/or gone on to leadership positions at UW and elsewhere. ♦ The UW Medicine Faculty Appointments and Promotions Guide, which augments departmental criteria and the University Faculty Code, states that “to foster innovation and creativity, flexibility is encouraged in how contributions to scholarship, teaching, and service are evaluated and weighted.” The guide describes the scholarship of teaching as an important type of scholarship; teaching contributions listed as scholarship include curriculum development, materials for in-house use, educational software or video, educational information on the Internet, and new methods to evaluate the success of educational programs and the progress of trainees. ♦ Virtually all promotion packets now include a teaching portfolio that documents and highlights the faculty member's educational contributions. ♦ Evaluation of the scholarship of teaching is elicited through solicited evaluations from outside reviews at the time of promotion, including users of the information (faculty, trainees, students, and so on) and/or publication in peer-reviewed journals and presentation at scientific meetings. Curriculum Renewal Process ♦ The UW School of Medicine launched a comprehensive review of the medical school curriculum in 1998. The review was completed in 2001 and implementation of the resulting plan began in 2001-02. ♦ The guiding principles of the charge by the Dean specified that the review should include a balanced, thorough examination of course content examine teaching methods employed, emphasizing the introduction and use of contemporary information technology assure continuity and internal integrity within the curriculum, with strong themes introduced in first year and followed throughout the four years develop clear lines of responsibility and authority for the administration and management of the curriculum and its component parts develop a new approach to teach core clinical skills and professionalism ♦ The curriculum review process was organized into three phases: Phase I assessed the current curriculum, identifying strengths, weaknesses, and opportunities for enhancement; Phase II developed recommended changes to address areas of concern in Phase I; and Phase III developed specific implementation plans for the recommendations. Changes to the first and second years as a result of the curriculum review included addition of an evidence-based medicine and critical thinking first-year course that has evolved into Medical Information for Decision Making greater emphasis on small-group versus lecture-based teaching addition of the Colleges program, in which a cohort of dedicated clinical faculty teach bedside clinical skills to small groups of assigned students throughout the second year and continue to mentor those students throughout their medical school education Major additions to the third and fourth clinical years included: a required 4-week Neurology Clerkship, a required four-week surgical selective, and expansion of the Chronic Care/Rehabilitation Medicine Clerkship from two to four weeks, with focus on chronic care, rehabilitation medicine, geriatrics, pain management, and palliative care. The medical student research requirement was restructured into an Independent Investigative Inquiry, with expanded options for completing the requirement, including data gathering/hypothesis-driven inquiry; critical review of literature; experience-driven inquiry; and a special simulation-based experience. The curriculum management system was restructured to implement year-specific curriculum committees and a curriculum oversight committee. Learning Outcomes/Competencies ♦ The University of Washington School of Medicine learning objectives are available at: http://uwmedicine.washington.edu/Education/MD-Program/Current-Students/Curriculum/Pages/default.aspx. New Topics in the Curriculum Since 2000 ♦ Patient safety is included in the following courses: Medical Information for Decision-Making (first year), Capstone I-Transition to Clerkships (second year), Medicine Health and Society (second year), courses in the Institute for Simulation and Interprofessional Studies (ISIS) (courses available in all years) ♦ Quality improvement is included in the following courses: Medical Information for Decision Making (first year), Medicine, Health and Society (second year), Introduction to Clinical Medicine II (second year), ISIS (all years) ♦ Team-based learning is included in the following courses: Capstone I-Transition to Clerkships (second year), Problem-based Learning (second year), Chronic Care Clerkship (fourth year), Emergency Medicine Clerkship (fourth year), ISIS (all years) ♦ Simulations/training in new surgical techniques are included in the following: Capstone I-Transition to Clerkships (second year), Capstone II-Transition to Residency (fourth year). Started in 2005, ISIS was founded to improve the cost, patient safety, and quality of medicine by improving the education system for health professionals. ISIS trains students, residents, and fellows in psychomotor skills, interprofessional and communication, crisis management, and team building. Currently, ISIS is one of the few simulation centers nationally with a focus on collaborative research and is the nation's only simulation center that has begun to quantify utilization. Future plans focus on integrating education and research to deliver patient safety and quality outcomes and further integrating simulation into education. ISIS currently has 16 courses in which medical students can participate, including basics of airway management, emergency medicine procedures and resuscitation, thoracentesis, suturing and wound management for medical students, fundamentals of laparoscopic surgery, and others. Areas of Increased Emphasis Since 2002 ♦ Cultural competency (incorporated into many courses and programs, including Introduction to Clinical Medicine I and II, Healthcare for the Underserved, and through longitudinal pathway programs that students may undertake: Hispanic Health Pathway, Indian Health Pathway, Global Health Pathway, and Underserved Pathway). ♦ Evidence-based medicine (including the required first-year course Medical Information for Decision-Making). ♦ Bedside clinical-skills teaching, especially through the Colleges program in Introduction to Clinical Medicine II. ♦ Professionalism and ethics (incorporated into multiple courses, including Introduction to Clinical Medicine I and II; Cases in Clinical Ethics; and others). ♦ Medical humanities (incorporated into a number of courses, including Mind, Body and Pen: Writing and the Art of Becoming a Physician; Thinking Visually: How to Observe in Depth). ♦ Global health (incorporated into courses offered through the Department of Global Health, including Introduction to Global Health, Multidisciplinary Perspectives in Global Health, Global Health Challenges, and others). ♦ Successful transitions between training stages (incorporated into Capstone I-Transition to Clerkships and Capstone II-Transition to Residency). ♦ Chronic care, including increased attention to end-of-life care (incorporated into the expanded Chronic Care Clerkship that offers rehabilitation medicine, palliative care, pain management, and geriatrics core options; Respectful Death: Exploring Interdisciplinary End-of-Life Care; and other courses). Changes in Pedagogy ♦ Increased emphasis on small-group learning; success is measured through student course evaluations and faculty course evaluations. ♦ New emphasis on alternative learning technologies—Podcasts, Mediasite, common learning resources across regional sites; success is measured through student and faculty course evaluations. ♦ Increased emphasis on bedside teaching of basic skills; success is measured through annual surveys, exit interviews, student performance, attitude surveys, and other methods. ♦ Provision of transitional instruction between classroom and clerkships and medical school and residency; success is measured by surveys at the completion of transition experiences/courses. ♦ Increased emphasis on vertical integration of medical skills; success is measured by regular discussions between College Faculty with clerkship directors. ♦ Increased emphasis on professionalism; success is measured by end-of-year student surveys, student course evaluations, and exit interviews. ♦ Increased emphasis on mentoring and incorporating mentoring into the educational process through the Colleges; success is measured by student surveys and exit interviews. ♦ Increased emphasis on student and faculty learning communities through the Colleges program; success is measured by student surveys, exit interviews, and faculty surveys. ♦ Increased focus on interprofessional collaboration and teamwork; success is measured through multiple ISIS evaluation mechanisms. Changes in Assessment ♦ Clarification of and emphasis on evaluation of professionalism/professional behavior in education and practice. ♦ Limited utilization of web-based testing in basic science and clinical courses. ♦ Use of NBME subject examinations in clerkships. ♦ Increased centralization and standardization of student evaluation of courses and clerkships across all teaching sites. Clinical Experiences ♦ As the regional allopathic medical school for more than one quarter of the land mass of the United States, the UW School of Medicine relies on approximately 200 clinical training sites throughout the five-state WWAMI region (Washington, Wyoming, Alaska, Montana, and Idaho) for ensuring that the students have exposure to an appropriate mix of clinical teaching settings. ♦ The main teaching hospitals and clinics in Seattle are the University of Washington Medical Center, Harborview Medical Center, UW Physicians Neighborhood Clinics, Seattle Children's Hospital, and the VA Puget Sound Health Care System; Northwest Hospital and Regional Medical Center joined UW Medicine in 2010. ♦ These sites are supplemented in the WWAMI region with major, well-established hospital teaching sites in Boise, Idaho, Anchorage, Alaska, Billings and Missoula, Montana, and Spokane, Washington, and smaller hospitals and clinics in towns and cities across the WWAMI region. ♦ The clinical instruction is rated very highly by medical students and is regarded as the greatest strength of the curriculum; the individual clerkships receive exceptional overall ratings, in particular for teaching and patient care interactions. ♦ Because students complete their clerkships across five states with multiple clinical instructors, collecting and providing grades and feedback on clinical performance can take long periods of time; new electronic resources are strongly mitigating this time lag. ♦ The logistics of travel to and housing and services at clinical sites throughout the five-state region can be challenging, especially for students with families; the school and individual clerkships attempt to reduce this challenge as much as possible by providing housing at distant sites. ♦ Residents do not teach students in all regional clinical sites; this introduces both challenges and opportunities. Residents are a good source of constant teaching for students and introduce different levels and types of instruction; where residents are not available for teaching, students have a unique opportunity to work directly and closely with attending physicians, particularly in small rural sites. Regional Campuses ♦ The University of Washington School of Medicine's WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) program utilizes six regional campuses, in addition to the main campus in Seattle, for the first year of medical school: Montana State University—Bozeman, Montana University of Alaska at Anchorage—Anchorage, Alaska University of Idaho—Moscow, Idaho University of Wyoming—Laramie, Wyoming Washington State University—Pullman, Washington Washington State University Riverpoint Campus—Spokane, Washington (started in 2008, adding 20 medical students per class to the School of Medicine) Highlights of the Program/School The Colleges program provides students with a combination of strong, standardized bedside clinical-skills training in the second year in small-group settings, sustained mentoring from a College faculty member throughout students' education, and community and connectedness in the context of a large medical school. As the medical school for the five WWAMI states, the UW School of Medicine's regional program is truly unique; the strong partnership that has developed among universities across these states, including legislatures, academic and community physicians, and health care professionals, is a model of collaboration, resource sharing, and cost efficiency. The School of Medicine focuses on and has relative success in addressing the need for primary care and health care for underserved regions while maintaining a strong research program. In its efforts to increase and enhance primary care and health care for the underserved, the School has developed unique programs, such as the Targeted Rural Underserved Track (TRUST), the WWAMI Rural Integrated Training Experience (WRITE), and the Rural/Underserved Opportunities Program (R/UOP) programs, in which students spend from weeks and months to entire years in rural and underserved communities learning medicine. The Department of Global Health, founded in 2007 as a joint department within the schools of Medicine and Public Health, builds and expands on long-standing strengths in infectious diseases. Students have multiple options for courses and international experiences. Additional educational opportunities are provided through the Institute for Health Metrics and Evaluation, established in 2007. It is a research center that measures the world's pressing health issues and provides scientific evaluations of health system and program performance for guiding health policy and accelerating global health progress.
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