The New Curriculum at Case Western Reserve School of Medicine · The New Curriculum at Case Western Reserve School of Medicine ... – Internal Medicine 12 weeks ... Clinical Activity

Transforming Medical Transforming Medical EducationEducation

The New Curriculum at Case Western Reserve School of Medicine

Daniel R. Wolpaw, M.D.Professor of Medicine

Case Western Reserve University School of MedicineCleveland, Ohio

Transforming Medical Transforming Medical Education at CWRUEducation at CWRU

Objectives:Compare and contrast changes in medical education at CWRU over the last centuryOutline the guiding educational principles of the new curriculumDescribe the new 4 year MD curriculum at CWRU

Western Reserve Before 1953Western Reserve Before 1953

Department Chairs “owned” the curriculumSeparate courses in basic science disciplinesMinimal patient or clinical contact before clerkships

The Education Revolution of The Education Revolution of 19531953

Department Chairs removed from ownership of the curriculumOrgan system organizationEarly clinical exposure – Family ClinicDramatic reduction in classroom time -increased student responsibility for learningThesis requirement

Living with the Revolution:Living with the Revolution:1953 to 20061953 to 2006

Scholarship (thesis) requirement removed - 1960’sPeriodic review without significant change in structureFalling behind in innovation and early patient contactClerkships unchanged other than increased ambulatory exposureModel LCME review 2001

The 2004 Curriculum:The 2004 Curriculum:Year 1 Year 1 -- NormalNormal

The 2004 Curriculum:The 2004 Curriculum:Year 2 Year 2 -- AbnormalAbnormal

The 2004 Curriculum:The 2004 Curriculum:Year 3 Core ClerkshipsYear 3 Core Clerkships

7 Separate rotations:– Internal Medicine 12 weeks– Surgery 8 weeks– Family Medicine 4 weeks– Pediatrics 8 weeks– OB-Gyn 7 weeks– Neurology 4 weeks– Psychiatry 6 weeks

The 2004 Curriculum:The 2004 Curriculum:Year 4 ElectivesYear 4 Electives

Student choice of 4 week experiencesActing Internships, Specialty Consult Services, ResearchResidency interviewing

Why Change Now?Why Change Now?The New EnvironmentThe New Environment

Increasing demands on Faculty time –demands of funding and clinical careTechnology: – Expanding electronic resources – Video-streaming and Pod-casting

Resident work hours

Why Change Now?Why Change Now?The Information EnvironmentThe Information Environment“The electronic environment has changed the role of content in learning by fiat. It has rendered the teaching-as-transfer-of-information model pretty much obsolete….

From Weimer, From Weimer, LearnerLearner--Centered TeachingCentered Teaching, 2002, 2002

Why Change Now?Why Change Now?The Information EnvironmentThe Information Environment…Today’s learners must be able to access information, find resources, organize them, and, perhaps most important, evaluate the ocean of information that now exists in that electronic sea.”

From Weimer, From Weimer, LearnerLearner--Centered TeachingCentered Teaching, 2002, 2002

Why Change?Why Change?A New VisionA New Vision

Dean Horwitz (2003): Four pillars:1. Scholarship2. Clinical Mastery3. Civic Professionalism4. LeadershipGraduate School environment – student responsibility for learningBeginning with learning objectives

The New Curriculum:The New Curriculum:LearningLearning--Centered PrinciplesCentered Principles

Medical education will be experiential and instill the skills for critical thinking and lifelong learningEducational methods will be chosen that stimulate an active interchange of ideas between students and faculty

The New Curriculum:The New Curriculum:LearningLearning--Centered PrinciplesCentered Principles

Students and faculty will be mutually respectful partners in learningStudents will be immersed in a graduate school educational environment characterized by flexibility and high expectations for independent study and self-directed learning

Focusing on the Learner:Focusing on the Learner:Constructivist TheoryConstructivist Theory

Learners must actively construct their own knowledge and meaning rather than passively receive information from teachers and textbooks.

A New ParadigmA New Paradigm

Old Paradigm New Paradigm

Teacher Centered Learner Centered

Faculty give information Students seek information

Teaching Time Learning Time

Summative assessments Formative, reflective assessment

Year I Year II Year III Year IV

Core Clinical Rotations(48 weeks, flexible scheduling)

Research and Scholarship(4-month block plus electives, flexible scheduling)

Advanced Clinical and Scientific Studies

(10 months, flexible scheduling)

Foundations of Medicine and Health

(20 months, including vacation)

Medical Education at CWRU: Integration, Scholarship, and Flexibility

The Foundations of Medicine The Foundations of Medicine and Healthand Health

Putting organ systems togetherLongitudinal themesBeginning with learning objectivesCase Inquiry Groups – PBLSelf-directed learning + extensive resourcesClinical immersionsFormative assessment

A Week at Case School of Medicine and Health:Aligning the Schedule with Educational

Objectives

Monday Tuesday Wednesday Thursday Friday

8-10 AM LearningGroups

Science ofClinicalPractice

LearningGroups

Self-directedLearning

LearningGroups

10-12 PM InteractiveSessions

Anatomy/Histopath/Radiology

Interactivesessions/Research &Scholarship(1 hr)

Self-directedLearning

InteractiveSessions

12-1 PM

1-5 PM Clinicalskills

Self-directedLearning

Self-directedLearning

Self-directedLearning

Self-directedLearning

Surface vs. Deep LearningSurface vs. Deep Learning

Surface learning: Memorization of facts, focus on the discrete elements of the reading, poor differentiation between evidence and information, absence of reflection, tasks seen as an external imposition

Marton and Saljo, 1976

Surface vs. Deep LearningSurface vs. Deep Learning

Deep learning: Learners focus on meaning, relate new information to prior knowledge + experience, work to organize + structure content, view the work of learning as important

Marton and Saljo, 1976

Assessment Methods:Assessment Methods:PrePre--ClerkshipClerkship

Weekly monitoring:Small group performance –

facilitator + peersSynthesis Essay Questions (SEQ’s)Multiple Choice Questions

Assessment Methods:Assessment Methods:PrePre--ClerkshipClerkship

End of Block:Summative SEQ’s – 3-6National Board of Medical Examiners (NBME) Cumulative Exams

Every 3-4 months:NBME Professionalism assessmentPortfolio Reviews

Impact of AssessmentImpact of Assessment

Candid, formative feedbackProductive reflectionPerspective across the full range of competenciesRetention of learningPreparation for Board exams

Research in the New Research in the New CurriculumCurriculum

Mentored experience in research and scholarshipMinimum of 4 months protected timeEach student will identify a question, develop an approach and proposal, engage the project, and interpret findingsProduct: Thesis in the format of a journal manuscript

July Aug Sep Oct Nov Dec Jan Feb Mar Apr May June

Year 1 Vacation or

research

Year 2 Vacation or

research

Researchor

clinical rotations

Year 3 Research or

clinical rotations

Research or

clinical rotations

Year 4

Research and Scholarship

Foundations of Research and Scholarship (1-2 h/week)

Elective research opportunities

Opportunities in Opportunities in Biomedical ResearchBiomedical Research

Basic research

Population-based

research

Clinical research

Translational research

Teaching Clinical Skills before the Teaching Clinical Skills before the Clerkships: Clinical MasteryClerkships: Clinical Mastery

8/06-12/06 1/07-12/08 Jan 08

Introduction to clinical skills

Advanced Clinical Skills

RAMP (Rotating Apprenticeships in Medical Practice)

Clinical Preceptorships

Science of Clinical Practice

Health Policy, Leadership

Civic Professionalism, Ethics

Web Resources

The Clinical Curriculum:The Clinical Curriculum:Key ConceptsKey Concepts

Meaningful collaboration between Departments Well-thought out learning objectivesUniform, criterion-based assessment across hospital sitesDevelopmental modelBasic Science Correlation

Clinical Curriculum:Clinical Curriculum:Required ActivitiesRequired Activities

Basic Core I – 16 weeks: Internal Medicine, Surgery, Family MedicineBasic Core II – 16 weeks: Pediatrics, OB-Gyn, Psychiatry, NeurologyThesis Block (Research) – 16 weeksAdvanced Core rotations – total of 16 weeks (taken as 4 separate rotations)

TYPICAL OPTIONS FOR CORE CLINICAL ROTATIONS AND RESEARCH

Research

16 weeks(March-July)

Basic Core 1 or 2

16 weeks

Basic Core1 or 2

16 weeks

Advance Core

16 weeksFlexible

scheduling

Basic Core1 or 2

16 weeks

Research

16 weeks(July-

November)

Basic Core1 or 2

16 weeks

Advance Core

16 weeksFlexible

scheduling

Basic Core1 or 2

16 weeks

Basic Core1or 2

16 weeks

Research

16 weeks(November-

March)

Advance Core

16 weeksFlexible

scheduling

March 08 July 09

Clinical Curriculum:Clinical Curriculum:Friday Afternoon LearningFriday Afternoon Learning

Basic science correlation – three sessions/month (2 hours each)Advanced Clinical SkillsEvidence-Based MedicineAdvanced Science of Clinical Practice

Advanced Clinical and Scientific Advanced Clinical and Scientific StudiesStudies

Two Acting Internships – each 4 week intensive inpatient or ER rotationAreas of Concentration: 12 weeks of linked experiences integrating basic science and clinical experiences and intended to result in an area of expertiseFurther clinical and research electives

Clinical AssessmentClinical Assessment

Clinical Activity Scores– Basic and Advanced Core rotations– Patient logs and episode-specific feedback– Cumulative Clinical Activity reports

NBME Progress testingNBME Professionalism toolYear 4 OSCE

Clinical Assessment:Clinical Assessment:A Developmental ModelA Developmental Model

Basic Cores Advanced Cores

NBME Progress Test

Clinical Activity Score

Basic Science Correlation

OSCE

Year I Year II Year III Year IV

Core Clinical Rotations(48 weeks, flexible scheduling)

Research and Scholarship(4-month block plus electives, flexible scheduling)

Advanced Clinical and Scientific Studies

(10 months, flexible scheduling)

Foundations of Medicine and Health

(20 months, including vacation)

Medical Education at CWRU: A New Vision