Brown University School of Medicine (2000)

Curriculum Management and Governance Structure ♦ The governance structure for the educational program at Brown University School of Medicine rests with the Medical Curriculum Committee (MDCC). ♦ A faculty member who serves a renewable five-year term chairs the MDCC. ♦ The MDCC recently underwent substantial revision of its structure to reflect the implementation of the competency-based curriculum, MD2000. The chairs of the assessment committees for MD2000 were added to the MDCC as voting members. The at-large membership to the MDCC was reduced to keep the overall membership at around 30. Standing subcommittees for the basic science years, core clerkships, and clinical electives were created for horizontal and vertical integration. The subcommittees on the basic science years and core clerkships have adopted a process for regular review of courses and clerkships. Office of Education ♦ The Office of Curriculum Affairs was created in 1991 concurrent with the planning and implementation of the competency-based curriculum, MD2000. ♦ The office has primary responsibility for the implementation, monitoring, and evaluation of the competency-based curriculum and the overall curriculum. ♦ The office plans and conducts faculty development and supports a mentoring program for faculty to develop their teaching skills. ♦ The office conducts long-term program evaluation in conjunction with an external institutional curriculum-assessment committee. Budget to Support Educational Programs ♦ Budgets are assigned for each course and clerkship, but generally do not include faculty salaries. ♦ In the last two years, the medical school has implemented a practice of compensating hospital-based faculty for teaching in the first two years of medical school based on a formula that reflects both effort and the quality of teaching. The funds for this are contributed by the teaching hospitals to the medical school. Valuing Teaching ♦ The school has two tracks for full-time faculty: the research scholar track and the teaching scholar track. ♦ Although faculty in the research scholar track are expected to teach, the teaching scholar faculty regard teaching as their primary mission. ♦ Each department sets its own goals on the proportion of its full-time faculty on one or the other track. ♦ Criteria for reappointment and promotion on the two tracks reflect their different emphases. ♦ For promotion on the teaching scholar track, faculty must be excellent teachers and play leadership roles in teaching, such as serving as a course leader. CURRICULUM RENEWAL PROCESS Learning Outcomes ♦ Brown faculty have defined the learning outcomes required of all students for graduation. ♦ The outcomes are reflected in the publication An Educational Blueprint for the Brown University School of Medicine (〈http://biomed.brown.edu/Medicine_Programs/MD2000/blueprint.html〉). ♦ The learning objectives consist of nine abilities and the knowledge base. The nine abilities are effective communication basic clinical skills using basic science in the practice of medicine diagnosis, management, and prevention lifelong learning self-awareness, self-care, and personal growth the social and community contexts of health care moral reasoning and clinical ethics problem solving ♦ The learning objectives were defined using a nominal group process, a Delphi technique, and further refinement through working groups. ♦ The process is described in detail by Smith and Dollase in Medical Teacher, 1999;21:15-22. Changes in Pedagogy ♦ The institution of our competency-based curriculum has resulted in significant changes in the pedagogic methods used. ♦ Each required course has responsibility for teaching not only the knowledge base in that discipline, but at least one of the nine abilities. ♦ Students are assessed using performance-based methods where they must synthesize the knowledge with the ability in order to perform at an acceptable standard of competence. ♦ The result of the changes is more active learning, more clinical relevance, and more nontraditional methods of teaching and learning, such as service learning, independent study, use of standardized patients, and group cooperative learning. Application of Computer Technology ♦ Students are not required to own computers, but most do. ♦ Computer technology is reflected in the educational program through Web-based resources and course Web pages. (For example, five slides from each lecture in pathology are placed on that course's Web site.) Changes in Assessment ♦ As described above, our competency-based curriculum has shifted the emphasis from traditional paper-and-pencil testing to performance-based assessment methods. ♦ Students are asked to do what they know, as reflected in: more individual and group projects self-reflective and interpretive writing such as journals community service use of standardized patients and OSCEs practical exercises case write-ups and presentations higher-order-thinking test problems ♦ OSCEs are now used in most clerkships and a summative, multidisciplinary fourth-year OSCE has been instituted. Clinical Experiences ♦ Students participate in clinical learning in hospitals, physicians' offices, neighborhood health centers, patients' homes, long-term care settings, hospices, occupational health clinics, planned parenthood clinics, HMOs, prisons, community centers, college health clinics, other community organizations and agencies, and the public health department. Curriculum Review Process ♦ Plans for evaluation and review of the curriculum include qualitative evaluation over the next five years by outside evaluation team(s) student evaluations of courses and clerkships monitoring of student achievement on performance-based assessments related to the nine abilities residency program directors' ratings of graduates on the nine abilities comparing practice patterns of Brown graduates with those of graduates of other schools Future Goals ♦ The major themes for our school in the next five years will focus on faculty development student assessment program evaluation mechanisms to reward and compensate faculty ♦ In the area of faculty development, the school needs to enhance the faculty's skills in teaching the new competency-based curriculum, particularly in nontraditional areas such as lifelong learning; moral reasoning and clinical ethics; self-awareness, self-care and personal growth; and the social and community contexts of health care. ♦ Student assessment is closely linked to these faculty development efforts. ♦ The school needs to perfect and validate new methods of performance-based assessment. ♦ The program-evaluation effort will examine how successful our new competency-based curriculum has been in achieving its goals. ♦ The school must grapple with the new reality in health care financing in which health insurers implicitly subsidize medical education.