Georgetown University School of Medicine (2000)

Curriculum Management and Governance Structure ♦ In 1989, Georgetown revised its governance structure. Reporting to an executive vice president and executive dean are four deans: the dean of the school of nursing, the dean for clinical affairs, the dean for research and graduate biomedical education, and the dean for academic affairs. ♦ The dean for clinical affairs has had responsibility for the clinical enterprise, including the hospital, faculty practice plan, and faculty practice network; he or she also has had responsibility for graduate medical education. ♦ The dean for research also has held an appointment in the graduate school and is responsible for graduate bio-medical education. ♦ The dean for academic affairs has had responsibility for the school of medicine's programs for undergraduate and continuing medical education. ♦ This structure was designed to strengthen the authority of the executive vice president for health sciences, who has had oversight over all medical-center-related efforts. It also placed additional emphasis on the importance of the clinical enterprise and graduate medical education, and underscored the focus on research. During the past decade, the research enterprise has grown considerably, with Georgetown now ranking as number 45 in receiving NIH support. The school receives over $100 million in sponsored research support annually. ♦ The restructuring process has also strengthened account-ability for graduate biomedical education, medical student education, and nursing undergraduate and graduate education. ♦ All of the administrators, including the deans, are expected to devote a portion of time to their clinical and/ or research activities as well as direct education activities. ♦ The current administrative governance structure in the school of medicine includes four associate deans and two assistant deans reporting to the dean for academic affairs. ♦ Of the four associate deans, one is full time and directs educational planning and evaluation and the Office of Continuing Medical/Professional Education. ♦ The associate dean for the clinical curriculum is 75% time, devoting 50% of the time to the education program, and the remaining 25% to student affairs and support. ♦ The associate dean for the preclinical curriculum spends half of his or her time in the education program. ♦ The associate dean for admissions spends about one fourth of his or her time in the admission function, working with a full-time director of the Office of Admissions. ♦ There is an assistant dean for students and special programs who also directs minority-related activities, and an assistant dean for international activities. ♦ Administrative educators also reporting to the academic dean are the director of the library and learning resource center, the director of educational media, and the director of student financial services. ♦ Educational policy is set by the executive faculty (composed of department chairs, institute directors, representatives from the faculty senate, deans, and associate deans), who approve policies recommended by faculty committees such as the Committee on Medical Education. ♦ Recent economic constraints on the academic health center, as well as in the local market, have led to further structural evolution. In February 2000, Georgetown signed an agreement with a not-for-profit partner, MedStar Health. Under the terms of this agreement, which was effective July 1, 2000, MedStar, not Georgetown University, will have responsibility for the clinical enterprise, including Georgetown University Hospital, the Faculty Practice Group, and the Community Practice Network. ♦ Clinical faculty will continue to hold university appointments, but they will be MedStar employees. ♦ There will be no change in the academic missions of research and education, and these areas will remain part of the university. ♦ Department chairs will be responsible to MedStar for the clinical functioning of their departments, and responsible to the deans of research and academic affairs for their research and educational functions. ♦ For the initial transitional period, the executive vice president will continue to have authority over all facets of the enterprise. ♦ It is anticipated that the positions of dean for academic affairs and executive vice president will be combined in the future, and there are plans to initiate a national search for someone to fill this position within the near future. ♦ Since early 1999, there has been an extensive planning process involving more than four dozen faculty who have served on an academic planning committee or its sub-committees (on basic science education, clinical science education, graduate biomedical education, and research) and who have assisted in defining the structure of the new academic relationship. ♦ The committee was co-chaired by the dean for academic affairs at the school of medicine and the dean of the graduate school, and had representation from all campuses. The committee assisted in developing an academic affiliation agreement for the new relationship. ♦ The design of this partnership is unique, but offers a strong balance of clinical strength, financial stability, and focus on the academic mission. Office of Education ♦ The office was established coincident with curriculum revision and re-evaluation in the early 1990s. ♦ The office is housed within the office of the associate deans of the school of medicine, and was initially staffed by a PhD educator and a staff of associates. It focused on the development of faculty skills, small-group teaching, curricular management, and evaluation. ♦ Current efforts have expanded to include course and student evaluation, informatics, and problem-solving activities. ♦ The associate dean for educational planning has assumed leadership responsibility, and an effort is under way to expand the professional staff, especially in the area of evaluation. ♦ The office interfaces with other educational support activities within the office of the academic dean, including the medical library, the biomedical academic computing center, and the Office of Educational Media. These activities are currently funded through the tuition-based budget. ♦ A goal of the current development campaign is to create a center for excellence in medical education, which includes an endowed chair for medical education (funded within the past year), a faculty development center for media and electronic methods, and professorships in medical education. The center would provide key teachers with partial support over two to three years to work with the center and the office of the academic dean in developing educational programs. Budget to Support Educational Programs ♦ The current budget for the school of medicine is funded through tuition-derived dollars. Since the costs of medical education exceed tuition, over the past decade the school has utilized funds from the clinical enterprise to subsidize both medical education and research. ♦ As the funding from the clinical enterprise has diminished, and as the process of the clinical partnership with MedStar Health evolved, the school has begun a process of valuation of its mission-based efforts, designed to analyze the structure of academic and research efforts, as well identify the difference between actual costs of these efforts and available tuition and grant funds. ♦ The mission-based valuation of the education process is becoming the template for a move toward rational budgeting process. ♦ As a part of the Third Century Campaign of the university (a development effort), the school is working to increase its resources and close the financial gap through grants and philanthropy. ♦ The clinical partnership is a gain-sharing opportunity with resources to strengthen the academic mission. Valuing Teaching ♦ The departments identify primary teaching faculty; department chairs work in concert with the academic dean to identify those responsible for educational efforts (e.g., a course or clerkship director). ♦ The faculty constitute the core membership of educational planning committees. ♦ The rank and tenure process traditionally is the mechanism to recognize teaching efforts by faculty. However, students honor faculty who have made significant contributions to their education through the yearly Golden Apple faculty teaching awards (one for each class year) and the Kaiser Permanente Awards for sustained excellence in teaching (one for clinical science and one for basic science each year). ♦ Students also award faculty for excellence in teaching anatomy, for gender equity, and for humanism. Students vote for these faculty through secret ballots, and both nominees and awardees are recognized at a formal school-wide banquet and at graduation ceremonies. ♦ Students evaluate each course and clerkship, and provide additional feedback through the AAMC graduation surveys and postgraduation surveys on the perceived quality of their education. Through their responses, it is apparent that students perceive that the faculty are committed to teaching. ♦ The promotion and tenure committee has increasingly valued teaching (in addition to other scholarly activity) in determining promotion and tenure of full time faculty. ♦ While educators have always been eligible for promotion and tenure based on nationally recognized scholarly recognition in education, in 1993 the school also began a clinician educator track. This non-tenure track recognizes individuals who dedicate significant and sustained efforts to scholarship in education: developing educational materials, administering educational programs, and demonstrating excellence in teaching. CURRICULUM RENEWAL PROCESS Learning Outcomes ♦ Faculty have begun the process of clarifying expectations for graduates through several venues. ♦ Education committees have been reviewing the education guidelines developed by the AAMC's Medical School Objectives Project (MSOP) and their applications to the school's curriculum. ♦ Both basic and clinical science faculty utilize the USMLE content area as a source in defining course and clerkship knowledge objectives. ♦ Clinical clerkship directors have drafted a core knowledge list for primary care and are developing a list of expected learning outcomes and clinical skills for each clerkship. They also are developing a brief introduction to clinical skills immediately prior to the third year, as well as a plan for specific clinical skills assessment. ♦ Students, through the student medical education committee (which provides ongoing input to the various faculty education committees upon which students serve and vote) and a student-developed Task Force on Professionalism, have drafted a statement of professionalism and expected behavior (of faculty as well as students), using a broadly representative process of soliciting input from students, faculty, and school leaders. This effort will lead to specific recommendations for course content and outcomes related to such topics as cultural diversity and professional behavior. Changes in Pedagogy ♦ The overall curriculum can be described as a hybrid of traditional department-produced, lecture-based instruction combined with problem-based learning, clinical problem solving, small-group teaching, and early clinical exposure. ♦ With the addition of PBL in the mid-1990s, course directors were asked to reduce lecture hours. ♦ In addition to the traditional basic science courses, the first and second years contain clinical bridging courses such as clinical bioethics and religious traditions in health care, as well as a practicum in ambulatory care. ♦ In the first year, small-group and case-based discussions are held in Introduction to the Patient, Introduction to Health Care, and clinical bioethics, which include interviews of actual patients. ♦ In the second year, clinical bioethics, psychiatry, dermatology, physical diagnosis, and problem solving also use case-based, small-group teaching, and a second semester about ambulatory care provides a practicum for developing clinical skills. ♦ Small-group discussions use PBL in the first year, in some courses. ♦ Case-based, patient-oriented problem solving occurs in pharmacology, pathology, and microbiology and immunology. ♦ The past two years have seen a de-facto decrease in small-group teaching, a change that is related to financial pressures on faculty time and effort. ♦ Standardized patients are used for teaching and/or assessment in the first year (Introduction to the Patient), the second year (physical diagnosis), and the fourth year (emergency medicine). ♦ In 1999-2000, the school initiated a required week-long course in clinical pharmacology and pharmacotherapeutics that was case-based and used both lectures and small groups. Application of Computer Technology ♦ Students are not required to purchase computers, but recent estimates indicate that at least 70% of the students are connected to the Internet at home. ♦ Computers with on-line capacity are available in the major classrooms, and plans are to upgrade additional educational venues so that computers can be utilized in both large-group and small-group teaching. ♦ All students have e-mail accounts through the school, and computer facilities are provided in the library's biomedical academic computing center. ♦ On an ad-hoc basis, courses have integrated computer technology to varying degrees. ♦ In the third-year family medicine clerkship, which lasts four weeks, students on rural tracks are provided with laptop computers and Internet accounts. They participate in small-group case discussions over the Internet, and have resources for medical information retrieval through links to the medical library. ♦ Third-year students also maintain computer-based logs of patients and of procedures observed and performed. ♦ Virtually all functions of student and course registration and management are handled on line. ♦ Each first-year student is required to complete an introductory informatics course. ♦ A task force is currently exploring an integrated four-year informatics curriculum. ♦ The medical library home page serves as a portal for most students to reach these resources. ♦ The school has added a MEDCAREERS home page with active links to all career-planning resources on line as well as the links needed for the matching process. ♦ A project has been initiated to develop a personalized home page for faculty that links important resources (Medline, MD Consult, and other licensed electronic journals available through the library) for education and faculty development. ♦ Classrooms are gradually being upgraded to state-of-the-art media equipment in conjunction with live access to Web-based curricular materials. The principal classrooms for the first and second years have been upgraded, and small classrooms will follow. ♦ One course has moved to a Web base for course materials —with all lectures being available outside class on the Web; others are following suit. ♦ The internal medicine clerkship has all objectives, study questions, and clerkship assignments on the departmental Web page; other departments are developing similar materials. ♦ There is a Web-based case log system that is being upgraded to track individual students' patient and problem exposures across all clerkships, and to relate such exposures to goals of the clerkship. ♦ The Department of Family Medicine has piloted a Web-based program for students at remote sites where case logs are reviewed, reference resources and learning objectives are provided, and a virtual small-group discussion is conducted once a week. ♦ At least three vertical integration groups (in geriatrics, clinical pharmacology and error reduction, nutrition, and bioethics) are planning Web-based tracking of educational themes across the curriculum so that students can utilize resources in the area and monitor their progress toward completion of objectives (mastery of materials) over four years. Changes in Assessment ♦ Standardized patients are used in the preclinical years, and there are plans to initiate OSCEs with SPs as part of clinical assessment. ♦ Every third-year student must complete one patient workup (history and physical) under faculty observation. ♦ One major new thrust of the interdisciplinary curriculum in clinical ethics is reflected in the curriculum's use of skill-based exercises in certain topic areas of clinical ethics, e.g., truth telling and breaking bad news, informed consent and refusal, and genetic counseling. ♦ In part two of the curriculum, faculty observation of student performance of these skills has been included, along with the usual assessment methods (e.g., observations of small-group interactions and contributions, essays, and objective examinations on content). Clinical Experiences ♦ Students go to physicians' offices all four years: in years one and two as part of ambulatory care (one semester each year), and in year three as part of extensive ambulatory care experience in pediatrics, family medicine, and internal medicine. ♦ Brief experiences in physicians' offices or other ambulatory settings may occur in neurology, psychiatry, obstetrics—gynecology, and/or surgery and the surgery specialties. ♦ The fourth year contains two four-week required ambulatory care rotations (selected from internal medicine, family medicine, pediatrics, obstetrics—gynecology, and psychiatry), which may take place in physicians' offices or in other ambulatory settings. Students may also elect to have rotations in physicians' offices. ♦ Second-year students learn physical diagnosis in physicians' offices, other ambulatory settings, and the inpatient units of Georgetown University Hospital and its affiliated hospitals. ♦ All third-year rotations (and the required 12 weeks of acting internships in the fourth year) have inpatient components at Georgetown University Hospital and/or its affiliated hospitals. ♦ Fourth-year students also have four weeks' clinical experience in an emergency department setting. Curriculum Review Process ♦ The school has recently launched a process of curricular review. ♦ In the 1998-99 academic year (more than three years ahead of the schedule for the self study in preparation for reaccreditation by the LCME), the school initiated an ongoing process of intensive analysis of each component of the preclinical (both basic sciences and bridging courses) and clinical curricula. ♦ The reviews are conducted by ad hoc committees composed of faculty (with expertise in or relevant to the subject matter of the clinical and ♦ utilized in the include basic information and curricular materials from the such as and the of student of the and and internal student performance (e.g., along with other information including developed by or academic topic from the and and recommendations of such as the and the ♦ all in the third and fourth years have been reviewed, and one of the preclinical courses have been ♦ There have been several major curricular and specific including ethics and medical informatics, clinical problem solving and and geriatrics, and clinical skills. ♦ The ethics and professionalism in the design of an curriculum (which graduate nursing students and medical students), which is now in year two of its with one and two and in In 2000, a of part three will be and in a of part four will be ♦ The informatics assessment in 1998-99 a the integration of informatics materials the four-year curriculum. ♦ The problem-solving and has a a move toward more learning that will the preclinical and clinical and students to and the relevant objectives with a of such as those between problem-based learning and clinical ♦ The clinical skills has a new addition to the third-year curriculum that will a brief basic introduction to several key skills prior to the of the ♦ A of the curriculum has initiated a process of vertical integration of topics and the curriculum, with goals and skills, case-based as well as Web-based materials and and ♦ The planning and resources required for these efforts include and from the and from other in similar efforts e.g., on student performance and on evaluation administrative leadership faculty time student time funding for materials and support ♦ The of this process include the of constraints on faculty time, the to faculty to lead and participate in these efforts the to that for change the system to be working the of to or more for curricular change and ♦ The and described will be by students the for curricular evaluation and feedback by the faculty and with reference to and including student on and ♦ Educational reviews take place through the on clinical curriculum and preclinical curriculum of the Committee on Medical Education. There is a Web-based evaluation program for students to individual courses, their and teaching faculty. The information is with course directors responsible for the courses and with their department chairs, course faculty, student education and the ♦ Students their of courses to the deans, course and clerkship directors, department chairs, and student education committees in a of the ♦ directors, department chairs, and students deans in to the clinical sites in the teaching and ambulatory care settings. ♦ The school reviews to the AAMC's and graduation postgraduation to the graduates at the of the year), to about the and from the USMLE and other ♦ the of the year 2000, the process of to by the will be It will upon and the work by the reviews described and will also the school in an analysis of including of the objectives for the program as a and for each of its ♦ In addition to the of the curriculum in students for the learning of the one of the key the school will have to will be the and of its recently clinical partnership with MedStar the not-for-profit health