MPCCOctober 12, 2012

Drivers: Local needs/challenges• Physician shortage current – perhaps 1,800• By 2020: 4,000-6,000• Closing the gap and the ongoing loss of physicians to

their communities through retirement, etc.• Distributional issue

• Recruiting to rural environment• Retaining physicians in rural environment• Who will come, who will stay?• Pipelines-AHEC

• Inability to recruit and retain in central-north region• Let’s start our own medical school!

Challenge: Criticality of retention

• Retain currently practicing physicians• Retain our trainees• Issue of access to care

• Physician supply: global, by specialty – general surgery, psychiatry, family medicine, internal medicine, pediatrics

• Physician distribution – geographic• Distribution - specialties

Medicine’s Challenges/Drivers of change:

(Reports: Macy, HHMI, AAMC)• Accelerating pace of scientific discovery• Calls for more public accountability• The economy• Rising cost of health care• Shortfalls in health care quality: IHI call for care that is safe, effective, pt-ctrd., timely, equitable (personal, evidence-based, holistic)

• Racial/ethnic disparities• Rising burden of chronic illness/disability (boomers)

Challenges/needs – improving medical education• Re-define foundation sciences of medicine

• Psychology, social science, quality improvement, decision science, epidemiology, EBM…

• Social determinants of health/wellness• CQI and Evidence-based practice

• Facilitate problem solving and self-directed learning skills

• Assure students experience continuity of care• Emphasis on community-based education rather than the hospital (reality, retention)

Improving medical education

• Prepare students to work as team members (inter-professional teams)

• Increase knowledge of public health and non-biological determinants of health and disease• CQI in practice• Reporting publicly, and for MOC

• Develop teaching and mentoring skills of faculty – lecturing does not facilitate learning…

Improving medical education

• Proper learning environment• Hidden curriculum and professionalism (Hafferty)• Learning in simulated and actual clinical environment

• Simulation• Patient presentation model (rich case model, digital presentation)• Standardized, simulated patients• Teaching OSCE – actual patients• Computer simulations

• Integration of instruction• Clinical relevancy of content

Carnegie 2010-Med Ed System Expectations• Creates opportunities for integrative and collaborative

learning• Inculcates habits of inquiry and improvement• Provides a supportive learning environment for

professional formation (students and residents)• Advances health of patients and populations• Standardizes learning outcomes• Integrate formal learning with clinical experience –

community engagement• Develops habits of inquiry and improvement into medical

education at all levels• Focuses on progressive formation of professional identity

The CMU plan• Location of the college• Holistic admissions process• The curriculum• The teachers and mentors• The training sites• Control debt• AHEC

Mission

•Prepare exceptional physicians• Improving access to individualized, essential care (health care delivery)

•Focus in rural and medically underserved regions of Michigan

• Rural/small community focus• Differentiated skill set• Generalist focus: (FM,IM, Peds, Gen Surg, Ob/Gyn, Psych, EM,

PM&R)

Vision

• Excellence in instruction/active learning• Team-based learning experiences• Early patient contact • Student-centered environment/program• Patient-Centered care• Residencies (new, distributed)• Community-based, 11 affiliations thus far

Future Practice of Medicine• Patient-centered care

• Patients as individuals and member of population to be cared for supporting health assessment, patient outreach, illness prevention strategies

• Systematic assessment and improvement of quality indicators for physicians, hospitals, systems, patient populations

• Coordinates and delivers care through organized systems

• Places value on cost-effective care• Helps address constraints on health care resources

Helps to define physician skill set for future

Formal Knowledge/ Courses embedded in:

Clinical Experience (real and virtual), in an environment of:

Inquiry, Discovery, Innovation

Year I Year II Year III Year IV

Integrated Curriculum

Course StructureYEAR 1

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46

47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94

95 96 97 98 99 100 101 102 103

YEAR 31 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

MED 640: REPRODUCTIVE/HUMAN DEVELOPMENT

(8 wks)

SPRI

NG

BREA

K

MED 650: CARDIO/PULMONARY: WELLNESS & DISEASE

(10 wks)

BREA

K (2

wks

)

MED 600 SOCIETY AND COMMUNITY MEDICINE

MED 610 ESSENTIALS OF CLINICAL SKILLS

MED 620 ART OF MEDICINE

ORI

ENTA

TIO

N MED 630: FOUNDATIONAL SCIENCES OF MEDICINE (21 wks)

WIN

TER

BREA

K (3

wks

)

MED 620: THE ART OF MEDICINE

MED 600: SOCIETY AND COMMUNITY MEDICINE

MED 610: ESSENTIALS OF CLINICAL SKILLS

YEAR 2

MED 730: RENAL/ENDOCRINE: WELLNESS & DISEASE

(10 wks)

BREA

K (2

wks

.)

MED 740: NEUROSCIENCES/BEHAVIOR:WELLNESS & DISEASE

(12 wks)

MED 750: MUSCULO-SKELETAL/

DERMAL(4 wks)

MED 610: ESSENTIALS OF CLINICAL SKILLS MED 610: ESSENTIALS OF CLINICAL SKILLS

MED 620: THE ART OF MEDICINE MED 620: THE ART OF MEDICINE

BOARD PREP

RESEARCH PROJECT

MED 770: HEMATOLOGY/

ONCOLOGY (5 wks)

MED 600: SOCIETY AND COMMUNITY MEDICINE MED 600: SOCIETY/COMMUNITY MEDICINE SOCIETY/COMMUNITY MEDICINE SOCIETY/COMMUNITY MEDICINE

WIN

TER

BREA

K (

3 w

ks)

MED750: MUSCULO-SKELETAL/

DERMAL (4 wks)

MED 760: GASTRO-

INTESTINAL: WELLNESS &

DISEASE (4 wks)

SPRI

NG

BREA

K

MED 760: GASTRO-

INTESTINAL (3 wks)

ESSENTIALS OF CLINICAL SKILLS ESSENTIALS OF CLINICAL SKILLS

THE ART OF MEDICINE THE ART OF MEDICINE

LONGITUDINAL CLERKSHIPS

HOLI

DAY

BREA

K (2

wks

)

LONGITUDINAL CLERKSHIPSCC - A

(4 wks)CC - B

(4 wks)CC - C

(4 wks)CC - D

(4 wks)

YEAR 451 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100

CC/CE (4 wks)

LONGITUDINAL CLERKSHIPS

HOLI

DAY

BREA

K (2

wks

)

LONGITUDINAL CLERKSHIPSCC - A

(4 wks)

CC/CE (4 wks)

CC - B(4 wks)

CC - C(4 wks)

CC - D(4 wks)

CC/CE(4 wks)

CC/CE(4 wks)

CC/CE (4 wks)

CC/CE(4wks)

CC/CE(4 wks)

CC/CE(4 wks)

CC/CE (2 wks) 2

wk.

Ho

liday

br

eak CC/CE

(2 wks)CC/CE

(4 wks)CC/CE

(4 wks)CC/CE

(4 wks)

Curriculum• College culture: respect, compassion, inclusiveness,

social responsibility, excellence, innovation, curiosity• Integration of foundation and clinical science

• Anatomy, biochemistry, physiology, pharmacology…• Psychology, decision science, continuous improvement…

• Early clinical experience• Continuing foundation science education• Schemata and Patient Presentation model, simulated

patients and families (relevancy)• Team-based learning (learning communities, in practices,

in the hospital, friendly competition-game theory)• Inter professional (PA, PT, et al.)• Self directed learning/cognitive science

Curriculum years 1-2• Longitudinal clinical skills curriculum – integrated with

anatomy, imaging, physical examination, interviewing• Integrated content courses: Professionalism, Ethics

Population & Community Health, Research, CQI, EBM• Clinical and health services/delivery research• Lean, process and quality improvement – including as research, at

the practice and system levels• Population health, epidemiology, community health• Evidence-based medicine (proven practice)• Health system, care delivery, business of medicine, financing…

• Assessments: to facilitate success for individual and team (simulations, mannequins, simulated patients, actual patients)

Curriculum – years 3-4• Longitudinal, integrated clerkship – PCMH, a member of

the team• Gradual transitions as skills/knowledge develop• Focus on self assessment, lifelong learning, practice-

based learning and improvement…• Community engaged…learning in the community

• Clinical experience based there

• Community faculty as preceptors and facilitators• GME community setting• Patient Centered Medical Home (more later)

Affiliations• Alpena• Charlevoix• Carson City• Hancock Hospital• McLaren (Central MI, Bay Regional, Northern MI)• Mercy, Grayling• MidMichigan (Midland, Gratiot, Clare, Gladwin)• Saginaw (St. Mary’s, Covenant)• West Branch• West Shore

Predictors of specialty choice• Indebtedness• Lifestyle wants• Married, female – Family Medicine• Public medical school• Primary care track• Community training

Predictors of choosing rural practice• Rural birth• Interesting serving the underserved• Interest in serving minorities• Public medical school• Males more likely than females• Entering career plan: Family Medicine• Training in the community• Near final training location

Factors in retention• Environment of training• Location of training (100 mile radius)• Institutional funding, culture and curriculum• Context• Experience (role models, happy generalists)• Opportunities identified during residency…• Linkage to home (grew up there)• Scholarships to limit indebtedness• Loan-repayment programs to address indebtedness

Environment/Institution• Training in rural/small town communities• Primary care more likely to choose rural• Focus on primary care/generalism• Public medical schools• Based in primary care practices• Role models who value primary care/generalism

Holistic admissions• Application review – GPA, MCAT, home town, etc.• Response to essay questions• Personal statements, values• Letters of recommendation• Campus visit – MMI process• Selection

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CMU College of MedicineOffice of the Dean208 Rowe Hall

Phone: (989) 774-7547

Web site: www.cmich.edu/med