Pre-curriculum Pre-curriculum Review Advisory Review Advisory Committee ReportCommittee Report

Suzanne Allen, MD, MPHMichael Ryan, MD

OverviewOverviewBackgroundProcessFindingsRecommendationsNext steps

BackgroundBackgroundSuccessful LCME accreditation June 2010Last curriculum review 1998-2001Expansion of class size for workforce

needsPre-curriculum review advisory

committee charged September 2010Curricular strengths and areas for

improvementApproaches to expand class sizeEngage with all constituents across the regionDevelop rationale and proposed approach to a

curriculum review

Committee MembersCommittee MembersCo-Chairs:Suzanne Allen, M.D., M.P.H., Vice Dean for Regional AffairsMichael J. Ryan, M.D., Associate Dean for CurriculumCommittee Members:David Acosta, M.D., Associate Dean for Multicultural AffairsDaniel Benedetti, Fourth-year medical studentCourtney Boulton, Fourth-year medical studentJan Carline, Ph.D., Professor, Medical Education & Biomedical InformaticsKellie Engle, Program Operations Manager, Regional AffairsYogesh Khanal, Fourth-year medical studentDennis Kirby, Fourth-year medical studentAndrew Luks, M.D., Assistant Professor, MedicineRamoncita Maestas, M.D., Associate Professor, Family MedicineKathleen Mulligan, Ph.D., Senior Lecturer, Biological StructureKenneth Roberts, Ph.D., Assistant Dean, WWAMI-SpokaneLorna Shanks, Fourth-year medical studentRoger Tatum, M.D., Associate Professor, SurgeryMarjorie Wenrich, Chief of Staff, UW MedicineMark Whipple, M.D., Associate Professor, Otolaryngology-Head & Neck Surgery

Information ReviewedInformation ReviewedPast curriculum reviewsCurrent curriculumCurricula at other medical schoolsCurrent literature on curricula in

medical schoolsLCME self-studyAAMC graduation study resultsInternal end-of-year program

evaluationUSMLE Step 1 and Step 2 Board

scores

Meetings HeldMeetings Held Curriculum committees Educational leaders Educational program leaders Teaching faculty: basic science and clinical

region-wide Medical students Community physicians and leaders Residency program directors Medical school finance administrators Technology specialists ISIS leadership Other health science disciplines UW Medicine senior leaders Town Hall and open forum meetings Catalyst website

FindingsFindingsStrengths:

ICM course/Colleges program/mentoring Small classes/unique opportunities at 1st

year sites The few current active learning/small groups

in 2nd year classes Diversity and quality of clinical offerings

across the region Dedicated and enthusiastic faculty Many opportunities for unique, rural learning

FindingsFindingsAreas identified for improvement:

Governance Large, growing content without clear

mechanisms to decrease content Departmentally based curricula do not

foster integration of basic science and clinical, horizontally or vertically

Lack of flexibility in the curriculum to adapt to changes

Decline in USMLE Step 1 scores Inadequate standardization across

regional sitesReliance on lecture-based instruction

FindingsFindings

Areas identified for improvement:Insufficient instruction in critical thinking

and evaluation of the medical literatureInsufficient emphasis on life-long

learningEmphasis on memorization instead of

clinical thinkingInsufficient instruction in biomedical

informatics and population-based medicine

Lack of opportunities for career exploration

FindingsFindings

Areas identified for improvement:Insufficient time carved out for faculty

to teach and lack of acknowledgement of teaching as core activity

Difficulty in attracting and retaining clinical community teaching sites due to clinical productivity demands

Insufficient attention to the continuum of education from pre-med to practice

Continued need for physician workforce development

Applicants comments who Applicants comments who declined admission to declined admission to UWSOMUWSOM

“I decided to go to Columbia University because I was accepted into the Columbia-Bassett program--a new program that focuses on longitudinal care….Plus, I really liked the 18-month curriculum at Columbia, which gets me into clinicals earlier.”

Applicants comments who Applicants comments who declined admissions to declined admissions to UWSOMUWSOM

“Strengths of UCSF include ….systems based curriculum, pass/fail for 2 years, more small group work, emphasis on early clinical experience, and more innovative and adaptive curriculum.”

Applicants comments who Applicants comments who declined admissions to declined admissions to UWSOMUWSOM

“UCLA has a non-traditional curriculum with a systems-based approach, PBL and doctoring minimizing the number of hours spent in a lecture hall to 2 hours/day. This was a HUGE difference when compared to the traditional curriculum that UW has and was one of the major factors influencing my decision.”

Applicant comments who Applicant comments who declined admissions to declined admissions to UWSOMUWSOM

“I did not like the curriculum at the University of Washington. I am an active learner and I felt that the curriculum had too much lecture time. Also, I prefer curriculum that are more integrated and after talking to students the curriculum at the UW is not that integrated.”

““A good hockey player plays where A good hockey player plays where the puck is. A great hockey player the puck is. A great hockey player plays where the puck is going to plays where the puck is going to be.”be.”Wayne GretskyWayne Gretsky

Time for changeTime for change

Explosion of medical and scientific information

Explosion of information technologyEnhanced patient knowledge and

understandingGenerational characteristics of

studentsChanges in learning stylesNational movement to active

learning modalitiesChanges in the roles of physicians in

rapidly evolving healthcare system

Areas for changeAreas for change

Increase active learningIncrease curricular flexibility Integrate the curriculum

vertically and horizontallyAllow students to individualize

their trainingIntegrate critical thinking,

information management, techniques for lifelong learning throughout the curriculum

Specific Specific RecommendationsRecommendations

Continuous curriculum improvement process

Governance structure Convene a “visioning committee”

Develop and define the “product” i.e. overarching curricular goals, objectives and outcomes

Adjust and redesign the curriculum to meet these goals, objectives and outcomes

Improve USMLE Step 1 and 2 scores to increase successful residency matches for students

Specific Specific RecommendationsRecommendations

Focus on continuum of education and life-long learning

Maintain focus on contextual learning opportunities and needs through horizontal and vertical integration

Incorporate new training foci and modalities into the curriculum, including simulation, IPE, information management

Support faculty through faculty development, funding, sufficient time for teaching and acknowledgement of value of teaching and curriculum involvement

Specific Specific RecommendationsRecommendations

Continue working to meet workforce needs across the WWAMI region

Expand class size to help meet workforce needs

Will require all of basic sciences to be taught in the region

Next StepsNext StepsShare findings and

recommendationsCharge and appoint the

visioning committeeEstablish interactive web site

for ongoing curriculum improvement and communication

Pilot teaching all of the basic sciences in the region

Questions?Questions?