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UCSF Self Study

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UCSF SCHOOL OF MEDICINE

SELF-STUDY

FOR THE LIAISON COMMITTEE ON MEDICAL EDUCATION

JANUARY 2011

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TABLE OF CONTENTS

INTRODUCTION ........................................................................................................................................ 3 A.  Background ................................................................................................................................... 3 B.  Institutional Self-Study Process .................................................................................................... 3 C.  Prior Site Visit Findings ................................................................................................................ 4 D.  Institutional Response ................................................................................................................... 5 

I.  INSTITUTIONAL SETTING .............................................................................................................. 6 

A.  Governance and Administration ................................................................................................... 6 B.  Academic Environment................................................................................................................. 8 

II.  EDUCATIONAL PROGRAM FOR THE MD DEGREE ................................................................. 13 

A.  Educational Objectives ............................................................................................................... 13 B.  Structure of the Educational Program ......................................................................................... 14 C.  Teaching and Evaluation ............................................................................................................. 18 D.  Curriculum Management ............................................................................................................ 21 E.  Evaluation of Program Effectiveness .......................................................................................... 24 

III.  MEDICAL STUDENTS ................................................................................................................. 28 

A.  Admissions .................................................................................................................................. 28 B.  Student Services .......................................................................................................................... 31 C.  The Learning Environment ......................................................................................................... 34 D.  Student Perspective on the Medical School ................................................................................ 36 

IV.  FACULTY ...................................................................................................................................... 38 

A.  Number, Qualifications and Functions ....................................................................................... 38 B.  Personnel Policies ....................................................................................................................... 39 C.  Governance ................................................................................................................................. 40 

V.  EDUCATIONAL RESOURCES ....................................................................................................... 42 

A.  Finances ...................................................................................................................................... 42 B.  General Facilities ........................................................................................................................ 45 C.  Clinical Teaching Facilities ........................................................................................................ 46 D.  Information Resources and Library Services .............................................................................. 48 

SUMMARY ................................................................................................................................................ 50  APPENDICES A: LIST OF SELF-STUDY COMMITTEE MEMBERS ........................................................................ 53  B: GLOSSARY OF TERMS ................................................................................................................... 57  C: ORGANIZATIONAL CHART FOR THE UCSF SCHOOL OF MEDICINE DEAN’S OFFICE .... 62  D: ORGANIZATIONAL CHART FOR MEDICAL EDUCATION ...................................................... 63 E: MAP OF UCSF AND SAN FRANCISCO………………………………................Inside Front Cover F: CURRICULUM BLUEPRINT……………………………………………...............Inside Back Cover

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UNIVERSITY OF CALIFORNIA, SAN FRANCISCO SCHOOL OF MEDICINE

INSTITUTIONAL SELF-STUDY REPORT

INTRODUCTION 

A. Background  The UCSF School of Medicine, the second medical school established in the Far West, was founded in 1864 as Toland Medical College and became affiliated with the University of California in 1873. As the only all health sciences campus of the 10-campus University of California public system, UCSF has a unique campuswide unity and commitment to advancing health worldwide™. The campus has four professional schools (Dentistry, Medicine, Nursing and Pharmacy) and a Graduate Division plus UCSF Medical Center and Children’s Hospital and the Langley Porter Psychiatric Institute. In addition, UCSF faculty and housestaff provide care at two closely affiliated medical centers: San Francisco General Hospital (SFGH) and the San Francisco Veterans Affairs Medical Center (SFVAMC). UCSF’s trainees include approximately 3,600 professional and graduate students, residents, and fellows. The School of Medicine matriculates 149 medical students in San Francisco and 16 in the Joint Medical Program at UC Berkeley, for a total enrollment of 678 in 2009-10. UCSF made a remarkable transformation from a small regional medical school in the 1960s to its current position as a world leader in scientific discovery and translational science. In 2009, UCSF received more NIH research funds than any other public institution and received the second-largest amount of all institutions nationwide; the School of Medicine ranked second in receipt of NIH research funds among all United States medical schools. The UCSF faculty has four Nobel laureates, 57 members of the American Academy of Arts and Sciences, 40 members of the National Academy of Sciences, 69 members of the Institutes of Medicine and 17 Howard Hughes Medical Institute investigators. In the 2010 survey on “America’s Best Graduate Schools” conducted by U.S. News & World Report, the UCSF School of Medicine is ranked among the top five medical schools in the nation (fourth in research and fifth in primary care). In the same 2010 U.S. News & World Report, the other professional schools at UCSF were ranked first or second, and the graduate programs in the biological sciences were rated seventh. For the 10th consecutive year, UCSF Medical Center ranks among the nation’s top 10 premier hospitals and is the best in Northern California, according to the 2010-11 America’s Best Hospitals survey conducted by U.S. News & World Report. In addition, the SFVAMC receives the most research funding of any Veterans Affairs Medical Center in the nation. Over the past decade UCSF School of Medicine has also been recognized as a leader in medical education research and innovation.

B. Institutional Self­Study Process  This report summarizes the findings of the UCSF Institutional Self-Study Task Force and is based upon the Institutional Database and seven committee reports. From 2007 to 2009, the educational leadership team worked on a model of “LCME compliant all the time” by creating an LCME Standard-Tracking database to track institutional data relevant to each LCME standard, and by working with each of the

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curriculum committees to ensure compliance with all standards. The LCME self-study database was completed in December 2009 and the self-study committees met from January through March 2010. The Overall LCME Institutional Self-Study Committee assimilated the six subcommittee reports, identified greatest strengths and addressed areas for improvement. In the spring of 2010, several task forces were appointed to complete work on these improvement initiatives. The self-study report was reviewed and approved by the LCME Institutional Self-Study Committee and discussed by the school and campus leadership, the School of Medicine Faculty Council, and the Committee on Curriculum and Educational Policy. This summary report has been posted on the School of Medicine website and distributed broadly. Members of the LCME Institutional Self-Study Committee and its subcommittees, who are listed at the end of the summary, were broadly representative of the school and campus. This summary report describes the ways in which UCSF is continuing to innovate and pursue its mission of advancing health worldwide™. Overall, the LCME self-study committees identified great strengths in every mission. Specifically, UCSF has exceptional students, teachers and residents; a culture of innovation and excellence across the continuum of medical education; rich research opportunities and individualized learning experiences; strong support of the Dean and senior education leadership; an effective and active system of central oversight for the curriculum; and outstanding educational technology. In addition, the educational enterprise is guided by and contributes to the scholarship of teaching and learning. Our faculty members, students, residents, fellows and staff published 78 peer reviewed journal articles; gave 233 scholarly presentations or workshops on medical education locally, nationally and internationally; and received 73 honors and awards for their leadership and scholarship in medical education. Several areas were identified for improvement: advising, clarity of clerkship grading, student health services, library access, anatomy lab, VA shuttle service and call rooms at some hospitals. Each area has subsequently been addressed.

C. Prior Site Visit Findings  The 2003 LCME site visit team recognized many strengths of UCSF, including exemplary leadership by Dean Haile Debas, the new integrated curriculum, the Office of Medical Education, student learning through a wide spectrum of educational technology and information resources, excellence in biomedical research, and department Chair support of the school’s mission and educational programs. Notwithstanding these considerable strengths, there was one noncompliance item and four transition items:

1. Noncompliance item: Administrative control of clerkship education at UCSF Fresno raised concerns about the comparability of learning experiences between the main campus and Fresno (ED-8).

2. Transition item: Impact of Mission Bay on school’s faculty, students and programs. 3. Transition item: Vision and goals of the new Dean, particularly as they relate to the medical

education program. 4. Transition item: Outcome measures reflecting successes or challenges in the implementation of

the new curriculum. 5. Transition item: Small group instructional space needed for new curriculum.

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D. Institutional Response 

1. UCSF Fresno: Clerkship directors and the educational leadership are actively engaged with site directors at Fresno. Detailed examination of evaluation data revealed no significant differences in learning outcomes across UCSF clerkship sites, including Fresno.

2. Mission Bay Campus: The beautiful new research campus at Mission Bay has expanded research, classroom and recreational capacities. An extensive shuttle system connects Mission Bay with the other primary campus sites around the city, and videoconferencing systems are expanding to reduce commuting requirements.

3. New Dean: Dean Debas was succeeded by Dr. David Kessler, who in turn was replaced with Dr. Sam Hawgood as Interim Dean from 2007 to 2009 and as Dean from 2009 to the present. All have provided strong leadership for the school and supported the educational mission.

4. Outcomes: All performance outcome measures for the new curriculum are excellent (see database).

5. Small Group Classrooms: With the development of Mission Bay classrooms and the upcoming completion of the Teaching and Learning Center in the Parnassus library, classrooms will soon be more than adequate to meet the needs of the school and the campus.

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I. INSTITUTIONAL SETTING 

A.  Governance and Administration  Planning. At the campus level, the school participated in a broad-based strategic planning process led by the Executive Vice Chancellor and Provost from 2005 to 2007. This extensive process resulted in a unified mission and vision statement, which the school has adopted to guide ongoing strategic decisionmaking. The UCSF mission is advancing health worldwideTM, and there are specific visions and goals for each mission, including education (to develop the world’s future leaders in health care delivery, research and education). These plans have successfully established budget priorities, strategic directions and capital development plans for the campus; and continue to guide the campus. On an annual basis, the School of Medicine Dean and Vice Deans identify strategic issues that need engagement of the entire school’s leadership. These issues become the focus of the School of Medicine Leadership Retreat, which sets strategic and tactical direction for the school. The approximately 150 invited participants include the leadership of the Dean/Vice Chancellor’s office, department Chairs, directors of centers and organized research units, the leadership of the medical center and Chancellor’s office, Deans of other schools and the graduate division, and key faculty and trainees appropriate for the chosen topic. Task forces are formed each year to prepare for the retreat. Examples of the impact of past retreats include endorsing and receiving the first Clinical and Translational Science Award from NIH; site selection for the new children’s, women’s specialty and cancer hospitals at Mission Bay (which will open in 2014); and, most recently, identifying a sustainable funding model for the educational mission. This last topic resulted in the appointment of a post-retreat committee to develop measures of the teaching contributions of the faculty that will be used by the SOM Executive Budget Committee to guide resource allocations in 2012. Additional planning occurs for each mission. For example, the leadership of clinical departments participates with the leadership of the medical center in strategic planning to address changes in the health care landscape, challenges of clinical growth, and improvements to be gained from a culture of shared accountability between the school and the medical center. The Dean, who also serves as Vice Chancellor for Medical Affairs, meets on a regular basis with the Chancellor’s executive team to set, implement and evaluate progress on strategic plans at the campus level. The Vice Dean for Education oversees an annual process in which each Associate Dean in medical education develops goals, objectives and an action plan for his or her unit. This system of campus, school and educational program planning works exceptionally well. Taken together, these planning processes work very effectively to engage the UCSF community and make timely decisions about the school’s future.

Governance. The Dean of the School of Medicine/Vice Chancellor for Medical Affairs reports directly to the Chancellor of UCSF, who reports to the President of the University of California. For more than a century, shared governance between the Board of Regents, the University of California systemwide President and the faculty has ensured the highest standards of excellence in fulfilling the University of California's mission of teaching, research and public service. The Academic Senate, the representative body of the University faculty, is empowered by the Regents to exercise direct control over academic matters. With the exception of the School of Medicine Faculty Council, a representative body of the Academic Senate, all committees in the school report directly or indirectly to the Dean. This dual governance system works well to advance the missions of the school and University. The Dean has overall responsibility for medical student education, which he delegates to the Vice Dean for Education as

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the Chief Academic Officer for all professional education in the school (undergraduate, graduate and continuing medical education). The Vice Dean for Education oversees a superb team of educational leaders who steward the academic programs of the school.

The medical school has seven Vice Deans, 12 Associate Deans and two Assistant Deans. The size and composition of the medical school administration are comparable to those of similar institutions, are appropriate to its mission and work exceptionally well.

Safeguards to prevent conflict of interest at the level of the Board of Regents are well delineated and closely monitored at the UC Office of the President to ensure compliance. Approval of the Board of Regents is required for significant strategic decisions, including the appointment of the Dean and senior leadership in the Chancellor’s Office at UCSF, any salaries over a certain level, fundraising campaigns above $5 million, major capital projects, acquisitions, mergers, the establishment of new schools, and the campus Long Range Development Plan. Medical  School/University/Clinical  Affiliates. The School of Medicine Dean/Vice Chancellor for Medical Affairs works closely and effectively with the Chancellor. In addition to providing leadership and direction for the School of Medicine, the Dean/Vice Chancellor for Medical Affairs is part of the UCSF senior management team and has a significant leadership role in campuswide strategic planning, management and policy development. Dr. Hawgood has the necessary and appropriate access to the Chancellor to perform his duties. Dean Hawgood also works closely and collaboratively with the UCSF Medical Center CEO Mark Laret; they have weekly meetings and each serves on the other’s key advisory committees. A new clinical enterprise governance model under their joint direction has recently been adopted. The School of Medicine’s large and robust educational, research and clinical programs extend beyond UCSF and its medical center to a wide array of affiliates. The diversity of these affiliates adds immense value to the research, education, clinical care and public service missions of UCSF. The role of these affiliates varies from extremely close and integrated, as in Langley Porter Psychiatric Institute (LPPI), San Francisco General Hospital and Trauma Center (SFGH), and the San Francisco Veterans Affairs Medical Center (SFVAMC); to UCSF Fresno and its three affiliated hospitals, Community Regional Medical Centers, Children’s Hospital Central California and the Central California Veterans Affairs Medical Center; to less closely affiliated hospitals such as the California Pacific Medical Center, Kaiser Permanente, and Children’s Hospital and Research Center Oakland, among others. The School of Medicine manages its roles and relationships with its partners carefully, thoughtfully and effectively. In 2014, a new, 289-bed, 878,000-gross-square-foot children’s, women’s specialty and cancer hospital complex at Mission Bay is scheduled to open. Additionally, in 2009, construction began on a new 448,000-square-foot SFGH building. Scheduled to open in 2015, it will have 284 inpatient beds, which is 32 more than the current hospital. Organizational  Stability. Since 2003, the UCSF School of Medicine has had two Deans, Dr. David Kessler (2003-2007) and Dr. Sam Hawgood (Interim Dean 2007-2009, Dean 2009-present). Dr. Hawgood enjoys great respect and support within the school and campus. There has been notable stability in the cadre of 19 Vice Deans and Associate Deans, all but three of whom have held their positions between five and 15 years. The core medical education leadership team, under the direction of Vice Dean David Irby, has been very effective and stable for more than a decade. Dean Kessler appointed the leadership (chairs or co-chairs) of nine of the 29 Departments: Cellular and Molecular Pharmacology; Epidemiology & Biostatistics; Laboratory Medicine; Medicine; Obstetrics,

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Gynecology & Reproductive Sciences; Ophthalmology; Orthopaedic Surgery; Physiology; and Radiation Oncology. Medicine was vacated when the previous Chair became Dean of the Columbia School of Medicine, and Obstetrics was vacated when the Chair was promoted to Provost of the UCSF campus. In addition, Dr. Kessler successfully recruited leadership to a new Institute for Human Genetics and a new Center of Regeneration Medicine and Stem Cell Research. Dr. Hawgood has appointed Department Chairs of: Anesthesia & Perioperative Care; Biochemistry & Biophysics; Cellular and Molecular Pharmacology; Physical Therapy & Rehabilitation Science; a new Department of Bioengineering and Therapeutic Sciences; and a new Department of Emergency Medicine. In addition, he appointed new Directors for the Philip R. Lee Institute for Health Policy Studies and the Osher Center for Integrative Medicine. He has selected Interim Chairs in Pediatrics; Psychiatry; and Anthropology, History and Social Medicine (DAHSM). Active searches are underway in Pediatrics and Psychiatry; the Department of Anthropology, History and Social Medicine (DAHSM) search is pending a program review of the department. Chancellor Sue Desmond-Hellmann replaced Chancellor J. Michael Bishop in 2009; she has pursued an active agenda of improving strategic and operational excellence of the campus. Her leadership is greatly admired and appreciated.

B. Academic Environment  Graduate Programs. The graduate programs at UCSF play a prominent role in making UCSF an international center of excellence in biomedical research and education, and offer medical students opportunities to explore biomedical sciences in greater depth. Graduate programs are distributed throughout the schools of medicine, dentistry, nursing and pharmacy with a total enrollment in 2009-10 of 1,604 graduate students. The majority are split between the schools of medicine (625 students) and nursing (749 students). The graduate programs housed in the School of Medicine include: Advanced Training in Clinical Research (37 master’s students); Biochemistry (119 PhD students); Bioengineering (73 PhD students); Biomedical Sciences (156 PhD students); Biophysics (55 PhD students); Cell Biology (23 PhD students); Developmental Biology (10 PhD students); Genetics (12 PhD students); Medical Anthropology (15 PhD students); History of Health Sciences (8 PhD students); Neuroscience (84 PhD students); and Physical Therapy (33 master’s and 25 PhD students). Graduate students are distributed throughout 35 different departments, including basic science and clinical departments, institutes and centers. Clinical departments and research institutes with significant numbers of students include Cardiovascular Research Institute (17 students), Medicine (27 students), Neurology (16 students), Obstetrics, Gynecology and Reproductive Sciences (8 students), Pathology (20 students), Pediatrics (8 students), Psychology (10 students), Radiology (22 students) and Surgery (8 students).

The graduate programs are organized into two umbrella programs, the Program in Biological Sciences (PIBS) and the Biomedical Sciences Program (BMS). Within PIBS, there is a further grouping of graduate programs into an entity called Tetrad, which groups the programs in Biochemistry, Cell Biology, Developmental Biology and Genetics into a single organization with an integrated educational system that included 164 students in 2009. Each graduate program is reviewed approximately every five years. Since 2008, 10 UCSF basic science graduate programs have been reviewed. All of these programs were considered excellent to outstanding in comparison with peer institutions around the country. In addition, the graduate program in Medical Anthology received an excellent review in comparison to its national peer group.

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Basic science faculty members teach throughout the medical school curriculum. The graduate programs and the research associated with them provide a rich opportunity for medical students to pursue in-depth research, with or without attainment of a doctorate. UCSF has a strong Medical Scientist Training Program (MSTP) that enrolls approximately 12 students per year. In addition, a majority of medical students engage in research projects that range from several months to a full year either independently arranged or through the Pathways to Discovery programs in Molecular Medicine and Clinical and Translational Research. All graduate courses are open to medical students and some take advantage of this opportunity. A small number of graduate students enroll in medical school courses. Finally, the numerous seminar series hosted by graduate and clinical programs are an important venue for interactions among the different academic communities. Graduate Medical  Education.  UCSF sponsors 73 residency and fellowship programs. Each program is fully accredited by the ACGME, with an average accreditation cycle of 4.5 years (out of a maximum of 5.0). The GME programs attract trainees from among the nation’s best medical students and residents. Residents and fellows are given defined time to teach on each clinical service and receive explicit training in teaching. At teaching workshops and other seminars designed for residents and fellows, trainees learn how to create a positive learning climate, teach effectively in brief periods of time, teach procedures, provide effective feedback and evaluate learners, facilitate small group discussions, teach as a consultant, and lead a clinical team. Similarly, each chief resident participates in a specifically designed curriculum on effective teaching skills, with additional emphasis on leadership development, conflict management and effective mentoring skills. Medical students evaluate residents and fellows at the conclusion of each clinical rotation. These evaluation data are an important component of each GME trainee’s formal twice-yearly evaluation. In addition, medical students select residents and fellows for an array of teaching awards. These elements further foster an environment in which teaching is valued as an essential feature of each resident’s and fellow’s position. Residents and fellows participate in the UCSF Pathways to Discovery program alongside UCSF medical students. This unique learning environment allows residents and fellows to form a different type of learning partnership with medical students and to provide valuable “near-peer” role modeling and mentoring in pursuit of scholarly activities. Approximately equal numbers of residents and fellows participate in the Pathways program. More than half of UCSF residents and fellows presented a scholarly poster or oral presentation at a regional or national meeting in the last academic year. This program is just one example of the close working relationship and joint programming between GME and UME. There are no major changes planned in UCSF Graduate Medical Education programs through 2014. Continuing Medical Education. UCSF sponsors more than 200 CME activities for more than 26,000 learners each year. These include live courses, regularly scheduled conferences and online enduring materials. Medical students participate in CME activities at UCSF in several ways. Students are directly impacted by regular attendance (typically while on core clinical rotations and/or clinical electives) at CME activities, including grand rounds, morbidity and mortality conferences, and other regularly scheduled series. UCSF’s CME also contributes to medical student education through ongoing professional development of medical school faculty.

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Research. UCSF’s research activities are outstanding as measured by a variety of metrics and continue to grow. This is true not only for the faculty of the School of Medicine but also for the faculty of the schools of dentistry, nursing and pharmacy. According to figures released by the National Institutes of Health (NIH) in 2010, UCSF was the second-largest recipient of research support in 2009. UCSF ranked first among public institutions. UCSF school of pharmacy was number one amongst pharmacy schools as it has been for the past 30 years and the schools of dentistry and nursing were second in total NIH dollars in their fields, and have consistently ranked either number one or number two in recent years. The School of Medicine ranked second in the nation, and 14 departments ranked in the top 10, including four departments that were ranked first: Anesthesia & Perioperative Care; Medicine; Neurological Surgery; and Obstetrics, Gynecology & Reproductive Sciences. Our exceptional faculty continues to receive national and international acknowledgment for their impact on the health sciences, including Elizabeth Blackburn, who won the 2009 Nobel Prize in Physiology or Medicine and became the fourth Nobel laureate from UCSF. In the area of educational scholarship, our faculty, students, residents, fellows and staff gave 233 scholarly presentations or workshops on medical education locally, nationally and internationally, and have published 78 peer-reviewed journal articles in 2009-10. The faculty received 73 honors and awards for leadership and scholarship in medical education. Historically, UCSF’s research programs were constrained by limited space at the Parnassus campus. This has changed dramatically since the opening in 2003 of the Mission Bay campus, which currently has six research facilities, including Genentech Hall, the California Institute for Quantitative Biosciences (Byers Hall), Rock Hall, the Cardiovascular Research Institute Building, and the Helen Diller Family Cancer Research Building. In addition, ground has been broken for a new Neuroscience building. Construction also is underway at the Parnassus campus for the new Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research at UCSF. The combined expansion of UCSF research space has enabled the development of new research programs and initiatives. It is expected that recruitment of new faculty over the next five years will stimulate new research directions that will be at the forefront of biological sciences. Resources for clinical and translational sciences at UCSF were significantly enhanced in 2006 with an NIH award to fund the Clinical and Translational Science Institute (CTSI). UCSF was one of 12 institutions nationally to be funded in the first round of these transformative awards designed to enhance the infrastructure for clinical and translational sciences. There are extensive resources available to faculty members to enable them to be successful in conducting their research. Medical  Student  Research. Research activities at UCSF have a substantial impact on the education of medical students, who are frequently attracted to UCSF because of its reputation as a premier research institution and often take advantage of these exceptional research opportunities. For two decades, the UCSF Director of Medical Student Research has linked students with research opportunities. Self-reports from UCSF graduates suggest these efforts are successful: Approximately 82% of the 2010 graduating class participated in research with a faculty member, and 63% reported authorship on a research paper submitted for publication. The breadth of high-quality research opportunities was identified as a major area of strength in the LCME independent student analysis report. Numerous programs, including several initiated since the previous LCME review, support and encourage the connection of students with research. Long-standing programs include the MD/PhD Medical Scientist

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Training Program (MSTP), the UCSF-UC Berkeley Joint Medical Program (JMP), the Certificate Program in Biomedical Research (CPBR), and the MD with Thesis. Recently initiated programs include: UCSF’s Program in Medical Education for the Urban Underserved (PRIME-US), which is the UCSF branch of the UC systemwide PRIME; the Pathways to Discovery program, a School of Medicine strategic initiative to support student careers in scholarship and innovation; and the Pathways Funding Agency, which has consolidated and rationalized student research funding opportunities. The infrastructure to support student research is strongest in basic biomedical sciences and in clinical and translational sciences. Recent initiatives seek to enhance student research opportunities in global and population health sciences, behavioral and social science research, and educational research. All of these programs are elective, communicated to students though the medical student web portal and class listservs, and involve the majority of students. According to the AAMC MSMMT-2010 report, 78% of UCSF students participated in research over the past three years, which places UCSF in the 75th percentile of all medical schools nationally. Service­Learning. Service-learning is a key component of student learning experiences and is often integrated into the curriculum, providing ongoing opportunities for students to prepare for, and subsequently reflect on, their community engagement and its influence on their identity as an emerging health professional. Through a rich array of elective and selective opportunities, students engage with underserved populations in San Francisco, the larger Bay Area and the greater state of California. Many electives are student-run and some draw nearly classwide participation. Students hold information sessions to engage their peers and encourage participation in various opportunities for subsequent years. Ongoing recruitment and publicity for these groups and related activities continue through the class listservs and postings in the Student Lounge. The Office of Student Affairs, individual departments and additional faculty preceptors support these initiatives, offering guidance and financial support for student service-learning. Diversity. UCSF is strongly committed to nurturing diversity and ensuring that UCSF continues to attract the best and most diverse candidates for faculty, staff, students and trainee positions. Our goal is to create a climate and culture that welcome, celebrate and promote respect for the contributions of all; and we are making strides in each area. As defined in the UC Diversity Statement:

Diversity refers to the variety of personal experiences, values and worldviews that arise from differences of culture and circumstance. Such differences include race, ethnicity, gender, age, religion, language, abilities/disabilities, sexual orientation, socioeconomic status, and geographic region, and more.

Progress in achieving a diverse work and learning environment starts with enhancing the pipeline of students and UCSF has several initiatives to achieve this. Inside UCSF, a two-day program featuring UCSF student panels, interactive workshops, and receptions with faculty and staff is an annual event that brings potential applicants to campus. Last year, the majority of participants were African American and Hispanic; more than 50% were female and many were first-generation college students. Additionally, the Office of Outreach and Academic Advancement in the School of Medicine and the Office of Academic Diversity on the campus assist in coordinating many student outreach events sponsored by all four professional schools. Medical school faculty members travel to professional meetings throughout the country, making contact with potential candidates committed to diversity and encouraging them to apply to positions at UCSF. The percentage of total medical students underrepresented in medicine (UIM) rose from 16% in 2004 to 29% in 2010, making UCSF the most diverse medical school class in California. Female medical students

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comprised 54% of the entering class. The premium that UCSF places on diversity appears to be successfully communicated to students, who, in our LCME independent student survey, rated highly their overall sense of acceptance based on race, sexual orientation and religion. In 2006, the school launched the Program in Medical Education for the Urban Underserved (PRIME-US) with the purpose of addressing the issues of physician shortages, health disparities and health care access that affect millions of low-income and minority patients living in urban areas. Once enrolled in UCSF PRIME-US, students participate in seminars and preceptorships that connect students with urban underserved patients and programs. Half of the entering class in 2010 applied for the 16 available positions in this program and it continues to be a magnet for a diverse class. Diversity in residency and fellowship programs is 9.2% UIM and 53% female. Significant efforts are being initiated at the school and department levels to recruit UIMs and to continue developing a welcoming learning and working environment. While the school has increased the total number of UIM faculty members, the overall percentage remains constant at 5%. The school faculty is 41% female. Faculty support programs include the efforts organized by the Chancellor’s Council on Faculty Life, which provides welcoming and orientation sessions, a Coro leadership development program, mentoring for all new and junior faculty, mindfulness training and a new faculty biography program. Among the 40 Chairs and Directors who report to the Dean, 25% are women, and 4% are underrepresented in medicine. Professional and clerical staff in the school includes 17% UIM and 70% female. Policies and practices encourage diversity in hiring and professional development. Our greatest success has been achieved in medical student diversity. To enhance diversity at all levels throughout our campus, the Chancellor has created a position in her executive team, a Vice-Chancellor for Diversity and Outreach. The Vice Chancellor will be responsible for developing and implementing a strategic plan with campus wide goals on diversity and outreach, focusing on overall campus climate, recruitment, and retention for students, faculty and staff and operating within federal and state legal restraints.

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II. EDUCATIONAL PROGRAM FOR THE MD DEGREE  The school has created a well-integrated medical student curriculum that promotes achievement of core competencies while also encouraging students to pursue individualized learning plans and scholarly interests. An environment of continuous quality improvement that is responsive to student input is created from a strong central oversight that actively engages faculty members and students and a comprehensive evaluation system. The curriculum is significantly enhanced by partnership with an outstanding educational technology team that provides cutting-edge resources for tracking curriculum, online learning, and program evaluation.

A. Educational Objectives Beginning in 2004, the school began the transition to a more competency-based curriculum, which has resulted in a set of educational objectives (also known as graduation competencies) categorized by ACGME competency domains. Between 2004 and 2006, a detailed plan for the modification of schoolwide objectives and alignment of those objectives with the ACGME competency domains was drafted by the Committee on Student Assessment (COSA), a 25-member committee charged with recommending a longitudinal assessment system. Based on COSA’s work, another working group, the Program on Student Assessment, modified the schoolwide objectives and stewarded their approval in 2007 by the Committee on Curriculum and Educational Policy (CCEP). During the past two years, under the leadership of the Chairs of the curriculum oversight committees in conjunction the Director for Student Assessment, these schoolwide objectives and competencies have served as effective guides for education program planning as educational committee leaders have mapped course and clerkship objectives to competencies. Similarly, these schoolwide educational objectives and competencies have guided the mapping of assessments to course and clerkship objectives. In 2009, milestones for each year were approved and the competencies were used with entering medical students as guides for their portfolios, which beginning in fall 2009 they were required to develop. Understanding Objectives. The process of transitioning to a more competency-based curriculum has markedly increased the level of understanding of schoolwide educational objectives among educational leaders, administrators, faculty, students and others in the medical education community. Across the curriculum, course directors ensure that administrators, faculty and trainee teachers, and students are aware of the schoolwide, competency-based objectives for the educational program. These objectives are published on the medical education web pages at: http://medschool.ucsf.edu/curriculum/competencies/ The 2009-10 introduction of a portfolio system to the first-year class is creating a visible and accountable structure for documenting and tracking student progress in competency-based objectives across the full range of ACGME domains. With a shift to competency-based assessment in the Essential Core curriculum (first two years), there has been increased emphasis during small group leader training sessions on understanding objectives across the competency domains and, in particular, on ensuring opportunities during small group sessions for students to practice skills in the Interpersonal and Communication Skills and Practice-Based Learning and Improvement domains. In clinical settings, departments have responsibility for ensuring that faculty, fellows and residents understand student assessment in the context of educational objectives. The range of approaches includes: providing objectives in written and electronic form, reviewing objectives during orientation sessions, workshops on teaching skills, grand rounds on medical education, and transition-to-service sessions. Measures of

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competency related to objectives are also communicated to clinical teachers through Clinical Core Experience Cards (CEC) used by all core clerkships. Objectives/Competencies. As is the case for schoolwide educational objectives, all course and clerkship objectives have been categorized by the ACGME competency domains and have been linked to assessments and thereby to competency-based outcome measures and a sequential set of milestones defined for the “competent MD.” In the Essential Core (EC), course reports submitted annually to the Essential Core Steering Committee (ECSC) describe competency-categorized course objectives and related assessments. Written examinations in the EC link each question to session objectives, which can, in turn, be mapped back to course objectives, competencies and schoolwide educational objectives. Over the past several years, the Clinical Clerkships Operations Committee (CCOC), which is composed of core clerkship and structured program directors, has crafted a clear set of general core clerkship competency-based objectives and sets of clerkship-specific objectives, all of which have identified competency-based assessment activities. Embedded in the clerkship-specific objectives are the specified types of patients or clinical conditions that students are required to either directly encounter or study through alternative methods. Patients/Clinical  Conditions. Core clinical experience cards (CECs) serve as the primary mechanism to ensure that all students encounter the specified types of patients/clinical conditions needed to meet clinical objectives. In this paper-based system, students track their core clinical experiences and clinical teachers verify students’ clinical encounters. The cards, which list key clinical skills objectives as well as types of priority patient encounters, are provided at the beginning of each clerkship or integrated clerkship program, then reviewed at midpoint feedback or quarterly advising meetings, and are required to be turned in at the conclusion of the clerkship. Data from completed cards are electronically logged by clerkship coordinators; the data are used for monitoring of student experiences by clerkships and CCOC. Recent review indicates that student compliance rates for the completion and submission of the CECs have been high (76-100%). The few gaps that have occurred were student-specific and do not reflect a consistent challenge for students at a specific site. When students are unable to practice and demonstrate the key clinical skills or see all of the priority patient prototypes by the midpoint feedback session or quarterly advising meeting, clerkship and program directors modify student schedules and clinical experiences to ensure that clinical skill competencies are achieved and that specific types of patient encounters are completed. Several clerkships also offer alternative activities such as assigned readings, written or computerized patient case modules, online learning activities, and additional or alternative patient care activities to remedy gaps. All clerkships administer a final written exam, which serves as another benchmark for ensuring that students master the knowledge objectives corresponding to each priority patient prototype on the core clinical experience cards. Core clinical skills are assessed across clerkships, progressively and longitudinally, through an integrated series of clinical skills performance assessments (mini-CPX 1, 2 and CPX).

B. Structure of the Educational Program  When applying to UCSF, prospective students can select to enter the program in San Francisco or request to be considered for the cohort of 16 students who participate in a separate track in the preclerkship curriculum at the Joint Medical Program (JMP) at UC Berkeley, where they spend three years to complete the preclinical curriculum and a master’s degree in public health before joining the San Francisco students in the clerkships. The San Francisco preclerkship curriculum consists of an 18-month Essential Core, which is composed of eight integrated block courses plus the longitudinal Foundations of Patient Care

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(FPC) clinical skills course. On average, students have 24 hours of formal instructional activity per week during the Essential Core. After the first year, students have an eight- to nine-week summer break, which many use to participate in research, curriculum development, and domestic or international clinical experiences. After completing the Essential Core and taking USMLE Step 1 in late March or early April of the second year, students begin 54 weeks of core clerkships in mid-April of the second year. The third-year clerkships are taught in eight-week blocks that are separated by one or two weeks of Intersession, an innovative course that brings students back to the Parnassus campus to engage in discussions of medical ethics, evidence-based medicine, medical sciences and health systems, and to participate in career advising and professional development activities. The fourth or final year of medical school is called Advanced Studies and contains selective and elective rotations as well as time for independent inquiry. It concludes with the three-week Coda course, which prepares students for internship. The total number of weeks of medical school is 156. Appendix F on the back inside cover displays the curriculum blueprint. General Professional Education. The curriculum is designed to provide an excellent general foundation combined with many structured programmatic as well as individualized options for experiencing a wide range of specialties and physician roles in society (e.g., research, advocacy, education). The rich variety of practice settings available for required and elective clerkships and preceptorships allows students to experience a mix of practice environments, which further helps them select their specialty and career options in medicine. Evidence of success in providing a strong general professional education comes from the students’ strong performance on USMLE Steps 1-3 and the UCSF fourth-year Clinical Performance Exam, which is an objective structured clinical examination that is common to all medical schools in California. Another demonstration of the breadth of educational opportunities and exposure offered to the medical students is the broad range of specialties students enter; the graduating class of 2010 matched in 21 clinical specialties areas with a ratio of primary care/specialties of 43%/57%. In addition, UCSF students are highly satisfied with their educational experience and preparation for residency. The 2010 AAMC Graduation Questionnaire reports that 93% of UCSF students agreed or strongly agreed that they “have the fundamental understanding of common conditions and their management encountered in the major clinical disciplines,” which is similar to the response for all schools (94%); and 94% of UCSF students agreed or strongly agreed that “overall, I am satisfied with the quality of my medical education,” which is higher than all schools (87%). Active/Lifelong Learning. Students have many opportunities for active learning and independent study in the required curriculum and through elective courses, sponsored programs and other resources. Skills of lifelong learning are included in UCSF’s schoolwide educational objectives and in course, clerkship and small group session objectives. The opportunity for students to individualize their learning experience and professional development was identified by the self-study process and the LCME independent student survey as one of the school’s most highly rated strengths. An important feature of the time frame and schedule of the required course of study is that it offers flexibility and support for exploration of particular areas of interest. For example, in the Essential Core students on average have three afternoons a week free from scheduled activities. Monday afternoons are consistently cleared so that campus and interprofessional activities such as graduate courses can be scheduled at a time when medical students are available. An eight- to nine-week break between the end of year one and the start of year two provides a well-positioned time for students to explore an area of individual interest. The scheduling of the Clinical Core, which begins in April of year two, also positions students well for those who choose a yearlong break to explore an area of interest in depth.

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The Essential Core and Joint Medical Program (JMP) curricula include an abundance of small group activities, independent learning activities (e.g., modules, field trips, kinesthetic labs, problem-based learning), and other activities such as interactive large group question/answer sessions. Goals of Essential Core small group activities include consolidation of information presented in lectures, clinical reasoning and problem solving, and discussing sensitive topics such as substance abuse or the students’ personal experiences and perspectives on race and gender. In addition, some small group sessions focus on teamwork, group dynamics and communication skills. In the JMP, the emphasis on active learning and self-assessment of learning needs is extraordinarily high, as the entire curriculum is based upon the problem-based learning method. Beginning in the fall of 2009, first-year students in the Essential Core and the JMP completed a portfolio requirement designed to advance skills in reflection and lifelong learning and to provide a structured process for assessing competency in lifelong learning skills. As the graduating class of 2013 moves through the curriculum, portfolio and competency milestones requirements for the remaining years will be implemented. In the Clinical Core, students engage in active learning through direct participation in clinical care. Students are highly motivated to pursue independent learning about their patients and to demonstrate an understanding of the nature of their patients’ illnesses, across the entire bio/psycho/social domain. Students’ skills in self-improvement are routinely assessed through an item on the common clerkship summative evaluation. Beyond the Essential Core and Clinical Core, students may choose from a large number of electives. There are also many opportunities for independent study through the Pathways to Discovery program, the Program in Medical Education for the Urban Underserved (PRIME-US), and intramural and extramural fellowships overseen by the Office of Student Research and the Office of International Programs. In addition, students often take additional time to pursue other graduate degrees offered at UCSF (e.g., master’s in clinical research or in global health), and elsewhere (e.g., master’s in public health or public policy programs). Consistency Across Sites. The preclerkship curriculum is taught at two sites (two tracks): the UCSF School of Medicine in San Francisco and the Joint Medical Program (JMP) at the University of California, Berkeley (UCB) School of Public Health. Whereas educational approaches, evaluation and grading differ between UCB and UCSF, mechanisms are in place to ensure consistent quality of education. These include a similar process in both programs of mapping the ACGME competencies onto curricular structure, content and assessment. Additionally, there is full participation by JMP education leadership in UCSF’s curricular planning and oversight process (including an annual review at CCEP), with membership on all key committees and at annual curriculum retreats. The effectiveness of mechanisms to ensure consistent educational quality in the two tracks is borne out by the comparable performance of JMP and UCSF students in the same end of preclerkship OSCE and the end of core-clerkship Clinical Performance Examination (CPX); the comparable percentage of JMP and traditional UCSF students brought to the attention of the Clinical Studies Screening and Promotions Committee, and election of students from the two tracks to Alpha Omega Alpha (AOA); and similar pass rates on USMLE Steps 1 and 2 (with the exception of 2010 Step 1 scores). The comparability of evaluation systems is important because while at UCB, JMP students receive letter grades according to that campus’s regulations, whereas UCSF students take all courses pass/fail in their first two years. Grades given to JMP students at UCB during preclerkship and graduate studies are converted from letter grades into the pass/fail grading system at UCSF upon their transfer to the UCSF campus for the final two clerkship years.

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In the clerkship curriculum, several systems are in place to ensure consistency of educational quality and student assessment across alternative sites within a clerkship. Data collected by these systems provide objective evidence to evaluate this consistency. While the “structured clerkship” programs (PISCES, Model SFGH, VALOR and most recently LIFE in Fresno) have different organizational structures, they are monitored by the same evaluations as discipline-based block clerkships, and students in the structured clerkship programs achieve the same or better educational outcomes. All core clerkships have competency-based objectives that are used across all clerkship sites and monitored in the same way with the core clinical experience card (CEC) system described above under “Patients/Clinical Conditions.” The criteria for grading and policies for determining grades are the same at all sites and students at all clinical sites take the same end-of-clerkship written exam. Additionally, the online E*Value form used by teaching faculty and residents to evaluate students is the same across all sites. The Office of Medical Education produces annual reports to evaluate educational outcomes for each clerkship site. These reports use a range of outcome measures, including performance on written clerkship examinations, grades (percentage of honors) in the clerkship, performance on the CPX, and students’ specialty choice. This information is monitored by clerkship directors and Clinical Clerkship Operations Committee (CCOC), with oversight by the Clinical Studies Steering Committee (CSSC). To date, we have identified no major or consistent differences in student assessment results, based on clerkship site. Despite objective evidence of consistency in student evaluation across clerkship sites, the independent student survey report identified the honors grading system during clerkships to be an area of concern for third- and fourth-year students. In particular, students expressed concern about the consistency of evaluation criteria and grading patterns. In response to student concerns, the CSSC and the CCOC have jointly appointed a task force, with representation by faculty, students, clinical course administrators and evaluators, to propose solutions for future competency-based assessment, improved approaches to grading and the use of portfolios within the clinical courses. Data from student evaluations of core clerkship sites are also summarized regularly by Office of Medical Education and reported to CCOC and CSSC. These committees provide guidance to clerkships about how to rectify variations. Actions resulting from this guidance have included the course directors visiting with the site directors, adding an additional learning opportunity to supplement a consistently identified gap, or providing skills development sessions to teachers/evaluators. Content  Areas. All content areas required for accreditation are included in the curriculum and appropriately addressed. The curriculum is designed to deliver learning experiences that provide requisite foundations for the subsequent stage, thus permitting students to encounter an iteratively expanding repertoire of content, clinical experience, skills and opportunities for professional development. Ilios, our award winning electronic curriculum database, provides invaluable support for this process. In the current version of Ilios, each teaching session is tagged by learning objectives, key words, MeSH terms, disciplines and themes. This permits thorough review and summary of curriculum content by any of these attributes. In the next version of Ilios, which is due to be released in early 2011, each learning objective will additionally be linked to program objectives, competency domains and assessment activities in order to provide an even greater degree of mapping of curricular content. Regular review of data by curriculum committees and assessment tools supports our confidence that LCME content criteria regarding breadth and adequacy are being met, and also informs ongoing quality improvement. In addition to student ratings of courses, these supporting data include: UCSF students’ performance on USMLE Step 1 and Step 2 (CK) by subjects and disciplines, which is consistently above the national mean and at the national mean respectively; UCSF students’ clinical performance exam scores (CPX) that compares favorably with the pool of more than 1,000 California students taking the

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same exam and better than all students taking USMLE Step 2 CS; UCSF students’ satisfactory experience of content and skills in specific domains beyond general medical knowledge reported in the AAMC Graduation Questionnaire as well as residency program directors’ satisfaction with the performance of UCSF graduates during internship across an array of competencies. Balance of Inpatient and Ambulatory Teaching. The core MD curriculum is designed to ensure good balance between inpatient and ambulatory teaching. Students participate in at least three years of in-depth longitudinal ambulatory experiences. Foundations of Patient Care preceptorships span the first and second years and the Longitudinal Clinical Experience (LCE) preceptorships run throughout the third year. In addition, many core clerkships explicitly address ambulatory medicine and ensure student clinical experiences in the outpatient setting. Students spend half of their time (three out of six weeks each) during the Pediatrics and Obstetrics & Gynecology clerkships, and their entire Family & Community Medicine clerkship (six weeks) in the ambulatory clinics. In addition to structuring time in the outpatient settings, these three core clerkships also include expectations for the achievement of competencies in the care of ambulatory patients in their Core Clinical Experience Cards (CECs), which are used to document student accomplishment of key learning objectives. Sixteen students per year participate in the PISCES (Parnassus Integrated Student Clinical Experiences) program, an integrated longitudinal clerkship that provides a yearlong patient-centered and ambulatory approach to core clerkship learning. Twenty-five students per year participate in a second structured clerkship program, the six-month Model SFGH (San Francisco General Hospital) that shifted in 2009-10 from sequential block clerkships to a longitudinal, integrated, ambulatory set of clerkships. These 38 students meet the same competency expectations as all other clerkship students, and use the same clinical experience cards to document their learning experiences. However, they primarily achieve their competencies via ambulatory clinical experiences with their own patient cohort, and have only brief structured components in the inpatient settings to ensure opportunities for inpatient experience and teaching. A similar six-month structured program is offered at SFVAMC, the VALOR program, which offers an integrated mentoring overlay to the block rotations that combine inpatient and outpatient experience. LIFE (Longitudinal Integrated Fresno Experience), a new structured six-month program, began in July 2010 and will take advantage of the new ambulatory building and community clinics in Fresno. Elective  Courses. There is an appropriate balance between required and elective courses in the curriculum. Electives account for 57 out of 239 credits required for graduation. While elective time is primarily available in the fourth year, almost all students take electives in the first two years as well. There are 70 electives available to first- and second-year students and 220 clinical electives available to third- and fourth-year students. The maximum number of weeks students can take elective courses/clerkships at another institution is 22. In summary, the curriculum is carefully designed to facilitate student achievement of the requisite competencies and learning objectives for the MD program. Overall student satisfaction with the educational program is high, as measured by the self-study and the AAMC Graduation Questionnaire. The school provides an appropriate balance of instructional methods (lectures, labs, small groups, PBLs, preceptorships), inpatient and outpatient experiences, and primary care and specialty care experiences.

C. Teaching and Evaluation  Adequacy  of  Supervision  and  Preparedness  for  Teaching. During the self-study process, exceptional teaching by faculty and residents, and availability and accessibility of faculty were identified as top strengths of the institution. Faculty members and residents provide appropriate levels of

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supervision for students’ clinical experiences as measured by clerkship evaluations, core clinical experience cards (CECs) and the 2009 AAMC Graduation Questionnaire. Core clinical teaching sites have a well-structured hierarchy of supervision that includes faculty, fellows and residents; at community sites without residents volunteer clinical faculty provide direct supervision. All of the core clerkship directors and site directors and the majority of clinical instructors who supervise students during core and elective clerkships hold faculty appointments. Exceptions include some Foundations of Patient Care small group leaders and preceptors, some Fresno preceptors, some Longitudinal Clinical Experience preceptors and some attendings at affiliated community hospitals. All clinical instructors are offered and encouraged to apply for volunteer clinical faculty appointments, which have the advantage of free access to online resources through the UCSF library and through Continuing Medical Education courses and resources. Substantial effort goes into helping faculty and trainee educators (fellows, residents, postdoctoral fellows, graduate students, medical students) prepare for their teaching roles. In the Essential Core, faculty organizers of small groups and laboratory sessions distribute written “tutor notes” and, in most cases, hold training sessions that cover session content and instructional strategies. Support for content training is also provided by the online curriculum, which emails instructors automated reminders of teaching sessions from the Ilios database and provides full access to the iROCKET resources used by students (i.e., electronic syllabus, lecture PowerPoint files and lecture-casts, discussion forums, independent learning modules, etc.). For clerkships, clinical departments employ a variety of methods to prepare faculty members and trainee instructors for their roles in teaching medical students. In addition to course- or clerkship-specific training, the University provides programs and workshops to help faculty members and trainees improve their teaching skills. Examples of programs for trainees include the Becoming an Effective Teacher (BEST) course for graduate students, the UCSF Postdoctoral Teaching Fellowship program, and the Pathways to Discovery program’s Health Professions Education pathway for medical students, residents and fellows. The Office of Graduate Medical Education (GME) offers workshops on teaching for all UCSF residents and fellows. The Office of Medical Education (OME) and the Academy of Medical Educators (AME) also provide workshops to all teaching faculty and non-faculty. In 2009-10, 550 out of 2,000 individual faculty members participated in these workshops. Finally, the AME offers the innovative Teaching Improvement and Teaching Observation Program (TIP-TOP) peer mentorship program in which any UCSF faculty member can request to observe an Academy member teach and meet afterward to discuss the teaching session, or have an Academy member who has been trained in observation and feedback techniques observe him or her in a teaching session and provide focused feedback afterward. Across the entire curriculum, the quality of teaching is closely monitored through student evaluations of every instructor submitted through the E*Value electronic system and review of these evaluations by discipline and theme leaders, course and clerkship directors, department Chairs, curriculum committees and the educational leadership. Evaluation of Students. The educational program employs a range of formative and summative methods to assess student progress toward expected levels of competency in the six ACGME competency domains. In the Essential Core, assessment activities include integrated clinical exams; written and practical examinations; online self-assessments; faculty and peer feedback on performance in small group, laboratory and problem-based learning sessions; and formative assessment from peers, preceptors and small group leaders on a range of interviewing and physical exam skills. Standardized patients provide feedback on interviewing and physical exam skills during integrated clinical experiences, Problem Based Learning (PBL) sessions and a mini-Observed Structured Clinical Exam (OSCE) at the end of the first year. A summative OSCE assessment occurs at the end of the second year; if a student

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does not pass the OSCE, he or she receives remediation and careful assessment in the first clerkship. Students are required to take the USMLE Step 1 before beginning core clerkships, and to pass the USMLE Step 1 before continuing past their first core clerkship. Beginning in the 2009-10 academic year, the school initiated a portfolio requirement for all UCSF and Joint Medical Program (JMP) first-year students, to advance students’ development of skills in lifelong learning. The portfolio requirement will extend into subsequent years as the class advances through the curriculum. The core clerkships and Intersession course also employ a mix of formative and summative assessments to gauge performance on general competencies shared by all and competencies unique to some clerkships. These assessments include observation by faculty members and residents, written tests, case write-ups, oral case presentations, reflective writing, community engagement and systems-based practice projects. In each clerkship, the students’ progress is reviewed during a midpoint meeting with the site director or faculty supervisor and plans are made to address any areas of weakness or insufficient exposure. At that meeting, the students’ core clinical experience cards (CECs), which list the number and types of patients and clinical skills that must be performed and signed off by a faculty member, are reviewed. Students must turn in the cards at the end of the rotation to pass the course. Clerkship grades are reported using a common summative evaluation form that includes ratings on 13 items, a summative comment and constructive comments. Students take two formative examinations and one summative clinical performance examination (CPX) that are integrated across core clerkships and throughout the core clerkship year. Currently, students are required to complete the USMLE Step 2 CK and CS exams by December of their fourth year. As of the graduating class of 2013, students will be required to pass Step 2 (CK and CS) to graduate. In addition to these assessment activities, UCSF has a well-defined, transparent system for addressing professionalism issues that is based on the Physicianship Evaluation Form developed at UCSF. Physicianship Evaluation Forms are used in the event that a student exhibits behavior indicating a need for help in developing physicianship skills. Implementation of this system across all years has allowed early identification of problems and institution of remediation efforts. Timeliness  of  Performance  Feedback. In the Essential Core, timeliness of performance feedback to students is excellent. Results of midterm and final examinations are released within a day or two. Longitudinal reports of student performance by subject area are also released at the conclusion of each block as soon as the 70% threshold of completion of evaluations is achieved. Assessments that involve narrative descriptions, such as feedback from small group leaders, are returned to students within four to six weeks after the conclusion of the Essential Core course. Clinical Core and Advanced Studies evaluations and grades are due six weeks after completion of the clerkship. There was variability in the average length of time when clerkship grades were made available to students. Recognizing this problem, the educational leadership and the Clinical Clerkships Operations Committee worked collaboratively to remedy this problem. All core clerkships are now meeting the six-week deadline. Assessment of Core Clinical Skills. A comprehensive longitudinal and integrated approach to clinical skills education and assessment ensures that students have acquired the core clinical skills specified in the school’s educational program objectives. Clinical skills education begins in the preclerkship years in the Foundations of Patient Care (FPC) and Transitional Clerkship courses and continues into core clerkships and Advanced Studies. In the preclerkship years, students are assessed on their clinical skills throughout the FPC course and with summative objective structured clinical exams (OSCEs) at the end of the first (mini-OSCE) and second

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years (OSCE). In the clerkship years, students are assessed on their clinical skills in each core clerkship block or structured clerkship program, and in standardized patient exam formats. After the first few months of core clerkship experience, students take the formative mini-CPX1 exam. They are assessed halfway through their core clerkships with a mini-CPX2. At the conclusion of the third year, students take a summative CPX along with all medical students in California. Students not meeting benchmark expectations in the mini-CPX2 or in the CPX are referred to a structured Clinical Skills Guidance Program for remediation and reassessment. Students are observed and regularly receive feedback on their clinical skills throughout their training. The standard clerkship evaluation asks students: 1) whether they were observed at least once performing a specific element of the physical examination relevant to the specific clerkship; 2) the adequacy of direct observation of their clinical skills; and 3) the adequacy of feedback on their performance. In the 2009-10 clerkship evaluation data, students reported being observed performing the specific physical examination element in >93% of all instances. Across core clerkships, the mean scores for adequacy of direct observation and adequacy of feedback were 3.88 and 3.86, respectively, on a 5-point scale. Data from the 2010 AAMC Graduation Questionnaire also indicate adequate frequency of students being observed and given feedback. UCSF students agreed or strongly agreed that faculty observed their physical exams during the core clerkships, which ranged from 65% to 91% compared with 56% to 79% for all schools; and that faculty provided adequate feedback, which ranged from 60% to 88% compared with 65% to 84% for all schools.

D. Curriculum Management  Curriculum Coordination. The self-study identified curricular oversight and planning, student engagement in the curriculum, the authority and leadership of the chief academic officer, and the support of the Office of Medical Education as major strengths. The coordination, coherence and efficacy of the curriculum are ensured by the effective oversight of five curriculum committees combined with strong educational leadership and the assistance of the powerful curriculum database, Ilios. Students play a significant role in curriculum oversight, planning and development through participation on curriculum committees, ad hoc working groups and the curriculum ambassador program, a summer program for 20-30 medical students who work on improvements to the curriculum. The Academic Senate of the School of Medicine elects the members of the Faculty Council, which in turn appoints the Committee on Curriculum and Educational Policy (CCEP) to oversee the entire curriculum. Four standing committees report to the CCEP: the Essential Core Course Committee (ECCC) and Essential Core Steering Committee (ECSC), the Clinical Clerkship Operations Committee (CCOC) and the Clinical Studies Steering Committee (CSSC). The Chair of each of these committees is appointed ex officio to the CCEP. A simplified organizational chart follows; a more detailed chart is found in the database.

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The Essential Core Course Committee reviews the teaching, content, structure and format of the Essential Core courses, identifies best practices, and develops guidelines for course operations. It is composed of course directors, students and central educational leaders, with additional representation by course administrators, theme stewards and the Chair of ECSC. The Essential Core Steering Committee oversees quality improvement, planning and policy formulation. It reviews reports submitted by Essential Core course directors and considers issues of policy and overall integration. Membership is drawn broadly from the faculty at large, with emphasis on clinician-teachers, and includes representation from Essential Core course directors, central educational leadership, and the Chair of Essential Core Course Committee. The Essential Core Steering Committee brings items of direction and policy to the Committee on Curriculum and Educational Policy. The Clinical Clerkship Operations Committee reviews and improves learning objectives, site standards, student assessment and evaluation of clinical courses. The committee is composed of clerkship and site directors, students, and central educational leaders, with additional representation by course administrators and the Chair of Clinical Studies Steering Committee. The Clinical Clerkship Operations Committee reports to the Clinical Studies Steering Committee for oversight of quality, priorities and policy. The Clinical Studies Steering Committee oversees the curriculum for the third and fourth years of medical school, including core clerkships, the structured clinical programs (Model SFGH, VALOR, PISCES, LIFE), Intersessions, the fourth year’s Advanced Studies curriculum, Coda, and the Pathways to Discovery program. Membership is drawn broadly from experienced clinical faculty, with participation by students, central educational leaders, Essential Core and core clerkship directors, and the Chair of Clinical Clerkship Operations Committee. The Clinical Studies Steering Committee brings items of direction and policy to the Committee on Curriculum and Educational Policy. This coherent and coordinated set of committee structures and reporting paths provides robust oversight and quality assurance across the curriculum. It represents an important strength, and reflects substantive input and ownership by the faculty and students. The curriculum database Ilios informs and supports this process by providing readily accessible information on content, sequence, gaps and unintended redundancies, which helps ensure balanced coverage of all desired content.

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Academic Officer Resources. The authority of the chief academic officer and the organization of the Office of Medical Education are significant strengths of the educational program; both have contributed substantially to fulfilling the school’s vision of educational innovation and excellence. David Irby, PhD, the Vice Dean for Education, is responsible for leading, managing and evaluating undergraduate, graduate and continuing medical education. He also directs the Office of Medical Education and oversees development, alumni relations and outreach. This involves oversight of five associate Deans, one assistant Dean, 100 staff members, 25 faculty members and a budget of $17 million. The Vice Dean for Education reports directly to the Dean of the School of Medicine and is part of the Dean’s leadership team. These resources and strong leadership were identified as major strengths. The Office of Medical Education supports all the educational programs in the school. These include the offices of: Admissions, Community Based Education, Continuing Medical Education, Curricular Affairs, Educational Technology, Educational Research and Development, Graduate Medical Education, and Student Affairs. In addition, the Office of Medical Education oversees special programs in the school, including: Foundations of Patient Care, the Haile T. Debas Academy of Medical Educators, the Kanbar Center for Simulation and Clinical Skills Education, Medical Student Well-Being, Outreach and Academic Advancement, the Pathways to Discovery program, the Program in Medical Education for the Urban Underserved (PRIME–US), and the UCSF-UCB Joint Medical Program. Each academic office and program has an administrative director who oversees the academic office or program’s staff and supports faculty working in that office, and who reports to the Assistant Dean for Medical Education. A budget for medical education is determined by the Dean of the School of Medicine and the Vice Dean for Education. Dedicated funding for medical education comes from five revenue sources: State support, student professional fees, alumni philanthropy, grants and contracts. Decisions about funding allocations to programs, departments, individual faculty members and staff members are made by the Vice Dean for Education in consultation with the financial analyst for medical education, relevant Associate Deans, and the Assistant Dean for Medical Education. The proposed funding allocations are then reviewed and approved by the Dean of the School of Medicine. Resources are sufficient to continue supporting our academic programs. Curriculum Planning. Design, management and evaluation of the curriculum are well integrated with clear organizational structure, expertise and participation of medical school leaders, faculty members, assessment experts and students. The planning process actively engages the participation of all stakeholders, and includes a robust oversight system that belongs to the faculty. Additionally, this process is fully informed by the literature, as well as by a substantial scan of the medical education practices across the country. In addition to the curricular committee structure described above, additional components in this process include collaboration in priority-setting with the Academy of Medical Educators’ Innovations funding, the Office of Medical Education’s support for evaluation and faculty leadership of innovation, work groups tasked with specific aspects of innovation, and annual education retreats. At each curriculum committee level, there is participation in planning and review of effectiveness. This includes data on the teaching, content, structure and format of the integrated block courses in the Essential Core, and learning objectives, clinical experiences, site standards, student outcomes assessment, and evaluation of clerkships and structured programs in Clinical Studies. Through this process, best practices are identified, guidelines are developed for areas in need and working groups are formed to focus on specific areas for improvement. The Essential Core Steering Committee and the Clinical Studies Steering Committee are responsible for ensuring that content is coordinated and integrated within and across academic periods of study. The committee Chairs participate in each other’s committees and undertake joint initiatives – ensuring active engagement and coordination.

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Educational Workload. The curriculum committees ensure that students have sufficient time for learning by setting policies on contact hours in the Essential Core and clerkship duty hours in the clerkships and by reviewing course and clerkship adherence to these policies. In the Essential Core, formal instruction is limited to 24 hours per week on average with a goal of only two hours of lecture per day and limited numbers of days with three or more lecture hours. These policies are designed to encourage active learning modalities and to ensure that students have sufficient time for independent and collaborative learning. As part of the annual review of each course’s performance, the Essential Core Steering Committee reviews data on the hours of instruction and their distribution between different activities (lecture, lab, small group discussion, etc.). The Essential Core Steering Committee also ensures that Foundations of Patient Care activities are well coordinated with the other course schedules and curricular content in order to even out peaks in course hours and study demand, especially prior to student assessment activities. In the clinical years, the Clinical Studies Steering Committee provides oversight of clerkship activities, which have been structured to ensure learning and help maintain a balance between education and service. Student evaluations and outcomes are also reviewed in the Clinical Core Operations Committee. All clerkships and integrated/structured clerkship experiences have protected teaching time exclusively for students. In addition, students are expected to participate in other teaching conferences in the department and to complete activities that are purely educational (e.g., case presentations, reflective essays). The duty hours policy for students is modeled after the ACGME policy for resident work hours. Clerkships have established procedures to ensure that all residents, fellows and faculty are informed of the policy and that compliance is consistent across all sites. Students are oriented to the policy and to the reporting mechanism for concerns or perceived violations of the policy. Clerkship directors investigate all reports and work with each site to determine whether there are consistent violations requiring changes in clerkship expectations or structure. Clerkship directors also screen clerkship evaluations for comments relating to workload.

E. Evaluation of Program Effectiveness  Achievement of Objectives. The UCSF institutional objectives are designed to ensure students’ mastery of the core knowledge, skills and attitudes needed to achieve their goals as physicians, researchers, teachers and public servants. As a global measure of achievement of the institutional objectives, a survey of residency program directors in 2009 found that they considered 87% of UCSF graduates in the upper and middle third in relation to other residents. In the questions on the 2010 AAMC Graduation Questionnaire (GQ), UCSF students agreed or strongly agreed that basic science objectives were clear (85% UCSF/86% national). Similar affirmative responses were made across clerkships. Evidence indicating that students are achieving institutional objectives in the patient care domain includes evaluation results from the Foundation of Patient Care (FPC) course, clerkships and standardized patient assessments. In the past three years, 100% of students have passed the end-of-second-year objective structure clinical exam on the first try. Students have high rates of first-time passing on the summative clinical performance exam (CPX), administered yearly by the California Consortium for the Assessment of Clinical Competence to students in eight California medical schools, and on the USMLE Step 2 CS. In the 2010 AAMC Graduation Questionnaire, 91% of graduates agreed or agreed strongly that they are “confident they have acquired the clinical skills required to begin a residency program,” compared with 91% for all schools. In the medical knowledge domain, the strong performance of students in Essential Core midterm and final exams is echoed by their performance on USMLE Step 1. In the 2010 AAMC Graduation Questionnaire, 91% of graduates agreed or agreed strongly that basic science content objectives and examination content

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matched closely, compared with 74% for all schools. For the past three years, 90% to 99% of UCSF students who take the USMLE Step 1 for the first time passed, compared with 93% to 95% of students from all schools. Total and discipline averages for UCSF students on USMLE Step 1 are consistently above the mean for all takers. In 2010, the pass rate for first-taker examinees unexpectedly fell to 90% on USMLE Step 1, while the overall class mean remained strong. The 2010 UCSF pass rate is an exception to the historically strong performance of our students. According to the NBME, the failure rate for first-taker examinees thus far in 2010 is 7%, which is 1% higher than 2009 due to the change in the passing standard. To date, all of the students who have retaken Step 1 have passed. We are analyzing this event and formulating action plans at UCSF and UC Berkeley. Strong student performance on medical knowledge items on the standard clerkship evaluation form are echoed by their performance on USMLE Step 2 CK. For the past three years, 96% to 100% of UCSF students who took the USMLE Step 2 CK for the first time passed it compared with 95% to 96% for all schools. Total and discipline averages for UCSF students on USMLE Step 2 CK are predominantly at or above the average for all first-time takers. Evidence indicating that students are achieving institutional objectives in the practice-based learning and improvement domain comes from the consistently high scores that students attain in the Biostatistics and Epidemiology subject area of the USMLE Step 1 exam. For the past three years, UCSF first-takers have scored one standard deviation above the mean in this subject. In the 2010 AAMC Graduation Questionnaire, UCSF students rated as appropriate the instruction in epidemiology (93% UCSF vs. 84% all) and biostatistics (90% UCSF vs. 79% all) much more highly than their national counterparts. Data from the residency program directors survey indicate a high level of satisfaction with UCSF graduates’ application of evidence-based practice and self-directed learning. Evidence of achievement of institutional objectives in the interpersonal and communication skills and professionalism domains is obtained from internal and external observed clinical exams with assessment items in these domains; UCSF students demonstrate high rates of passing. These competencies are routinely assessed in all formal courses across the curriculum; the limited number of flags regarding such concerns affirms the achievement of objectives in these domains. Internal data regarding Physicianship Evaluations, which specifically highlight professionalism as an academic competency, document that a very small number of students fall below expected competency in this domain. Additionally, UCSF students indicate on a number of AAMC Graduation Questionnaire items that they receive adequate preparation in the communication skills area. Student performance on the objectives of the systems-based practice domain meets expectations. In the Foundations of Patient Care course, first-year students do exceptionally well at conducting an interview of the preceptor regarding his or her practice, in which they gather information on different practice systems related to the longitudinal care of a patient with a chronic illness. Summative evaluations from the Family & Community Medicine clerkship reveal that third-year students are accomplishing a rich array of systems-based practice activities in the clerkship’s required community outreach project. The consistent performance of students across core and elective clerkships settings indicates that students are successfully navigating the wide variety of health care systems that they encounter. Finally, results from the 2010 AAMC Graduation Questionnaire indicate UCSF students perceive that they receive appropriate instruction on “teamwork with other health professionals” and aspects of population-based medicine. Performance/Program  Improvement. At the overview level, education leaders and curriculum management staff and oversight committees regularly review outcome data to ensure that the educational program is preparing students for the next stage of training. The school also tracks the residency and career choices of its graduates. As an example of how information about graduates is used to evaluate and improve the medical education program, the school leadership noted from a review of

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several national databases in 2004 that the percentage of UCSF graduates holding faculty positions in academic medical centers was smaller than that of graduates from comparable institutions. These data were discussed at a School of Medicine leadership meeting in January 2005 and served as part of the impetus to launch the Pathways to Discovery program, which provides students with early mentored experiences in inquiry, discovery and innovation, thereby motivating them to pursue academic careers. As a result, the number of UCSF graduates with faculty appointments at U.S. medical schools has risen from 12% (11% national mean) in 2004 to 22% (18% national mean) in 2010, according to the AAMC Medical School Mission Report. At the course and clerkship level, information about students and graduates is used in several ways to improve the educational program. First, when substantive curriculum modifications are undertaken, external outcomes are considered in detail. The finding that student performance on USMLE Step 1 was not changed after the transition to the Essential Core curriculum in 2001 provided reassurance that the new Essential Core curriculum adequately prepares students in the sciences that are basic to medicine; additional evidence of comparable outcomes was documented on an internal survey of clerkship teachers, comparing clerkship readiness and early performance between students prepared in the traditional and the Essential Core curricula. We believe that this year’s Step 1 scores represent an anomaly and not a trend. For students in innovative clerkship models, similar or better outcomes have been documented on the high-stakes clinical performance examination at the end of third year, on surveys of attitudes toward clinical learning and patient care, and on the USMLE Step 2 CK and CS. Similar studies have revealed no significant differences in student performance across different sites (e.g., Fresno and the UC Berkeley Joint Medical Program). Second, information about students and graduates is used at the course and clerkship levels to adjust the learning objectives and content taught in courses, clerkships, disciplines and themes. In the Essential Core, results of student course evaluations and midpoint student feedback session have a prominent place in the course directors’ reports, which are reviewed each year by Essential Core Steering Committee. If student perceptions or performance in a particular preclerkship topic raise concerns, the Office of Medical Education Evaluation Unit undertakes an in-depth theme or discipline report, interviewing key faculty, searching the curriculum database and soliciting student input through focus groups. Examples of recent theme or discipline reports include gross anatomy, biochemistry, nutrition, geriatrics, pathology, health policy, ethics, epidemiology and evidence-based medicine, and radiology. Examples of educational improvements that have stemmed from Essential Core Steering Committee reviews and theme reports include: appointment by the Department of Pathology of a new faculty position to steward the teaching of pathology across the curriculum; greater effort by all themes and disciplines to show students a roadmap of the theme or discipline’s content and location in the curriculum; and departmental review and restructuring of medical student education in radiology. When content gaps are identified, a working group is often established to review existing resources and recommend best practices and curricular innovations. An example is the recent student concern about inconsistent dissemination of conflict-of-interest information by their teaching faculty, which resulted in the appointment of a working group charged with outlining a new curriculum intended to address the new policies on conflict of interest. In the Clinical Core, results of student evaluations of clerkships overall and of clerkship sites are reviewed annually by the curriculum management and oversight committees, and the educational leadership. Examples of improvements in the educational program that have resulted from these reviews include: identification of specific physical exam components to be observed in each clerkship, development of a series of integrated clinical performance assessments, clarification of core clinical experiences in each clerkship, and introduction of associated documentation, midpoint review and a range of options for rectifying gaps.

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The approach of piloting curricular innovation provides an additional way in which information about students and graduates is used to improve the educational program. Curricular innovations are often introduced as pilot programs involving either small numbers of students or a limited scope for an entire class. The pilots are carefully monitored during the initial phase before being more generally adopted. Examples of successful pilot programs that have gone on to implementation as standing programs include the Program in Medical Education for the Urban Underserved (PRIME-US), the Transitional Clerkship, and the structured clerkship programs of Model SFGH, VALOR and PISCES. At the level of individual instructors, student evaluations are taken seriously and used to improve teaching. Essential Core courses create reports with scores from student evaluations, student comments and benchmark scores of the entire group of comparable instructors, which is shared with all instructors. When course directors or theme or discipline directors have concerns about instructors on the basis of student and/or peer evaluation, course directors work with the instructors directly and encourage them to make use of the Academy of Medical Educators Teaching Improvement and Teaching Observation Program (TIP-TOP) or other campus faculty development programs. In the clinical core, teaching evaluations by students are provided to instructors and benchmarked against the mean of other instructors in the clerkship or department. These reports are also sent to clerkship and course directors as well as to the appropriate department Chairs. Student ratings of teaching are required for faculty promotion and provide an incentive for teaching excellence. Teaching awards are highly valued by residents and faculty, and are an important part of promotions in all series.

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III. MEDICAL STUDENTS 

A. Admissions  Process/Results. The medical school receives around 6,000 applications for an entering class of 149 in San Francisco and 16 in the Joint Medical Program at UC Berkeley; a more than adequate applicant pool. The selection process involves multiple screenings by members of the Admissions Committee and the Associate Dean for Admissions. While academic factors are taken into consideration, they are not the only criteria by which applicants are assessed. The Admissions Committee values all aspects of an applicant’s background. As such, the Admissions Committee practices holistic file review, where an applicant’s unique background, work experience and special talents are considered. Emphasis is placed on an applicant’s potential to narrow disparities in health care, become a leader in health policy or health education, and add to the diversity of the school and the profession. The Admissions Committee is shielded from external pressures and rigorously maintains the integrity of the admissions process. The class’s composition validates that the selection criteria are consistent with the mission and other mandates of the school. For the entering class in 2009, the academic excellence of the class was reflected in an average undergraduate GPA of 3.74 and average cumulative MCAT score of 34. Table 1 shows that this level of academic accomplishment is on par with the top five schools in the U.S. News & World Report rankings and compares favorably with the other University of California campuses and national means. Table 1 Median GPA and MCAT Scores of Peer Medical Schools for 2009 Medical Schools Overall

GPA BCPM MCAT

Total MCAT WS

MCAT VR

MCAT BS

MCATPS

Harvard Medical School 3.9 3.9 35 R 11 12 12 Johns Hopkins 3.9 3.9 36 R 11 13 12 University of Pennsylvania 3.9 3.9 36 Q 11 12 13 Washington University in St. Louis 3.9 3.9 37 Q 11 13 13 UC San Francisco 3.7 3.8 34 R 11 12 11 UC Davis 3.6 3.6 32 Q 10 11 11 UC Irvine 3.7 3.7 32 Q 10 11 11 UC Los Angeles 3.8 3.8 34 Q 10 12 12 UC San Diego 3.8 3.9 35 R 11 12 12 National Mean for Applicants 3.5 3.4 28 O 9 10 9 National Mean for Matriculants 3.7 3.6 31 P 10 10 10

• School data from Medical School Admission Requirement Handbook • National data from AAMC report http://www.aamc.org/data/facts/applicantmatriculant/table17-

fact2009mcatgpa98-09-web.pdf The entering class composition also reflects UCSF’s commitment to diversity, with 32% of students from racial and ethnic groups that are underrepresented in medicine. This degree of diversity is substantially

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higher than that of the other eight medical schools in California, in which underrepresented groups comprised 17.5% of entering classes at other University of California campuses in 2009 and 16.2% of entering classes at the four private medical schools in California (data from University of California, Office of the President). An active outreach program, including a highly successful post-baccalaureate program, helps enlarge the pool of applicants that are underrepresented in medicine. Over half of the medical students are female (55%). Students/Resources. The size of the entering class increased from 141 in 2005 to 149 in 2009 at UCSF and from 12 to 16 at the Joint Medical Program at UC Berkeley. Enrollment increases were stimulated by the state legislature’s commitment to the Program in Medical Education as a mechanism for increasing enrollment in existing UC medical schools and targeting the needs of patient populations in the state of California (e.g., Latino health, urban underserved, rural). In 2009, the school reduced enrollment of the entering class by 3 (a reduction from 152 to 149) at San Francisco due to reductions in state support for enrollment growth. No further changes in enrollment are anticipated. The resources to support PRIME-US have been underfunded by the state but are anticipated to be restored in the near future. Enrollment of all types of students is appropriate to the resources available. Graduate Students and Graduate Medical Education. Graduate programs are distributed throughout the schools of medicine, dentistry, nursing and pharmacy with a total enrollment in 2009-10 of 1,604 graduate students. The majority are split between the schools of medicine (733 students) and nursing (749 students). Enrollment in pharmacy and dentistry has been stable over the past three years while enrollment in nursing rose. There are 73 graduate medical education training programs at UCSF, with a stable number of residents (865) and fellows (260) – total 1,125. Finances. The level of state support has decreased over the past three years: $1.78 M – FY08 actuals $1.71 M – FY09 actuals $1.46 M – FY10 projected Philanthropic giving decreased in 2009 but has returned to historic levels in 2010. In spite of this downturn in state funding and in 2009 philanthropic giving, the school increased scholarship aid and restored the fiscal year 2009 10% reduction in the medical education budget in fiscal year 2010. Ample reserves in medical education allow support for education to be maintained even with decreased state support. In 2010, clinical revenues increased due to better negotiated practice plan rates. This has led to a surplus in the clinical practice revenues that buffer decreased state funding. Size of the faculty. The School of Medicine includes 1,932 full-time faculty members, of which 167 are in basic science departments. Over the past three years, the clinical faculty increased by 220, while faculty appointed in basic science departments remained stable. The ratio of full-time faculty (1,932) to students (733) is more than a 3:1; a highly favorable ratio for conducting the medical education program. Library and information systems resources. The library experienced budgetary reductions and in response had to limit hours of service. Beginning in 2009, the Parnassus library was closed on Saturday and closed at 8:00 p.m. on Friday; the Mission Bay library was closed on Saturday and Sunday. In response to student concerns expressed through the LCME independent student self-study, the Parnassus library opened the Hearst Reading Room to UCSF students for Saturday study in February 2010; this area provides space for 136 students. The library is renovating the Hearst Reading Room to create a 24/7 study area that will open in January 2011. Plans are in place to add workstations to assist with research and study, as well as group study rooms. Upgrades to the wireless infrastructure will make access to the network available in classrooms, the library and public spaces on the campus.

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Classrooms, laboratories and clinical training sites. There have been modest increases over the past several years in teaching space. During the past year, one classroom was added at the new Mission Bay cancer research building and additional classroom facilities will be added with ongoing building at Mission Bay. The Laurel Heights Auditorium has been converted to a general assignment classroom. However, teaching space will increase dramatically with the opening in January 2011 of the new Teaching and Learning Center in the Parnassus library. The Teaching and Learning Center will add a simulation and clinical skills education center; new teaching and learning space, including technology-enhanced active-learning classrooms and computing labs; and communications technology to facilitate interaction with health care providers, students and support teams at other sites (telemedicine). With these additional classrooms, there will be ample instructional space available on campus. Clinical facilities and patients. One of the strengths of the UCSF educational experience is the great diversity of patient populations served by the three core hospitals (UCSF Medical Center and Children’s Hospital, San Francisco General Hospital, and San Francisco Veterans Affairs Medical Center) plus Langley Porter Psychiatric Institute, affiliated hospitals in the Bay Area and Fresno hospitals. There are ample patients and clinical experiences available to our students and residents. Student services. Augmenting an already strong and comprehensive student counseling and support program (Advisory College system, Career Advising Program, Medical Student Well-Being Program, Student Health Services), several new programs have been introduced over the last three years. These include the Learning Assessment Program, located in the Student Life Office, and a full-time Resource Advisor in the Student Financial Aid Office, who provides advice on credit and debt management. The Resource Advisor meets with each of the fourth-year medical students to review financial plans. Diversity. UCSF has a wide range of outreach programs aimed at increasing the number of qualified applicants among those who are underrepresented in medicine and science. The School of Medicine’s Office of Outreach and Academic Advancement directs programs targeted toward careers in medicine. One of its programs, the post-baccalaureate program, is now in its 11th year; 95% of its participants who apply to medical school are accepted. Twelve out of fourteen students in the program are underrepresented in medicine. The University strongly supports several other major outreach programs. The Science and Health Education Partnership is an outreach program that works with San Francisco schools and programs to support math and science education and encourage students to pursue a college education. The Department of Family & Community Medicine sponsors the University Community Partnerships program, which works with five elementary schools in low-income districts within San Francisco and is run in cooperation with the San Francisco Unified School District. UCSF Fresno sponsors the Sunnyside Doctors Academy for middle school students in the Fresno area who aspire to health and science careers and who are from economically or educationally disadvantaged backgrounds. In addition to these and other outreach programs, the UCSF Program in Medical Education for the Urban Underserved (PRIME-US) is serving an important role in enhancing diversity. In the fall of 2009, 73% of students accepted into PRIME-US came from groups underrepresented in medicine. The number of applicants to medical school who are underrepresented in medicine has remained steady throughout the past decade. Nonetheless, outreach efforts have attracted more students from underrepresented groups in recent years; the number has increased from 20% of the class during the first half of this decade to more than 30% of the class during the second half of the decade. This increase in diversity has been achieved despite the state’s budget cuts in education and the subsequent increases in

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student fees. The ability to overcome these external factors speaks to the strength and success of the outreach programs. Visiting/Transfer Students. Many UCSF School of Medicine electives are available to visiting students who are in their final year at an accredited medical or osteopathic school in the United States or Canada. UCSF students are given priority during the elective selection process and therefore visiting students do not compete with UCSF students. Available resources are adequate, since departments do not accept visiting students unless there is space available, as determined by the Office of Curricular Affairs. Visiting students may attend up to three four-week electives at UCSF. Approximately 150 visiting students enroll in UCSF electives annually; they register at UCSF, using the AAMC Visiting Student Application Service (VSAS). Faculty evaluations of visiting student clinical performance are completed by each department with the online E*Value system that is used for evaluation of UCSF students. UCSF does not accept transfer students into its medical school program.

B. Student Services  Academic Counseling. The overall rate of student attrition (~0.3%) is quite low, suggesting that the academic rigor is manageable for students selected according to UCSF admission requirements, even for those who require academic counseling or remediation. There is a robust program of supplementary instruction and tutors offered to students upon entry to UCSF and an advising system to monitor and facilitate access to these resources. UCSF has multiple systems for identifying students struggling academically. Following each course or clerkship block, a Screening Committee chaired by the Associate Dean for Student Affairs and composed of the course or clerkship directors, Advisory College Mentors, Associate Dean for Curricular Affairs, and director of the Office of Curricular Affairs meets to review student performance and discuss students who are not meeting core competencies. Once students at academic risk are identified, remediation resources are tailored to fit each student’s needs. Meetings with course directors, Advisory College Mentors or Associate Deans may be arranged. Learning assessments may be offered by a specialist at the Campus Resource Center. Tutoring by senior medical students is available through the Office of Curricular Affairs. First-year students may be encouraged to participate in the student-run Medical Scholars Program, which provides structured review sessions. Students experiencing academic difficulty are followed to monitor improvement and are discussed at later Screening Committees to identify performance trends. If the initial interventions are unsuccessful, students may be offered a decelerated curriculum or a leave of absence. These systems have been successful at early identification of students who have academic difficulty. Our records indicate that the number of times an individual student is discussed during Screening Committees significantly declines by the fourth year. This suggests that students are being identified early in their academic careers and counseled appropriately. The graduation rate for a typical class is more than 99%, which indicates that nearly all students are able to obtain the resources needed to attain their MD degree. Career  Counseling. The school has a variety of systems and opportunities to provide career advising; options include the Advisory College Mentors, access to approximately 55 designated faculty career advisors, the services of the campus Office of Career and Professional Development, and a host of online resources, including post-match surveys from past students. Third-year medical students are also invited to 14 informational sessions about specialty choices and have three hours of core curriculum focused on career options.

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The Advisory College system offers students one-on-one time with faculty members who support students in the area of academic and career advising and offer guidance related to school, professional and community resources. Students are assigned an Advisory College Mentor upon entry into medical school and are invited to participate in one-on-one meetings in person or through email, in small groups and at Advisory College social events. Beginning in the 2009-10 academic year, the eight Advisory College Mentors are responsible for reviewing the first-year students’ achievement of competency milestones as documented in their portfolios. The independent student survey rated the Advisory College system positively for access and ability to connect students with resources, but also recommended that more clear objectives and structure for the system be developed so it can more effectively provide career-oriented advising during the early years of medical school. As follow-up to the LCME self-study findings, an expanded career selection theme is being developed for the curriculum, faculty leadership has been identified and additional resources are being devoted to assisting students in the early phases of career decision making. Whereas the independent student survey report expressed concerns about career advising early in medical school, data from the 2010 AAMC Graduation Questionnaire and the LCME independent student survey indicate that UCSF students are quite satisfied with the academic advising they receive after deciding upon a field of interest. Departmental interest groups, confidential faculty advisors and faculty advisors in students’ fields of interest all received high scores in the independent student survey. In the 2010 AAMC Graduation Questionnaire, 62% of UCSF students were satisfied or highly satisfied with overall career planning services, compared with 60% for all schools. Financial  Aid  Counseling  and  Resources. The amount of accumulated debt for UCSF medical students is significantly lower that the national average. According to the AAMC, the average total debt of all graduating students nationally in 2010 was $124,598, whereas the average debt for UCSF graduates was $99,315. While the debt load of UCSF students is comparatively small, UCSF has made scholarship aid a campus priority and it will be a major part of the $1 billion development campaign beginning January 2011. In the interim, the school has continued to increase scholarship aid to offset recent increases in student fees. Eighty-seven percent of UCSF medical students receive financial aid. Types of aid include grants, loans, scholarships, work-study, veterans programs and outside resources. Scholarships and grants originate from three sources: (1) donations to the school for student scholarships; (2) campuswide return-to-aid programs in which a portion of funds raised from professional student fees is designated for scholarships; and (3) Universitywide return-to-aid programs in which a portion of funds raised from educational fees is designated for student scholarships. On average, grant awards comprise roughly 50% of total fees. For the 2009-10 academic year, medical student scholarships from the School of Medicine totaled $2,337,833, a 15% increase in scholarship support from the school over the prior year. The school has also designated student scholarships as the focus of its ongoing campaign with alumni and, as mentioned above, the next major campus capital campaign. Financial education and debt management counseling programs are available to medical students through the campus Student Financial Aid Office. Students have the opportunity to schedule individual sessions at any time during their medical education and also can obtain information through the Student Financial Aid Office website (http://finaid.ucsf.edu/student-loan-debt-management-repayment/debt-management). The LCME independent student survey expressed concern about financial aid counseling, and in response, the Student Financial Aid Office has added new staff and expanded individualized counseling. In May 2009, the Financial Aid Office hired a Resource Advisor to concentrate specifically on individual debt management strategies and the development of a robust four-year debt management curriculum

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geared specifically to medical students. The employee has masters’s degrees in both counseling and finance. During the 2009-10 academic year, student debt sessions were offered at student orientation and during the fourth-year Coda course, and the Resource Advisor personally counseled more than 114 graduating seniors in one-on-one sessions. Fourth-year students also were invited to attend group exit sessions, which the Resource Advisor conducted. Based on data from the 2010 AAMC Graduation Questionnaire, 63% of UCSF students indicated satisfaction with overall debt management counseling (compared with 64% nationally), an improvement in our rating of more than 24% in just one year, even though the Financial Aid Office was temporarily relocated to the basement of the Ambulatory Care Center and was bringing up a brand-new financial aid system – two situations that had the potential to impact the office’s ability to counsel students effectively. The Student Financial Aid Office continues to seek new and improved ways to deliver financial aid via online 24-hour services and a revamped website. But medical student issues are unique and the personal approach seems to work best. In addition to the focus on debt management and personalized financial assistance for seniors, the Student Financial Aid Office is restructuring its counseling caseload so that advisors can concentrate on students within a specific class, and thus have a laser-like focus on issues that arise during the medical school life cycle (for example, transitioning to clinics and the financial stresses that occur related to transportation and lifestyle). The Financial Aid Office is confident that the recent addition of the Resource Advisor, the new online capabilities that allow students to monitor their own aid process and the restructuring of the counseling caseload will provide continued opportunities to improve services. Personal  Counseling/Preventive  Health  Services. The Medical Student Well-Being Program provides free, confidential, on-campus counseling services to medical students. The program also provides preventive outreach programs that are connected with the curriculum to address students’ needs. The providers have expertise in treating medical students and are never involved in academic evaluation. This year, the staff Full Time Equivalent (FTE) has been increased from 1.1 to 1.3 and evening hours have been expanded. Students praised the Medical Student Well-Being Program in both the 2010 AAMC Graduation Questionnaire and the LCME independent student survey for its service, confidentiality and accessibility. The campuswide Student Health and Counseling Services (SHCS) provides free primary health care and counseling services at two campus sites. Services are provided during hours that are designed to be convenient for students. Evening appointments are available three days per week to accommodate students’ schedules. All students are enrolled in a school-sponsored health care plan for additional health care, unless the student provides proof of alternate, adequate insurance. Student satisfaction with student health insurance was higher than the national average indicated in the 2010 AAMC Graduation Questionnaire (64% satisfied or very satisfied at UCSF vs. 50% nationally) but student satisfaction with student health services was lower (65% satisfied or very satisfied vs. 72% nationally). Students commented on wanting greater availability of appointments, better responsiveness of staff and more services. The LCME independent student survey also confirmed areas of concern, including appointment availability, obtaining referrals, affordability and the ease of opting out of student health insurance. In response, SHCS examined these issues very carefully, met with students to better understand their concerns, and planned to both better communicate with students and make important changes. Prior to receiving the survey feedback, SHCS had already expanded evening hours to offer more flexibility to students with demanding schedules and will send written communications to students to increase awareness of these services. The clinic check-in process will be improved, as will referrals to UCSF Medical Center specialty services. Frustrations with the student health insurance waiver process will be improved in 2010-11 by relaxing the opt-out criteria and streamlining the online application tool.

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In the past, each University of California campus negotiated separate rates for student health insurance. Since UCSF has a small student population, the costs were significantly higher for UCSF students. This year for the first time, the UC system purchased health care plans for most campuses in a common pool, which resulted in increased benefits in medical, dental and vision plans and decreased costs by 11% (rather than the usual 10% annual increase in fees). Disability insurance is also mandatory for all students and is included in their student health insurance plan. Additionally, students are required to provide proof of immunization; the UCSF immunization policy follows CDC guidelines. Students are educated throughout the curriculum about infectious and environmental hazards, and formally at the start of third year in the Transitional Clerkship course. In general, students are not allowed to participate in procedures with potential for contamination during the first two years of medical school. Students who do participate in procedures as part of elective courses go through a program to learn about sterile techniques and exposure to bloodborne pathogens. Affiliation agreements stipulate that students who experience a needlestick exposure will be treated immediately at that site. UCSF runs a 24/7 needlestick and exposure hotline, and Student Health Services regularly sends information and reminders to students about what to do in case of needlestick at UCSF or other educational sites.

C.  The Learning Environment  The LCME independent student survey committee and the LCME overall self-study committee identified the strong sense of community and the general attitude of collegiality, acceptance and support as a major strength of the institution. The school and affiliates work collaboratively to create a positive learning environment, as described below. Environmental Influences. Teaching and evaluating professionalism are at the heart of the UCSF curriculum. Our effectiveness in making this issue a priority is reflected by the establishment of professionalism as a core competency at UCSF almost a decade ago and was noted as an institutional strength on the previous LCME visit. The requirement to demonstrate competence in professionalism applies throughout our educational programs and with all of our clinical partners. Students must demonstrate proficiency in professionalism in each of the following subdomains: (1) doctor-patient relationship; (2) boundaries and priorities; (3) work habits, appearance and etiquette; (4) ethical behavior; and (5) professional standards. Formal mechanisms are in place to ensure that problems in these areas are identified and remedied. Given the seriousness with which we address problems of professionalism and our demonstrated willingness to discharge students whose transgressions cannot be remedied, our high graduation rate attests to our effectiveness in this area. Student Mistreatment/Standards of Conduct. The school addresses allegations of student mistreatment with great sensitivity and gravity, and is committed to effectively educating the academic community about acceptable standards of conduct in the teacher-learner relationship. Guidelines of appropriate treatment are included on multiple websites and shared with members of the campus community in an ongoing fashion. For example, students receive this information during their first-year orientation through distribution of the UCSF School of Medicine Statement of Principles. Faculty members receive this information through the Faculty Code of Conduct and are required to participate in regular professional development and training sessions on this issue. Allegations of student mistreatment are seriously investigated in a process overseen by the Associate Dean for Student Affairs. The Associate Dean reviews data from the questions about respectful treatment included on clinical instructor evaluation forms completed by medical students at all clinical sites. Of the

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15,229 evaluations that students completed on housestaff and faculty for 2009-10, only 123 (<1%) were rated low. These data suggest that the climate at UCSF is positive. If the Associate Dean finds a persistent pattern of low scores for a faculty member or resident, she meets with course directors, the relevant department Chair and site directors to review the findings and determine an appropriate course of action. Efforts to focus on professionalism have increased, along with ratings of the learning environment as measured by the AAMC Graduation Questionnaire since 2003. In response to the question “Have you personally been mistreated during medical school?” there has been a 50% decline in the number of UCSF graduates answering “yes” (from 30% in 2003 and 2004 to 15% in 2009). This improvement places UCSF ahead of the national average of 17%. However, the 2010 data are 19% compared with 17% nationally, indicating continuing need for this effort. In the LCME independent student survey report, students expressed concern about insufficient knowledge of how to report mistreatment and of the steps taken by the institution once a report is made. In response, Dr. Papadakis, Associate Dean for Student Affairs, has been giving presentations to medical school classes on reporting mistreatment, which should be directly addressed to her. The procedure for reporting mistreatment has also been more prominently displayed on the student website. UCSF has established due process policies and procedures for dealing with an adverse academic action through the student grievance process outlined by the Academic Senate. Additional resources include the School of Medicine Advisory College Mentors, who serve as ongoing student advocates, and the Student Welfare Committee, a group of students and faculty members that is called upon as needed to review a contested physicianship evaluation or grade if the student is concerned about infringement of academic freedom. Familiarity with  Policies/Student  Records. Standards and policies are made known to medical students and faculty in several ways. The “SOM Regulations via the Academic Senate” and “Conduct and Professional Behavior” section of the student web portal publishes policies for degree requirements, grade and credit, disqualification, withdrawal and the procedure for student grievance. Appropriate due process is afforded students through these policies. All student, resident and fellow grievances for academic dismissal or claims of discrimination are handled by the Vice Dean for Education in a timely manner per University policy, which involves the appointment of an ad hoc hearing committee and final appeal to the Academic Senate. Students and faculty members can directly access the policies provided in the Bylaws, Regulations and Procedures of the School of Medicine at: http://www.ucsf.edu/senate/0-bylaws/somr.html Website links to standards and policies are listed in an orientation handbook distributed to first- and second-year students. In addition, students’ Advisory College Mentors serve as a resource for information about policies and procedures. The confidentiality of paper and electronic components of student records is carefully protected. Paper-based files are stored in locked file cabinets in the Office of Curricular Affairs, where they can be viewed by students during business hours. Electronic files are located in a secure drive. To ensure confidentiality, the officials authorized to examine the records are limited to the staff of the Office of Curricular Affairs, the staff of the Office of Student Affairs and the Data Manager for the Office of Medical Education. The process for accessing files is communicated to students during Orientation at the beginning of first year and students are reminded of the process when they begin the residency application process. Students may ask for clarification and review of their examinations and course grades within the course and clerkship, and can appeal to the Student Welfare Committee if they believe that there has been an infringement of academic freedom.

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Student Study/Lounge Space. The Parnassus campus library has adequate study space and a branch library is available at the Mission Bay campus. Both libraries have computers with printing capabilities and campus network and Internet connections. An Interactive Learning Center computer lab on the Parnassus campus and Genentech Hall Study space at Mission Bay are open 24/7. According to the 2010 AAMC Graduation Questionnaire, the majority of UCSF students are “satisfied” or “very satisfied” with the library (UCSF 84% vs. national 86%), the computer resource center (UCSF 87% vs. national 86%) and student study space (UCSF 67% vs. national 77%). These are lower levels of satisfaction than in prior years. The LCME independent student survey report indicated dissatisfaction among first- and second-year students with library open hours since budgetary cuts forced the library to reduce its hours of operation in 2009. The campus has taken steps to provide alternative student study space in open classrooms and the Parnassus library has arranged for student access to the Hearst Reading Room from 8 a.m. to 8 p.m. on Saturday when the main library is closed. Opening in January 2011, the Parnassus library is renovating space for a 24/7 study space. Additionally, the Office of the Registrar has launched a pilot program to provide students after-hours card-key access to classrooms at the Parnassus and Mission Bay campuses. Lounge and relaxation areas. In addition to public lounges and community fitness centers on campus, medical students have 24/7 access to their own lounge with comfortable furniture, computers, printer, white board, conference table, telephones, typewriter and copy machine. The independent student survey report praised the fitness centers at Parnassus and Mission Bay. According to the 2010 AAMC Graduation Questionnaire, 47% of UCSF students rated their satisfaction with student relaxation spaces as “satisfied” or “very satisfied,” compared with 65% for all students. Personal storage facilities. First- and second-year students are assigned a locker on the Parnassus campus that they share with another student. An area of concern in the LCME independent student survey report for first- and second-year students is a secure space to store their backpacks while they are in the anatomy lab. Plans for remodeling the anatomy lab are underway and a secure place for students to store their backpacks will be built into the facility. While on third- and fourth-year clinical rotations, students either have lockers or a designated locked area for their personal belongings.

D.  Student Perspective on the Medical School  The LCME independent student self-study committee was composed of 22 students from all classes. The committee created a survey that was open to all medical students from February 22, 2010, through March 8, 2010. Student participation in the survey was high, with 430 students, approximately 70% of the school, responding to the survey (65% of the first-year class, 77% of the second-year class, 67% of the third-year class and 64% of the fourth-year class). Major Areas of Strength. Students expressed appreciation for the strong sense of community that is fostered by a general attitude of collegiality, acceptance and support. Students felt that they have a voice in their education and that school administrators care about their opinions. The Deans and faculty all received high satisfaction ratings for their availability. In addition, students highly rated their overall sense of acceptance (based on race, sexual orientation, religion, etc.). The breadth of high-quality research opportunities available to students is a cornerstone of the school and the Pathways to Discovery program offers students the structure and support to explore research in molecular medicine, clinical and translational science, global health sciences, health professions education, and health policy. Students were satisfied with funding for research.

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Students highly praised the strong support from school leadership to pursue individualized learning opportunities throughout medical school. They felt that there is a deep commitment to student mental health and well-being at UCSF, especially through the work of the Medical Student Well-Being Program. The first- and second-year curriculum, which overall received high ratings from students, is another strength of UCSF, including: small group learning, the Foundations of Patient Care (FPC) course, the virtual learning environment (iROCKET and Collaborative Learning Environment), electives and the pass/fail system. Regarding the third and fourth years, students praised the breadth of clinical sites available and the excellent teaching during their clerkships. Students were very satisfied with many essential facilities at UCSF, specifically the shuttle system and fitness centers. Areas of Improvement. In general, the survey results reflected a need to improve financial and academic advising in all years. A notable exception was advising for fourth-year students by faculty members in their field of interest, which was rated very highly. Particular programs that students noted could benefit from improvement include the Advisory College system, the Big Sib Program, the clerkship scheduling and advising, career/research advising, financial aid counseling, and Student Health Services. The students felt that the grading system during clerkships needs greater clarity and transparency, and the teaching of physical exam skills could be improved for both third- and fourth-year students. Students also lacked knowledge of the procedure for reporting mistreatment. Students were concerned about library hours and the need for 24/7 study space, parking available on or near campus, more sleep areas at some clinical sites for third- and fourth-year students, and limited service of the VA shuttle between the Parnassus campus and the SFVAMC.

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IV. FACULTY 

A.  Number, Qualifications and Functions  Number, Qualifications and Functions. The School of Medicine has 1,932 full-time faculty members, of which 167 are in basic science departments. Since the last LCME site visit, the full-time faculty has grown by over 400 while the volunteer clinical faculty has decreased by over 500 to 2,876. The decrease in volunteer clinical faculty resulted from department decisions to uphold high standards for active engagement in educational programs as an eligibility criterion for faculty status. Fewer faculty members are being appointed in basic science departments because their primary work is increasingly being done in interdisciplinary research centers and clinical departments. With the completion of several new research buildings and increases in the research enterprise, the faculty will continue to grow over the next several years. All of these trends are positive and there is a more than ample number of faculty members to meet the educational mission of the medical school. The Office of Community Based Education, within the Office of Medical Education, recruits, monitors, supports and provides faculty development to more than 450 full-time faculty members and community preceptors. This number adequately covers all preceptorships in the first through third years as well as the small group teaching in the Essential Core and Intersessions. The level of interest in precepting our students remains consistently high. Improvement in Teaching Skills. The school has a robust faculty development program offered by the Office of Medical Education and the Academy of Medical Educators, designed to assist faculty members to improve their teaching, curriculum development and assessment skills. In 2009-10, they conducted 33 faculty development workshops in three series: 1) Key Educational Skills workshops (13 sessions); 2) Special Topics Educational Skills workshops (11 sessions); and 3) Community Based Educational Skills workshops (9 sessions), which are offered on campus and at community sites easily accessible to our volunteer clinical faculty. A total of 530 individual faculty and staff members participated in these free workshops, which award continuing medical education credit. In addition, the Office of Medical Education offers a yearlong Teaching Scholars Program to 12 faculty members, a Medical Education Research Fellowship for two faculty members, a weekly Educational Scholarship Conference (ESCape) averaging a dozen faculty members, and a monthly medical education journal club averaging another dozen faculty members. The Teaching Scholars Program provides faculty members with insights into learning theory, pedagogy, curriculum, assessment, scholarship and leadership. This course meets for a half day weekly for a year. Since 1999, this program has graduated 124 scholars, who now hold most of the educational leadership positions in the school and departments. The Academy of Medical Educators (AME) offers faculty development workshops, quarterly meetings, an Education Day, individualized teaching consultations through the Teaching Improvement and Teaching Observation Program (TIP-TOP), and educational innovation grants. In 2009-10, 28 faculty members enrolled in TIP-TOP and 242 faculty members participated in Academy events. Additionally, individual courses and clerkships invest considerable effort in helping instructors improve their teaching skills. This involves providing general orientation sessions, and specific content- and teaching strategy-focused sessions. Course directors also review instructor evaluations and provide feedback. In the Essential Core, there is significant collaborative peer feedback for lecturers from course

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and discipline leaders who routinely attend course lectures. There is also an extensive online teacher and course evaluation system that provides feedback to teachers and courses for improvement purposes. Mentorship for Scholarship. Faculty members receive extensive support and mentorship related to scholarship from the campus, school and their department. The Faculty Mentoring Program also collaborates with the Clinical and Translational Science Institute Mentor Development Program (http://ctsi.ucsf.edu/training/mdp-announcement) to develop an innovative curriculum for training midcareer and early senior research faculty to become the next generation of clinical and translational research mentors. In addition, a number of departments have implemented faculty mentoring programs for new and junior faculty members to meet their specific needs and goals as determined by the department, the Chair and other faculty leaders. The Office of Medical Education sponsors a weekly seminar, the Educational Scholarship Conference (ESCape), to mentor faculty in the development of their educational scholarship.

B. Personnel Policies  Faculty  Appointment. There are five faculty tracks at UCSF: Ladder/Tenure, In Residence, Clinical X, Health Sciences Clinical and Adjunct. Within each of these tracks, a faculty member holds a specific title/rank (Instructor, Assistant Professor, Associate Professor, Professor) and step (level within a given rank). Merit (“step”) increases refer to advancement within a given rank, while promotion refers to advancement from one rank to the next (e.g., Assistant Professor to Associate Professor). Each department sets its own guidelines for advancement and promotion in the individual tracks outlined above. These guidelines are meant to supplement, not replace, the Academic Personnel Manual and are provided to members of departments where additional qualifications are specified. The school’s Office of Academic Affairs monitors compliance with these guidelines through checklists that must be submitted with appointments, merit advancements and promotions. Departments vary in terms of whether they use a faculty committee or all faculty of a higher rank to vote on appointments, merit advancements and promotions. These committees or groups of faculty members in smaller departments are intended to ensure that merit advancement and promotion policies are applied consistently across the departments. The school and campus academic affairs offices monitor compliance with faculty governance procedures on this matter. For faculty members who carry heavy teaching loads or who are educational leaders, the Academy of Medical Educators portfolio provides a powerful way to make visible their contributions to the school’s educational mission and more broadly to medical education. These faculty members also receive letters of support for their leadership roles from the educational leadership and the Academy. This has resulted in accelerated advancements for many Academy members and other educational innovators and leaders. Promotion policies are widely communicated to the faculty through websites, brochures, workshops, department meetings and annual mentoring/performance review sessions with department or division Chairs/chiefs. In addition, the campus and School of Medicine academic affairs offices conducted a Faculty Information and Welcoming Week in the fall that attracted 90 new faculty members in 2009. This was followed up with luncheon meetings at three different sites that were attended by a total of 205 faculty members. While UC appointment and advancement policies are complex, they are well understood by faculty members and are carefully followed. Conflict of Interest. Campus administration, the Academic Senate and the School of Medicine have implemented a number of policies related to faculty interactions with industry and disclosure

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requirements. Reporting of industry relationships must be done annually and whenever a faculty member is proposing to initiate research activities. As part of the oversight structure, each faculty member is required to disclose all relationships with industry and all income received from industry for consultations, research activities, royalties and honoraria. UCSF continuing education activities have a strong and documented record of being free of commercial bias. All faculty members who participate in continuing medical education programs must comply with ACCME policies related to industry relationships. Feedback to Faculty. At the time of initial employment, all faculty members are provided with a written contract describing the terms and conditions of their employment. In addition, a detailed package of information is provided and reviewed that includes descriptions of policies related to the type of appointment (including review of other appointment types), compensation, responsibilities and expected distribution of time, mentoring and faculty development resources, and administrative support and resources. A checklist covering these points is signed by both the faculty member and the department Chair, division chief or designate.

Chairs and division chiefs are responsible for ensuring that all faculty members have an annual performance review and appropriate review for merit advancements and promotions. In addition, every faculty member is reviewed every two years for merit advancement at the assistant and associate professor levels, and every three years at the full professor level. As a University policy, all members of the Academic Senate have a formal appraisal of achievement and promise during the fourth year of appointment at the assistant professor level. The school’s Office of Academic Affairs annually reviews these activities to ensure compliance. Teaching/Faculty Promotions. There is strong support for the educational mission at UCSF as indicated by the requirement to teach and provide documentation of teaching excellence for academic promotion, the use of the educator’s portfolio in promotions, the resources committed to faculty development and educational scholarship, the strong educational program evaluation and teacher evaluation system, and the Academy of Medical Educators. The Dean’s recent appointment of a committee to measure the educational contributions of the faculty is another indication of the school’s commitment to promote and reward teaching excellence. Educational contributions of the faculty are factored into decisions about faculty retention and promotion at all levels. The greater the amount of faculty time devoted to teaching, the greater the influence of teacher ratings on the faculty member’s promotion and advancement.

C. Governance  Decisionmaking. The Academic Senate provides the primary structure for faculty engagement in organizational decisionmaking on the campus and in each school. One of those mechanisms is the School of Medicine Faculty Council, a governing body of peers elected by faculty members who establish all educational and faculty policies. Outside of the Academic Senate, there are more than two dozen faculty committees that regularly advise the Dean. For most issues, the Dean and the Chairs/ORU Directors together set policy. Annually, the Dean convenes the SOM Leadership Retreat to discuss the most pressing issues confronting the school. During these retreats, 140 faculty members are actively engaged in discussing and formulating strategic plans for the school, which are subsequently enacted. This both informs the faculty and engages them in finding creative solutions. Faculty members have sufficient opportunities for formal and informal input to the decisions of the school.

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Faculty Communication. In addition to the news office communications on the school’s website and periodic emails to the faculty, the Dean has hosted eight “Town Hall” meetings over the past two years to allow wide dissemination of information and input on key topics. The location of these meetings rotates among the major sites (e.g., Parnassus, Mission Bay, SFGH, SFVAMC and Mount Zion) and are telecast. The frequency and variety of communication are sufficient to keep the faculty informed.

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V. EDUCATIONAL RESOURCES 

A. Finances  Sources/Stability. The school’s finances are stable and increasing in spite of the financial challenges in the state of California. Total revenues have increased from $823 million in 2001 to $1.9 billion in 2009. Over the three-year period from 2006-07 to 2008-09, revenues grew by 9.5% from $1.7 billion to $1.9 billion. During this period, there has been little fluctuation in the components of total revenue from tuition and fees (1%-2%), government and parent support (8%-10%), grants and contracts (43%-45%), practice plan (21%-22%), hospital support (12%), and gifts and other (11%-12%). These totals include substantial funding provided by the City and County of San Francisco for faculty, trainees and staff stationed at San Francisco General Hospital. Even in difficult financial times, the school’s revenues continued to grow. In the coming three years, government and parent support is expected to trend down slightly to 7% of total revenue while grants and contracts revenue is expected to grow. The school maintains a healthy and consistently growing reserve balance in the Dean’s office, medical education and departments. At of the end of fiscal year 2010, the school had $303 million in unrestricted net asset balances and $260 million in restricted net asset balances.

MEDICAL SCHOOL REVENUE SOURCES ($ in Millions)

Source (2009-2010) % of Total Revenues Tuition and fees $ 35.7 1.9% State appropriation $ 145.8 7.7% University allocation $ 0.0 0.0% Grants & contracts (direct) $ 692.2 36.8% Indirect cost recoveries $ 165.9 8.8% Practice plans $ 405.5 21.5% Gifts and endowments $ 108.4 5.8% Hospitals $ 233.1 12.4% Other revenues $ 95.3 5.1% Total revenue $1,882 100%

Data from the preliminary 2010 UCSF LCME Part I-A Annual Financial Questionnaire on Medical School Financing

The school has long benefited from a well-balanced portfolio of revenue sources so that pressure on any one source is mitigated by other funding. UCSF’s strengths should position it well financially for the next five years. UCSF ranks second in NIH funding and, according to the 2009 Council for Aid in Education survey, UCSF ranks 15th in private giving among all American universities and fourth among public campuses. The top 10-ranked UCSF Medical Center and Children’s Hospital and the faculty medical group have remained highly competitive in the Northern California market and continue to grow in patient revenues. In addition, clinical revenues from the practice plan are up this year with the switch to Hill Physicians Preferred Provider Organization.

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Of concern to all University of California campuses is the reduction over the past several years in state funds appropriated by the California legislature. Because state appropriations account for only 7.7% of the School of Medicine budget, the financial impact of even proportionately high budget cuts is relatively limited. Due to the school’s fiscal restraint plus furloughs in 2009-10, revenues remained higher than expenditures; the same is true for 2010-11. UC, UCSF and the School of Medicine are all developing and implementing business efficiencies as a means to cut costs and as such mitigate the impact of reduced state support. While medical education, like the rest of the school, reduced its 2009-10 budget by 11%, it did so without any staff or faculty layoffs and with no program cuts. Because of the strong reserves in medical education and increases in revenue, the medical education budget was restored in 2010-11. No further reductions are anticipated and no harm has occurred to the educational program. With regard to the financial status of individual departments, the Dean and Vice Dean for finance meet with the Chairs and managers of all departments and organized research units in the spring to review the current year’s financial performance and the proposed budget for the upcoming academic year, including the list of actions to be taken to address a negative operating position if one exists. As part of the 2009-10 SOM Executive Budget Committee deliberations, the Dean’s Office stratified departments into groups based on their ability to cope with projected state budget cuts and other fiscal pressures. Two departments (Anthropology, History and Social Medicine; and Microbiology and Immunology) currently are experiencing severe financial stress while eight others are increasingly financially challenged. The school’s Executive Budget Committee reviews ongoing and requested program support and assists departments that need additional help. The Dean and medical center director also develop a coordinated response to revenue and cost issues in clinical departments. A Strategic Support Advisory Committee, which includes senior medical center leaders and school department Chairs, reviews requests for support by the UCSF Medical Center. Revenue Pressures/Faculty. Faculty clinical productivity standards are increasing but this has not eroded the clinical education of our students or residents. The school allocates the financial resources necessary to provide an outstanding educational program for our trainees and is committed to educational innovation and leadership. To help ensure an excellent educational program, the school created the Academy of Medical Educators, which now has 22 endowed Chairs. The Academy has been essential in institutionalizing the role of education in faculty recruitment and promotion. Another reason that the school has been able to enhance its educational efforts is because the Office of Medical Education has a stable and growing funding source and has, over the past decade, been able to accumulate substantial financial reserves. In addition, the Office of Curricular Affairs monitors the recruitment of teachers for the core curriculum to ensure that an adequate number of teachers is available. There continue to be more faculty members who want to teach than there are positions in the curriculum, so no problems have surfaced to date. The graduate medical education program has received an infusion of funding from the UCSF Medical Center to cover program costs for Graduate Medical Education. The Dean recognizes that the current financial allocation model to support teaching is challenging and needs restructuring. Following the School of Medicine leadership retreat in February 2010, the Dean appointed a committee to make recommendations on how to measure the teaching mission of the school. The school’s Executive Budget committee will take action on the report in the fall. Clinical Enterprise. The school deploys its faculty, clinical fellows, residents and medical students across three major health care systems located in San Francisco plus the UCSF Langley Porter Psychiatric Institute: UCSF Medical Center and Children’s Hospital (660 beds) and the UCSF Medical Group; San Francisco General Hospital and Trauma Center, the county hospital for San Francisco (536 beds) and its Clinical Practice Group; and the San Francisco Veterans Affairs Medical Center (244 beds) and its

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affiliates. Each of these systems plays a critical role in the provision of primary, secondary and tertiary care for the city and the region. For brevity, this response does not address the market position of other important UCSF affiliates, including Alameda County Medical Center (Oakland), California Pacific Medical Center (San Francisco), Community Regional Medical Center (Fresno), Kaiser Permanente Northern California (San Francisco, Oakland, Fresno), Marin General Hospital (Greenbrae), Natividad Medical Center (Salinas), Sutter Medical Center of Santa Rosa, and Valley Care Medical Center (Pleasanton). Since the mid-1980s, the school, UCSF Medical Group and UCSF Medical Center have worked in concert to position the medical center’s clinical enterprise advantageously in Northern California’s very competitive managed care marketplace because most of the clinical activity derives from referrals from throughout Northern California for highly specialized care. In 2009-10, UCSF Medical Center drew 36% of its inpatients from San Francisco, 35% from the greater Bay Area, 17% from California’s Central Valley and 12% from more distant locations in California, nationally and internationally. Market share in San Francisco for UCSF Medical Center has grown slightly from 12.7% in 2003 to 14% in 2008 (2009 data not available yet). The same increase is mirrored in the total Bay Area: 3.7% in 2003 and 4.3% in 2008. UCSF Medical Center continues to thrive and maintain a healthy margin. Since 1987, the UCSF Medical Center clinical enterprise has been a provider of primary and comprehensive care to enrollees within capitated health plans. From 1987 to 1996, UCSF managed its own enrollees, and from 1997 to 2009, UCSF participated in a local capitated network as part of Brown and Toland Medical Group. Although UCSF attempted to resolve a series of complex governance and management issues within this network, Brown and Toland Medical Group cancelled that contract as of December 31, 2009. UCSF selected a new partner – Hill Physicians – for its San Francisco network as of January 1, 2010, and UCSF’s primary care enrollees continue to be able to access care through this new arrangement. The negotiated rates for provision of patient care are higher with Hill Physicians, creating revenue increases for most clinical departments. UCSF physicians provide the clinical services for 20% of the residents of San Francisco at San Francisco General Hospital through the Affiliation Agreement with the City and County of San Francisco. The Healthy San Francisco plan launched by the City and County of San Francisco has further increased enrollment in primary care and comprehensive care in its community clinics and at San Francisco General Hospital. Medical education at all levels is provided at this major UCSF teaching affiliate. Within the past decade, the UCSF clinical enterprise has engaged in two successful strategic planning exercises: in 2002, resulting in major expansion of clinical services; and in 2008, with plans for a new hospital at Mission Bay. These planning processes involved the executive leadership of the school, medical group and medical center plus a broad array of clinical faculty and administrative leaders. In 2002, the strategic plan focused on strengthening the clinical enterprise’s five-year financial position to fulfill its academic missions, enhance its competitive position, and make it possible to raise capital to build a women’s, children’s and cancer hospital complex at the new Mission Bay campus. At the Dean’s Leadership Retreat in 2007-08, almost 100 participants revisited the goals and measures of the 2002 plan and noted that the enterprise had exceeded its goal for an increase in bed capacity, had grown service lines to increase the average daily census by 110 and had substantially exceeded its financial performance goals. Over the same period, patient satisfaction measures increased significantly. Following the 2007-08 strategic planning process, work proceeded quickly on fundraising and construction of the new state-of-the-art, 289-bed, $1.5 billion children’s, women’s and cancer hospital complex at Mission Bay, which will open in 2014.

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Capital Needs. In addition to the new UCSF children’s, women’s and cancer hospital complex at Mission Bay, San Francisco General Hospital has begun construction on a new acute care addition to the hospital that will increase beds from 311 to 386; it is scheduled to open in 2015. The University’s capital budget process works at three intersecting levels: state-funded projects focused on seismic, life safety and infrastructure improvements; projects of high priority to the entire campus, such as classrooms and new research buildings, which are funded through other campus and school sources; and renovation projects funded by the school for School of Medicine assigned space. Despite the inherent complexity of this system, an amazing array of high-priority capital projects have been funded, including four recent major research building projects (three at Mission Bay and one at Parnassus), a new medical office building at Mount Zion for primary care and integrative medicine, and a state-of-the-art clinical skills and simulation center with additional classrooms sited in the UCSF Library. The capital budgets and funding sources for new patient care, teaching and research facilities at San Francisco General Hospital and the San Francisco Veterans Affairs Medical Center are financed and constructed through those governmental entities.

B. General Facilities   UCSF has excellent facilities for teaching, research and patient care, which is more than adequate to meet all of the school’s missions. Over the past decade, a whole new biomedical science campus has risen at Mission Bay, and additional renovations and construction continue at Parnassus.

Adequacy of Facilities. Classroom, laboratory and clinical skills space: In January 2011 the campus’s classroom space will experience a major advancement with the opening of the remodeled second floor of the campus library (25,700 GSF and $23 million). This remodeling will create seven new small group and four new small-medium group classrooms with technology-enhanced active-learning environments, adding 11 new small group teaching spaces to the current inventory of 22. This technology-rich environment has been designed with space for standardized patient activities, mannequin-based simulation, telemedicine, interprofessional education, and reception and staff offices. The project was state-funded by the Telemedicine and PRIME-US Education Facilities initiative, which is part of California State Proposition 1D. All four professional schools and the library have collaborated on the plans for the new center, which will support the curricula for Dentistry, Medicine, Nursing, Pharmacy and other clinical programs.

Over the past three years, a Classroom Improvement Initiative renovated 75% of all classrooms at Parnassus and Mission Bay and upgraded technology in these classrooms. Regarding laboratory space, both wet (three classrooms for slide study, total capacity 80 students) and dry (five classrooms, total capacity 102 students), teaching laboratory space is adequate, as half the class can be accommodated at one time. A project is underway to bring the anatomy laboratory up to standards and to provide space for students to store their backpacks and personal belongings. Adult physical exam peer practice sessions are currently held in small group classrooms, using mats and other equipment, but will move to the new Teaching and Learning Center. Currently, small group instruction in eye and ear examination takes place at the Kanbar Center for Simulation and Clinical Skills, which is in leased space next to UCSF Mount Zion Medical Center. Formative assessment and consolidation experiences in physical examination also take place at Kanbar, as do the mini-OSCEs and clinical performance examinations; all of these activities will move to the more centrally located Teaching and Learning Center. Research space. The 57.5-acre Mission Bay campus was opened in 2003, providing research space and facilities that, when ultimately built out, will double UCSF’s research enterprise and speed the pace of

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biomedical discovery and innovation. Construction of new research facilities at UCSF is ongoing. Four new research buildings that are currently in design or construction, or were recently completed include:

• The new Helen Diller Family Cancer Research Building, 160,000 GSF, opened in the spring of 2009 at Mission Bay.

• Two additional research buildings will be completed in the fall of 2010: the Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research at the Parnassus campus, 69,000 GSF, and the Cardiovascular Research Institute Building at Mission Bay, 236,000 GSF.

• A new 237,000 GSF building dedicated to neurosciences research is currently in design and will open at Mission Bay in the spring of 2012.

Renewal and improvement of existing research facilities are also taking place. Currently five renovation projects for research space are in design or construction on the Parnassus campus. These range from $2 million to $8 million total in project costs and are fully or partially funded by the Dean’s Office. Security systems. All primary instructional sites (Parnassus/UCSF Medical Center/Mission Bay, Mount Zion, San Francisco General Hospital (SFGH), Veterans Affairs Medical Center (SFVAMC), and UCSF Fresno) have 24/7 on-site law enforcement (UCSF Police Department, San Francisco Sheriff’s Department, Veterans Affairs Police) or security personnel present on the campus and at clinical sites, including Emergency Departments. All sites have perimeter security, with outside doors locked nights and weekends, and after-hours access restricted to one or more main entrances. All sites have a means to notify students of local emergencies (e.g., PA announcement, text pager, WarnMe system, etc.). All parking structures and lots at training sites are patrolled by security or law enforcement, with the exception of SFGH, where there is a lot attendant at the parking structure entrance and cameras in the structure, but no patrol. In addition, there are emergency intercoms, panic buttons, walking escort services, shuttle services and dial-a-ride/night shuttle services. Clinical space. The UCSF Medical Center and Children’s Hospital is a 660-licensed bed, tertiary care referral center with two major clinical sites at Parnassus Heights and Mount Zion, approximately 735,713 outpatient visits per year, and annual revenue of $1.4 billion. UCSF Medical Center is consistently ranked as one of the nation’s top 10 hospitals by U.S. News & World Report. While the new medical center at Mission Bay is a key element of UCSF’s long-term vision to advance its education, research and patient care missions, it is only one part of the long-term vision for the campus, which is to create and sustain vibrant, integrated clinical, research and educational programs at the three main clinical sites. Specifically,

• Parnassus: Focus on quaternary adult surgical and medical services, including neurosurgery, cardiovascular and transplant services, with adult emergency care and a new stem cell focus.

• Mount Zion: Expand its use as a major outpatient hub with a diagnostic and therapeutic focus, as well as a focus on women’s health and related clinical research and education.

• Mission Bay: Focus on the care of children, women and cancer patients. • Each hospital will be integrated with the existing biomedical campuses at Parnassus and Mission

Bay to strengthen bench-to-bedside and bedside-to-bench collaboration among basic scientists, clinical researchers and physicians.

C. Clinical Teaching Facilities  Resources for Clinical Teaching. Required clinical rotations for medical students occur in 16 inpatient institutions and 10 outpatient facilities. The majority of clinical teaching is performed at four major teaching sites: UCSF Medical Center and Children’s Hospital (UCSF Medical Center) and associated Langley Porter Psychiatric Hospital, San Francisco General Hospital (SFGH), the San

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Francisco VA Medical Center (SFVAMC) and UCSF Fresno (Community Regional Medical Center and Affiliates). Each campus hosts four or more clerkships. The clinical volume at each institution is substantial and varied. The annual inpatient admissions are: UCSF Medical Center, 29,043; SFGH, 15,744; SFVAMC, 4,968; Fresno Community, 37,870. The annual outpatient visits are UCSF Medical Center, 735,713; SFGH, 466,699; SFVAMC, 425,914; Fresno Community, 123,810. There is an adequate number of faculty members at UCSF Medical Center, SFGH, SFVAMC and UCSF Fresno to supervise students on all inpatient core rotations. The clinical teaching network is adequate for medicine, surgery, psychiatry and pediatrics to accommodate current medical student enrollment. Psychiatry, neurology, and Obstetrics & Gynecology are expanding their clinical affiliates in order to accommodate the increased class size. Each major affiliate is known to have patient mixes appropriate for its mission and when looked at in aggregate, the affiliates provide an extraordinarily rich and balanced experience for students in terms of access to case mix, case acuity, patient ages, gender and cultural diversity. UCSF Medical Center is the major referral center for Northern California and with its quaternary services attracts many specialized care patients in addition to providing primary and specialty care. San Francisco General Hospital, the safety net hospital for the residents of San Francisco, is also a level I trauma center and provides both basic and specialty care for the ethnically and culturally diverse San Francisco residents. The SFVAMC provides primary and tertiary care to veterans in Northern California and is also a major regional and national referral center for specialized care. The Fresno hospitals serve the residents of the Central Valley of California, yet another culturally diverse patient population with some unique diseases that complement the diverse case mix of the San Francisco institutions. Ambulatory care facilities are available and fully functional at all sites. Over the years, more patient care as well as teaching has shifted to ambulatory sites. UCSF Fresno opened a new ambulatory care center in April 2010 that significantly expands capacity for ambulatory care and was designed with teaching in mind. It includes significant computer access and teaching conference rooms. Administrators  of  Clinical  Activity. Each major clinical affiliate (UCSF, SFGH and SFVAMC) has a Chief Medical Officer who is also an Associate Dean in the medical school; has a detailed affiliation agreement; and has a committee that provides oversight of educational activities at the institution. Representation on these committees includes educational administration of the medical school and clinical site. The high level of cooperation between administrators at each of the clinical teaching affiliates and medical school leadership is a hallmark of UCSF’s collaborative culture and results in a smoothly operating and effective clinical education program. This oversight ensures that appropriate resources (including faculty, space and equipment) are allocated to the clinical education program and that student supervision and safety are maintained at all times. Staff of Clinical Affiliates. Attending physicians at each of these medical centers (UCSF, SFGH, and SFVAMC) are UCSF faculty members; all students, residents and fellows are also UCSF trainees. Department Chairs are responsible for the clinical services of these medical centers, with the exception of Fresno, and the educational programs for medical students and residents. Departments have a designated faculty member who has oversight of the medical student education within the department and at each site. The combination of all of these factors results in an excellent, single educational program across three sites. Expectations for creating a positive learning environment at each of these affiliates are clearly stated in up-to-date affiliation agreements. These agreements prescribe the University’s primacy over academic affairs and the education/evaluation of students, appointment and assignment of faculty members with responsibility for medical student teaching responsibilities, and the affiliates’ responsibility to provide

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access to appropriate resources for medical student education as well as treatment and follow-up when students are exposed to infectious or environmental hazards or other occupational injuries.

D. Information Resources and Library Services  Quality  of  Holdings. The print and non-print collection of the UCSF Library is outstanding. Nationally, it is one of the largest health sciences libraries in square footage, with a large number of volumes and electronic journals. As part of the collaboration of the 10 University of California campuses, UCSF faculty and students, regardless of work location, have access to more than 13,000 electronic journals and more than 169 databases in all disciplines – all part of the UC Digital Library. All University of California campuses use the MELVYL system, which contains records for more than 32 million items. A robust web-based system for interlibrary loans allows efficient delivery of materials to anyone in the UCSF community. The UC libraries are actively digitizing print books; currently more than 2 million volumes have been digitized with availability of the full text dependent upon copyright. The UCSF Library purchases a number of eBook packages and image databases that support the School of Medicine curriculum. UCSF staff located at any affiliated hospitals – the SFVAMC, SFGH and UCSF Fresno – use the campus VPN for easy access to digital materials and to request services, such as Interlibrary Loans. All four affiliated sites have small libraries and professional librarians to serve students, faculty and staff. Information Technology Resources. The state of California, the campus and the School of Medicine have made good investments in information and educational technology and services. The school’s Office of Educational Technology provides outstanding learning technology support for teaching and learning, including: curriculum management with their award-winning Ilios system; instructional design; electronic portfolio development and support; multimedia services; and online course support. In addition, they partner with the library to provide learning technology leadership for the entire campus and to promote and support interprofessional education. A new and enhanced version of Ilios is now in development and will be made available to the other UCSF schools and other medical schools nationally. The library manages the Collaborative Learning Environment (CLE), student computing labs, electronic portfolio system (ePortfolio), the virtual microscopy database for the pathology and histology curriculum, and mobile loaner laptops for use in small group learning and faculty development. The new Teaching and Learning Center in the library will offer state-of-the-art educational technology facilities for teachers and learners, including a new student computing lab and classroom, general assignment classrooms and clinical skills/clinical simulation facilities. The TLC will offer telemedicine learning and communication capabilities within UCSF clinical sites and to selected public health clinics in San Francisco. The campus supports classroom technologies, the central campus information technology infrastructure, email and 24/7 computer help desk. Usability/Functional Convenience. The library is considered a strength of the institution and its staff provides high-quality service to the UCSF community. Library space is designed to support the diverse needs of the students – for quiet, individual study as well as for collaborative, group work. There are also individual carrels for faculty use. Fifteen study rooms are designed for student group work. Students can borrow laptops or use their own to work together on projects in these rooms and anywhere in the library. In September 2009, the library reduced its hours due to budget reductions. In response to student concerns, the library opened the Hearst Reading Room to students on Saturday in order to offer more study options. The room has 136 seats and several group study rooms. In response to the LCME independent student self-study report, the library is renovating one section of the building to allow 24/7

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access by January 2011. Additionally, the library will have extended hours during finals. Two small libraries at Mission Bay are used by faculty, graduate students and professional school students. The Technology Commons, planned as part of the new Teaching and Learning Center on the second floor of the Parnassus library, will feature flexible spaces and furniture for individual and collaborative work. Clusters of furniture around windows encourage students to work together while desks equipped with workstations enable individual study. There are several new small areas for collaborative work as well. Two additional group rooms, an audiovisual editing suite and a student presentation room are designed into the space. A separate area with high-end workstations will support the development of rich media for coursework. The Technology Commons will have new public workstations. Contributions to Education/Professional Development. Students are very proud of the library, the resources and available technology. The library works closely with the student organizations and the school to address student suggestions/concerns. A librarian is assigned to work with the school and also serves on the Essential Core Curriculum Committee. She is the co-principal investigator for the first-year Information Retrieval and Management (IRAM) curriculum, timed to coincide with the curriculum’s first problem-based learning case. Librarians visit the problem-based learning small groups to offer suggestions. All the IRAM material is also available as short tutorials. The librarian serves as a faculty facilitator for the Foundations of Patient Care course and teaches medical literature searching for students in other years as well. All new faculty members receive a letter introducing them to library services. The library has a regular schedule of classes for faculty members and others on topics such as EndNote, PubMed and advanced Google searches. Electronic newsletters are sent to the faculty to inform them of services and programs. Consultation with a librarian is available upon request. One librarian is assigned to work closely with the Office of Medical Education in the Teaching Scholars Program, providing workshops to faculty participants and Medical Education Research Fellows on literature reviews for their research projects. She also assists with medical research projects and has developed searching tips specific to medical education research. The library staff are exceptional, responsive and well connected to medical education.

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SUMMARY  UCSF School of Medicine is an exceptional place to learn and work. The depth, diversity, resources and strengths of the school are exemplary in every mission. The self-study committees identified 47 strengths. The mostly highly rated by the overall LCME committee are: 1. Exceptional students who are diverse, altruistic and high performing; 2. Outstanding teaching, availability and accessibility of faculty and residents; 3. A culture of innovation and excellence across the continuum of medical education; 4. Excellence of the research enterprise and rich research opportunities for students; 5. Opportunities for students to individualize their learning experience and professional development; 6. Strong support of the Dean and senior school leadership for the education mission; 7. Strong and active systems for quality improvement, oversight and governance of the curriculum; 8. Educational technology and the electronic curriculum (iROCKET, Ilios, CLE, ePortfolio). Based on the work of the LCME self-study committees and the LCME independent student survey committee, several areas were identified for improvement. Each area has subsequently been addressed. Areas for Improvement Actions Taken 1. Financial aid advising

New staff added and individualized counseling occurring

2. Career advising

Retreat held in June 2010, faculty member hired to create career development curriculum, team working on project with Office of Career and Professional Development, implementation in 2010-2011

3. Advisory College Mentoring

Meetings with students increased through portfolio reviews and stronger career advising program

4. Clerkship scheduling

Implemented new lottery system improvements, updating waiting list procedure and making communication clearer

5. Step 1 pass rate – Class of 2012

Collecting data and developing a plan

6. Grading in clerkships

The student evaluation form has been revised to ensure that language for each descriptor is standardized and behaviorally based.

The rating form now includes a question about length or intensity of contact between supervisor and student.

Each item on the student evaluation form and summary evaluation form now links the item to the relevant competencies. Task force appointed jointly between CCOC and CCSC to recommend improvements in clerkship assessment and grading.

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7. Observed physical exam skill development in clerkships

Currently documenting physical exam skills through the encounter cards and faculty sign-off

8. Timely reporting of grades Office of Curricular Affairs monthly reports and clerkship director action meet six-week deadline

9. Student Health and Counseling Services

SHCS analyzed issues, met with students to better understand concerns, and planned to both make important changes and better communicate with students. SHCS has expanded evening hours and will send written communications to students to increase awareness of these services, has improved clinic check-in processes and is working on enhancing referrals to UCSF Medical Center specialty services. Student health insurance waiver process will be improved in 2010-11 by relaxing the opt-out criteria and streamlining the online application tool.

10. 24/7 study space, library hours, cleaning library on weekends

Library opened the Hearst Reading Room to students on Saturday in order to offer more study options and is completing renovations to allow 24/7 access; construction will be completed January 2011. Cleaning and janitorial services upgraded.

11. Anatomy laboratory and student lockers

Renovation funded and in process.

12. Uncertainty about reporting mistreatment

Associate Dean for Student Affairs is communicating extensively on how to communicate mistreatment and has updated website.

13. VA Shuttle – expand hours Shuttle services expanded to meet request, effective June 2010

14. Hospital sleeping rooms and lockers for third- and fourth-year students

Detailed analysis completed and clinical rotations with call requirements provide sleeping rooms and lockers/secure space for students

The LCME independent student review committee examined the actions listed above in August 2010 and wrote an addendum to their report which states in part:

“Since submitting our independent student report in March 2010 the school’s leadership immediately began to address the areas for improvement raised in our report. The speed and thoughtfulness at which the school responded to our student concerns demonstrates the UCSF leadership’s commitment to its students and maintaining it as a place of excellence.”

 

Conclusion: UCSF is committed to being a leader in educating the next generation of physicians, scientists and leaders. Our faculty, curriculum, facilities and resources position us well to continue growing all mission areas and maintaining our preeminence in advancing health worldwide™.

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APPENDIX A: LIST OF SELF-STUDY COMMITTEE MEMBERS 

LCME TASK FORCE RETREAT MEMBERS

Sam Hawgood, MBBS, ChairOverall LCME Self-Study Committee

Dean, School of Medicine

LCME Task Force Joshua Adler, MD Professor; Chief Medical Officer

Nancy E. Adler, PhD Professor; Vice Chair Nancy L. Ascher, MD, PhD Professor; Chair

Robert B. Baron, MD Professor; Associate Dean Phaedra D. Bell, PhD Director, Curricular Affairs

Susannah C. Brock, MD Clinical Fellow Karen A. Butter University Librarian; Associate Vice Chancellor

Sue S. Carlisle, MD, PhD Professor; Associate Dean, SFGH Joseph Castro, PhD Professor; Vice Provost

Molly M. Cooke, MD Professor; Director Kevin Grumbach, MD Professor; Chair Beth S. Harleman, MD Assistant Professor

Karen E. Hauer, MD Professor Robert A. Hiatt, MD, PhD Professor; Co-Chair

Michael A. Hindery, MS Vice Dean, School of Medicine Harry Hollander, MD Professor; Residency Director

David M. Irby, PhD Professor; Vice Dean Talmadge E. King Jr., MD Professor; Chair

Mark R. Laret Chief Executive Officer, UCSF Medical Center Helen Loeser, MD, MSc Professor; Associate Dean, Curricular Affairs

Daniel H. Lowenstein, MD Professor; Associate Dean Alma M. Martinez, MD Professor; Director, Outreach and Advancement Susan B. Masters, PhD Professor

Mervyn Maze, MD Professor; Chair Nancy Milliken, MD Professor; Vice Dean Cathryn Nation, MD Associate Vice President, UCOP

Renee Navarro, MD, PharmD Professor; Associate Dean Patricia S. O’Sullivan, EdD Professor

Ryan C. Padrez Medical Student Jane Phillips, MD Professor, Volunteer Clinical Faculty

Read G. Pierce, MD Chief Resident Kevin M. Shannon, MD Professor; Director, MSTP

Kevin H. Souza, MS Assistant Dean John Edward Swartzberg, MD Professor; Director, Joint Medical Program

Lowell D. Tong, MD Professor; Vice Chair

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Sinae Vogel Medical Student Joan Voris, MD Professor; Associate Dean, UCSF Fresno

David Wofsy, MD Professor; Associate Dean Keith Yamamoto, PhD Professor; Executive Vice Dean

LCME SUBCOMMITTEE MEMBER LISTS

INSTITUTIONAL SETTING

Nancy Milliken, MD, Chair Professor; Vice Dean

Robert B. Baron, MD Professor; Associate Dean Kirsten Bibbins-Domingo, MD, PhD Professor

Molly M. Cooke, MD Professor; Academy Director Grae Wentworth Davis, PhD Professor; Chair

Gurpreet S. Dhaliwal, MD Assistant Professor Dan Paul Dohan, PhD Associate Professor

Elyse Foster, MD Professor; Chair, Faculty Council Elena Fuentes-Afflick, MD Professor; Chief of SFGH

Alan M. Gelb, MD Professor Julie Denese Gesch Student

Stephen L. Hauser, MD Professor; Department Chair Michael A. Hindery, MS Vice Dean

Gemayel Ahmad Lee Student Patricia E. Perry Department Manager

John Edward Swartzberg, MD Professor; Director, Joint Medical Program Joan Voris, MD Professor; Associate Dean

EDUCATIONAL PROGRAM FOR THE MD

Helen Loeser, MD, MSc, Chair Professor; Associate Dean, Curricular Affairs

Shelley R. Adler, PhD Associate Professor Mark D. Anderson, MD Professor

Colette L. Auerswald, MD Associate Professor Phaedra D. Bell, PhD Director, Curricular Affairs

Harold S. Bernstein, MD, PhD Professor Anthony Archibald Bertrand IV Student Huiju Carrie Chen, MD, MSEd Associate Professor

Bradley R. Cohn, MD Resident Renee M. Courey, PhD Coordinator, Pathways to Discovery

Amaranta Dominique Craig Student Madhavi Dandu, MD, MPH Assistant Professor Anthony L. Defranco, PhD Professor Tracy Boswell Fulton, PhD Professor

Godfrey Michael Harper, MD Associate Professor

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Karen E. Hauer, MD Professor Harry Hollander, MD Professor

Tai M. Lockspeiser, MD Resident Daniel H. Lowenstein, MD Professor; Associate Dean

Tiffany Yih-Ting Lu Student Susan B. Masters, PhD Professor

Manuel C. Pardo Jr, MD Professor Patricia A. Robertson, MD Professor Jason M. Satterfield, PhD Professor

George F. Sawaya, MD Professor Adam David Schickedanz, MD Resident

Aimee K. Sznewajs Student Arianne Teherani, PhD Associate Professor

Lowell D. Tong, MD Professor; Department Vice Chair Kimberly Topp, PhD Professor; Chair

Joan Voris, MD Professor; Associate Dean Daniel Charles West, MD Professor

Bruce U. Wintroub, MD Professor; Chair; Vice Dean

MEDICAL STUDENTS

Maxine A. Papadakis, MD, Chair Professor; Associate Dean, Student Affairs Adele Rhea Anfinson Director, Student Health Services

Hallen Chung Director, Admissions Sara E. Clemons, MEd Director, Student Affairs Mohammad Diab, MD Associate Professor

Kristen A. Fitzhenry, MEd Analyst Mary H. McGrath, MD Professor

Maureen E. Mitchell Analyst Kathryn Ashley Price Student Amanda Clare Reider Student

Rene Salazar, MD Associate Professor Carrie W. Steere-Salazar Director, Student Financial Aid

John Charles Stein Jr, MD Associate Professor Jody Ellen Steinauer, MD Associate Professor

Rachel Judith Stern Student Arul Thangavel Student

Rebecca Wendell Watters, MD Staff Psychiatrist David Wofsy, MD Professor; Associate Dean, Admissions

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FACULTY

Donna M. Ferriero, MD, Chair Professor; Vice Dean, Academic Affairs Deborah Elaine Barnes, PhD Assistant Professor

Allan I. Basbaum, PhD Professor; Chair Cynthia S. Chiu, MD Assistant Professor

Linda Giudice, MD, PhD Professor; Chair Carol A. Gross, PhD Professor

Rebecca A. Jackson, MD Professor Jacqueline Jew Associate Vice Chair

Sally J. Marshall, PhD Vice Provost, Academic Affairs Patricia S. O’Sullivan, EdD Professor

Emily Von Scheven, MD Professor; Interim Chair Ellen J. Weber, MD Professor

EDUCATIONAL RESOURCES

Kevin H. Souza, MS, Chair Assistant Dean, Medical Education Joshua Adler, MD Professor; Chief Medical Officer

Opinder Singh Bawa Director, Information Systems Unit Karen A. Butter University Librarian; Assistant Vice Chancellor

Sue S. Carlisle, MD, PhD Associate Dean, SFGH Peter R. Carroll, MD Professor; Chair

Joseph Castro, PhD Professor; Vice Provost Patricia A. Cornett, MD Professor

Robert A. Hiatt, MD, PhD Professor; Co-Chair Michael A Hindery, MS Vice Dean, Administration and Finance

David Stern Levitt Student Bonnie A. Maler Analyst

Michael W. Peterson, MD Professor; Vice Chair of Medicine Leslie Chung-Lei Sheu Student

Carrie W. Steere-Salazar Director, Student Financial Aid

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APPENDIX B: GLOSSARY OF TERMS  Term Abbreviation Definition

Academy of Medical Educators

AME A schoolwide program that advances teaching of medical students. The Academy of Medical Educators promotes teaching excellence and the academic advancement of teachers.

Advanced Studies Elective rotations and research that make up the fourth year of the medical program. Advanced Studies prepares students for postgraduate study and provides opportunities for international health, scholarly work and advanced clinical rotations.

Advanced Studies Committee

ASC A policy and operations committee that formulates requirements and creates the range of curricular opportunities available to fourth-year students.

Block Courses The Essential Core is made up of nine sequential blocks, which are courses organized around a central theme. Most blocks are about eight weeks long. Foundations of Patient Care runs longitudinally with the blocks for the entire Essential Core. The block courses are (in chronological order):

Prologue An introduction to essential anatomy, biochemistry, pharmacology, histopathology, genetics, and social and behavioral sciences, all linked together as a foundation for patient care.

Foundations of Patient Care

FPC Spans the entire Essential Core, covering clinical skills, professional development and clinical reasoning.

Major Organ Systems Organs An integrated approach to investigating the cardiovascular, pulmonary and renal systems.

Metabolism and Nutrition M & N An investigation of the gastrointestinal system, endocrinology and metabolic issues, with additional emphasis on prevention of disorders in these areas and on counseling for nutritional health.

Brain, Mind and Behavior BMB A comprehensive overview of general principles in neuroscience, neurology and psychiatry.

Infection, Inflammation and Immunity

I-3 The first block of the second year, covering microbiology, immunology and infectious disease as well as public and international health issues.

Methods, Mechanisms and M-3 An integrated look at human cancer, with emphasis on

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Malignancies the molecular mechanisms that underlie cancer development and treatment; epidemiology; pathology; genetics; clinical oncology; hematology; social and behavioral sciences; and ethics.

Life Cycle/Epilogue A study of the human developmental sequence, considering special topics in childhood and adolescent medicine, men’s and women’s health, and aging. One day a week, in the Epilogue component, students review and integrate concepts presented earlier in the Essential Core through case-based study in large and small groups.

Transitional Clerkship The first clerkship of the third year and the final component of Foundations of Patient Care. This two-week clerkship consists of multiple components: inpatient clinical preceptorships, procedure sessions, lectures and a small group.

Clinical Core The required clinical clerkships of the UCSF medical program. The Clinical Core begins in April of the students’ second year and runs for 54 weeks. It is composed of six eight-week-long clerkship periods and three Intersessions.

Committee on Curriculum and Educational Policy

CCEP Initiates plans, oversees and evaluates curriculum; sets educational policies; is a standing committee of the School of Medicine Council of the Faculty. Major policy proposals affecting the entire Essential Core and Clinical Studies are forwarded to CCEP for final review and approval. Course evaluations are also sent to CCEP.

Clinical Core Operations Committee

CCOC A committee that oversees all aspects of the operation of the third year’s required clerkships. Responsibilities also include defining goals and objectives within the competency framework, developing and implementing assessment methods, and developing and implementing innovative curricula. The committee is committed to the professional development of those involved in medical education and solves problems as a group to address issues and improve the Clinical Core. Responsible for establishing, implementing and reviewing the goals, objectives, evaluation and student achievement in the Clinical Core, and coordinating with the Longitudinal Clinical Experience and Intersessions course.

Clinical Performance Exam CPX A standardized patient program for all UCSF students at

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the end of the core clerkships. The CPX is designed by a consortium of clinicians and medical educators from all eight California medical schools to assess clinical skills essential to the practice of medicine regardless of specialty.

Clinical Studies Steering Committee

CSSC The oversight body for the Clinical Core, Longitudinal Clinical Experience, Intersessions, Advanced Studies and scholarship; reviews course objectives and achievement. A policy committee that oversees all aspects of clinical experiences in the third and fourth years of the program. It also considers the interface between the Essential Core and the clinical years.

Collaborative Learning Environment

CLE Online environment that provides a versatile framework designed to meet the current and future needs for learner-centered environments, collaborative learning and other collaborative activities at UCSF.

Core Clinical Experience Card

CEC This paper-based system relies upon the students to track their core clinical experiences and upon the clinical teachers to verify clinical encounters. The cards, which list key clinical skills objectives as well as types of priority patient encounters, are provided at the beginning of each clerkship or integrated clerkship program, then reviewed at midpoint feedback or quarterly advising meetings, and required to be turned in at the end of the clerkship.

Curriculum Ambassador Program

A summer program for 20+ medical students who work on improvements to the curriculum, one of the ways in which students have an active role in shaping their education.

Essential Core The first 18 months of the curriculum, composed of nine block courses (including FPC). The Essential Core integrates the study of the basic and clinical sciences and provides the foundation for students’ learning on the wards during the Clinical Core.

Essential Core Course Committee

ECCC An operational committee that examines course content, schedules, exam dates and grading policies. Course directors may use this forum to raise questions about redundant or missing topics. Manages practical details of block courses and recommends policy to ECSC.

Essential Core Steering ECSC A policy committee that considers issues of integration,

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Committee content quality, distribution, and consistency in the first- and second-year block courses. ECSC also reviews course evaluation reports and plans for improvement. Oversees the planning and implementation process for the first and second years of the curriculum; reviews plans submitted by committees responsible for designing individual block courses and considers issues of policy and overall integration. The Steering Committee reports to CCEP.

E*Value On-line system to manage student and resident evaluations of courses/rotations and teachers, and faculty evaluations of trainees.

Ilios The School of Medicine’s curriculum management tool. Ilios helps develop, track and manage curriculum details for the Essential Core and Clinical Core.

Intersession Third-year course that brings students back to the Parnassus campus three times in one- to two-week courses to engage in discussions of medical ethics, evidence-based medicine, medical sciences and health systems, and to participate in career advising and professional development activities.

iROCKET The digital curriculum. iROCKET encompasses a wide range of educational technologies based upon Moodle open source software platforms for the School of Medicine.

Longitudinal Clinical Experience

LCE Students work in an outpatient setting with a preceptor and will experience a longitudinal relationship with a specific type of patient population in the third year.

Observed Structured Clinical Exam

OSCE The OSCE is the final exam for FPC. Its purpose is to ensure that all students are clerkship-ready in basic interviewing and physical exam skills. All students must pass the OSCE in order to start the third-year clerkships.

Office of Medical Education OME Promotes academic excellence across the continuum of medical education through faculty and curriculum development, informatics and instructional support, educational evaluation and research, and legal consultation.

Parnassus Integrated Student Clinical Experiences

PISCES A structured yearlong longitudinal integrated clerkship in the third year in which a subset of students follows a patient cohort through multispecialty clinics at Parnassus.

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Pathways to Discovery Pathways A program that facilitates motivated learners in developing the knowledge, skills and experience to contribute to health beyond the care of individual patients. The Pathways program is available to all UCSF learners, including students and trainees from all four professional schools, graduate students, residents and clinical fellows. The five Pathways are: Clinical and Translational Research; Global Health; Health and Society; Health Professions Education; and Molecular Medicine.

Problem-Based Learning PBL A small-group problem-stimulated discussion format that encourages student self-directed learning. PBL sessions occur during the Essential Core blocks.

Program in Medical Education for the Urban Underserved

PRIME-US Five-year track for medical students interested in working with urban underserved populations. Addresses the issues of physician shortages, health disparities and health care access that affect millions of low-income and minority patients living in urban areas.

Teaching and Learning Center

TLC Opening in 2011, state-of-the-art educational technology facilities located in the Parnassus library that include student computing lab and classroom, general assignment classrooms and clinical skills/clinical simulation facilities. The TLC will offer telemedicine learning and communication capabilities within UCSF clinical sites and to selected public health clinics in San Francisco.

Teaching Improvement/Teaching Observation Program

TIP-TOP A voluntary peer mentorship program participated in by faculty of all levels, which consists of observation of teaching followed by a feedback session. Sponsored by the Academy of Medical Educators.

VA Longitudinal Rotations VALOR A structured program in which a subset of third-year medical students spends three consecutive clerkships (Internal Medicine, Surgery and Neurology/Psychiatry) based at the San Francisco Veterans Affairs Medical Center.

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APPENDIX C: ORGANIZATIONAL CHART FOR THE UCSF SCHOOL OF MEDICINE DEAN’S OFFICE 

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APPENDIX D: ORGANIZATIONAL CHART FOR MEDICAL EDUCATION

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ans

Org

ans

Clin

ical

Inte

rlu

de

Infe

ctio

n, I

mm

un

ity

& In

flam

mat

ion

Met

ho

ds,

Mec

han

ism

s &

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ign

anci

es

Win

ter

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tio

n

Co

re C

lerk

ship

Blo

ck 2

Blo

ck 3

Blo

ck 4

Inte

rses

sio

n 2

Blo

ck 5

Sum

mer

Blo

ck 2

Fall

Blo

ck 1

Fall

Blo

ck 2

Fall

Blo

ck 3

Win

ter B

lock

1

Feb

ruar

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arch

Ap

ril

May

Jun

eJu

ly

Bra

in,

Min

d &

Beh

avio

rSu

mm

er V

acat

ion

USM

LE S

tep

1

Exam

Co

re C

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ship

Blo

ck 1

Blo

ck 2

Blo

ck 6

Spri

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ck 1

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ng

Blo

ck 2

Win

ter B

lock

2W

inte

r Blo

ck 3

Spri

ng

Blo

ck 1

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enta

tio

n(9

/8 -

9/10

/09)

(9/1

1 - 1

0/30

/09)

(11/

2 - 1

2/14

/09)

(12/

15 -

12/1

7/09

)

(1/4

- 2/2

0/10

)

(10/

26 -

12/1

4/09

)(1

/4 -

3/8/

10)

(4/2

6 - 6

/18/

10)

Inte

rses

sio

n 1

(6/2

8 - 8

/20/

10)

(6/2

9 - 8

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09)

(8/2

4 - 1

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(10/

26- 1

2/18

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(10/

19 -

10/2

3/09

)

(1/4

- 2/

26/1

0)(3

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(6/7

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4/20

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)

(8/3

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30/0

9)(8

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9/2

7/09

)(9

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- 10/

25/0

9)(1

0/26

- 11

/22/

09)

(11/

23 -

12/2

0/09

)(1

/4- 1

/31/

10)

(2/1

- 2/

28/1

0)(3

/1- 3

/28/

10)

(3/2

9 - 4

/25/

10)

Inte

rses

sio

n 3

(4/2

6 - 5

/7/1

0)

Tran

siti

on

al C

lerk

ship

(4/1

2 - 4

/23/

10)

IDS

102A

IDS

101

IDS

102B

IDS

104

IDS

105

IDS

106

IDS

107

IDS

131A

/B/C

IDS

132A

/B/C

IDS

112

IDS

112

Ad

van

ced

Stu

die

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mm

er B

lock

1

(7/5

- 8/

1/20

10)

Sch

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Sch

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22 009

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1000

9 - 2

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Cla

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f 201

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Cla

ss o

f 201

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lass

of 2

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Cla

ss o

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of 2

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ss o

f 201

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lass

of 2

010

Co

da

Co

urs

e

(4/2

6 - 5

/13/

10)

May

14,

(2/2

2 - 4

/16/

10)

IDS

103

(4/1

9 - 6

/22/

10)

2 0

0 9

2

0 0

92

0 1

0

2

0 1

0

2

0 1

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(5/1

0 - 6

/6/2

010)

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Cyc

le /

Ep

ilog

ue

Cre

ated

by

the

SOM

Off

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of C

urr

icu

lar A

ffai

rs o

n S

epte

mb

er 8

, 20

09fo

r lat

est u

pdat

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leas

e ch

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the

cale

ndar

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Med

Stu

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tal a

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tp://

med

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cale

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of P

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nd

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of P

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IDS

132

C

Met

abol

ism

& N

utri

tion

6/23

- 8/

29/1

0

Sum

mer

Vac

atio

n6/

25 -

8/23

/09

(8/2

4 - 1

0/19

/09)

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ter

Vaca

tio

n

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rd Y

ear

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ins*

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th Y

ear

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ins*

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IDS

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Win

ter

Vaca

tio

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Win

ter

Vaca

tio

nFa

ll B

lock

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rad

ua

tio

n

Aca

dem

ic Y

ear

Pla

nn

ing

Gu

ide

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nn

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ob

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emb

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nu

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Pro

log

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Org

ans

Org

ans

Clin

ical

Inte

rlu

de

Infe

ctio

n, I

mm

un

ity

& In

flam

mat

ion

Met

ho

ds,

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han

ism

s &

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ign

anci

es

Win

ter

Vaca

tio

n

Co

re C

lerk

ship

Blo

ck 2

Blo

ck 3

Blo

ck 4

Inte

rses

sio

n 2

Blo

ck 5

Sum

mer

Blo

ck 2

Fall

Blo

ck 1

Fall

Blo

ck 2

Fall

Blo

ck 3

Win

ter B

lock

1

Feb

ruar

yM

arch

Ap

ril

May

Jun

eJu

ly

Bra

in,

Min

d &

Beh

avio

rSu

mm

er V

acat

ion

USM

LE S

tep

1

Exam

Co

re C

lerk

ship

Blo

ck 1

Blo

ck 2

Blo

ck 6

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ng

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ck 1

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ng

Blo

ck 2

Win

ter B

lock

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inte

r Blo

ck 3

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ng

Blo

ck 1

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enta

tio

n(9

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9/10

/09)

(9/1

1 - 1

0/30

/09)

(11/

2 - 1

2/14

/09)

(12/

15 -

12/1

7/09

)

(1/4

- 2/2

0/10

)

(10/

26 -

12/1

4/09

)(1

/4 -

3/8/

10)

(4/2

6 - 6

/18/

10)

Inte

rses

sio

n 1

(6/2

8 - 8

/20/

10)

(6/2

9 - 8

/21/

09)

(8/2

4 - 1

0/16

/09)

(10/

26- 1

2/18

/09)

(10/

19 -

10/2

3/09

)

(1/4

- 2/

26/1

0)(3

/1 -

4/23

/10)

(6/7

- 7/

4/20

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- 6/2

5/10

)

(8/3

- 8/

30/0

9)(8

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7/09

)(9

/28

- 10/

25/0

9)(1

0/26

- 11

/22/

09)

(11/

23 -

12/2

0/09

)(1

/4- 1

/31/

10)

(2/1

- 2/2

8/10

)(3

/1- 3

/28/

10)

(3/2

9 - 4

/25/

10)

Inte

rses

sio

n 3

(4/2

6 - 5

/7/1

0)

Tran

siti

on

al C

lerk

ship

(4/1

2 - 4

/23/

10)

IDS

102A

IDS

101

IDS

102B

IDS

104

IDS

105

IDS

106

IDS

107

IDS

131A

/B/C

IDS

132A

/B/C

IDS

112

IDS

112

Ad

van

ced

Stu

die

sSu

mm

er B

lock

1

(7/5

- 8/

1/20

10)

Sch

oo

l of M

EDIC

INE

Sch

oo

l of M

EDIC

INE

22 009

- 20

1000

9 - 2

010

Cla

ss o

f 201

3

C

lass

of 2

013

Cla

ss o

f 201

2C

lass

of 2

012

Cla

ss o

f 201

1C

lass

of 2

011

Cla

ss o

f 201

0C

lass

of 2

010

Co

da

Co

urs

e

(4/2

6 - 5

/13/

10)

May

14,

(2/2

2 - 4

/16/

10)

IDS

103

(4/1

9 - 6

/22/

10)

2 0

0 9

2

0 0

92

0 1

0

2

0 1

0

2 0

10

(5/1

0 - 6

/6/2

010)

Life

Cyc

le /

Ep

ilog

ue

Cre

ated

by

the

SOM

Off

ice

of C

urr

icu

lar A

ffai

rs o

n O

cto

ber

7,

2009

for l

ates

t upd

ates

, ple

ase

chec

k th

e ca

lend

ars

on th

e M

ed S

tude

nt P

orta

l at

http

://m

edsc

hool

.ucs

f.edu

/cur

ricu

lum

/ ca

lend

ars/

Fou

nd

atio

ns

of P

atie

nt

Car

e

Fou

nd

atio

ns

of P

atie

nt

Car

e

IDS

132

C

Met

abol

ism

& N

utri

tion

6/23

- 8/

29/1

0

Sum

mer

Vac

atio

n6/

25 -

8/23

/09

(8/2

4 - 1

0/19

/09)

Win

ter

Vaca

tio

n

***3

rd Y

ear

Beg

ins*

**

***4

th Y

ear

Beg

ins*

**

IDS

112

Win

ter

Vaca

tio

n

Win

ter

Vaca

tio

nFa

ll B

lock

4G

rad

ua

tio

n

Au

gu

st

Page 67: UCSF Self Study