the new curriculum at case western reserve school of medicine · the new curriculum at case western...
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Transforming Medical Transforming Medical EducationEducation
The New Curriculum at Case Western Reserve School of Medicine
Daniel R. Wolpaw, M.D.Professor of Medicine
Case Western Reserve University School of MedicineCleveland, Ohio
Transforming Medical Transforming Medical Education at CWRUEducation at CWRU
Objectives:Compare and contrast changes in medical education at CWRU over the last centuryOutline the guiding educational principles of the new curriculumDescribe the new 4 year MD curriculum at CWRU
Western Reserve Before 1953Western Reserve Before 1953
Department Chairs “owned” the curriculumSeparate courses in basic science disciplinesMinimal patient or clinical contact before clerkships
The Education Revolution of The Education Revolution of 19531953
Department Chairs removed from ownership of the curriculumOrgan system organizationEarly clinical exposure – Family ClinicDramatic reduction in classroom time -increased student responsibility for learningThesis requirement
Living with the Revolution:Living with the Revolution:1953 to 20061953 to 2006
Scholarship (thesis) requirement removed - 1960’sPeriodic review without significant change in structureFalling behind in innovation and early patient contactClerkships unchanged other than increased ambulatory exposureModel LCME review 2001
The 2004 Curriculum:The 2004 Curriculum:Year 1 Year 1 -- NormalNormal
The 2004 Curriculum:The 2004 Curriculum:Year 2 Year 2 -- AbnormalAbnormal
The 2004 Curriculum:The 2004 Curriculum:Year 3 Core ClerkshipsYear 3 Core Clerkships
7 Separate rotations:– Internal Medicine 12 weeks– Surgery 8 weeks– Family Medicine 4 weeks– Pediatrics 8 weeks– OB-Gyn 7 weeks– Neurology 4 weeks– Psychiatry 6 weeks
The 2004 Curriculum:The 2004 Curriculum:Year 4 ElectivesYear 4 Electives
Student choice of 4 week experiencesActing Internships, Specialty Consult Services, ResearchResidency interviewing
Why Change Now?Why Change Now?The New EnvironmentThe New Environment
Increasing demands on Faculty time –demands of funding and clinical careTechnology: – Expanding electronic resources – Video-streaming and Pod-casting
Resident work hours
Why Change Now?Why Change Now?The Information EnvironmentThe Information Environment“The electronic environment has changed the role of content in learning by fiat. It has rendered the teaching-as-transfer-of-information model pretty much obsolete….
From Weimer, From Weimer, LearnerLearner--Centered TeachingCentered Teaching, 2002, 2002
Why Change Now?Why Change Now?The Information EnvironmentThe Information Environment…Today’s learners must be able to access information, find resources, organize them, and, perhaps most important, evaluate the ocean of information that now exists in that electronic sea.”
From Weimer, From Weimer, LearnerLearner--Centered TeachingCentered Teaching, 2002, 2002
Why Change?Why Change?A New VisionA New Vision
Dean Horwitz (2003): Four pillars:1. Scholarship2. Clinical Mastery3. Civic Professionalism4. LeadershipGraduate School environment – student responsibility for learningBeginning with learning objectives
The New Curriculum:The New Curriculum:LearningLearning--Centered PrinciplesCentered Principles
Medical education will be experiential and instill the skills for critical thinking and lifelong learningEducational methods will be chosen that stimulate an active interchange of ideas between students and faculty
The New Curriculum:The New Curriculum:LearningLearning--Centered PrinciplesCentered Principles
Students and faculty will be mutually respectful partners in learningStudents will be immersed in a graduate school educational environment characterized by flexibility and high expectations for independent study and self-directed learning
Focusing on the Learner:Focusing on the Learner:Constructivist TheoryConstructivist Theory
Learners must actively construct their own knowledge and meaning rather than passively receive information from teachers and textbooks.
A New ParadigmA New Paradigm
Old Paradigm New Paradigm
Teacher Centered Learner Centered
Faculty give information Students seek information
Teaching Time Learning Time
Summative assessments Formative, reflective assessment
Year I Year II Year III Year IV
Core Clinical Rotations(48 weeks, flexible scheduling)
Research and Scholarship(4-month block plus electives, flexible scheduling)
Advanced Clinical and Scientific Studies
(10 months, flexible scheduling)
Foundations of Medicine and Health
(20 months, including vacation)
Medical Education at CWRU: Integration, Scholarship, and Flexibility
The Foundations of Medicine The Foundations of Medicine and Healthand Health
Putting organ systems togetherLongitudinal themesBeginning with learning objectivesCase Inquiry Groups – PBLSelf-directed learning + extensive resourcesClinical immersionsFormative assessment
A Week at Case School of Medicine and Health:Aligning the Schedule with Educational
Objectives
Monday Tuesday Wednesday Thursday Friday
8-10 AM LearningGroups
Science ofClinicalPractice
LearningGroups
Self-directedLearning
LearningGroups
10-12 PM InteractiveSessions
Anatomy/Histopath/Radiology
Interactivesessions/Research &Scholarship(1 hr)
Self-directedLearning
InteractiveSessions
12-1 PM
1-5 PM Clinicalskills
Self-directedLearning
Self-directedLearning
Self-directedLearning
Self-directedLearning
Surface vs. Deep LearningSurface vs. Deep Learning
Surface learning: Memorization of facts, focus on the discrete elements of the reading, poor differentiation between evidence and information, absence of reflection, tasks seen as an external imposition
Marton and Saljo, 1976
Surface vs. Deep LearningSurface vs. Deep Learning
Deep learning: Learners focus on meaning, relate new information to prior knowledge + experience, work to organize + structure content, view the work of learning as important
Marton and Saljo, 1976
Assessment Methods:Assessment Methods:PrePre--ClerkshipClerkship
Weekly monitoring:Small group performance –
facilitator + peersSynthesis Essay Questions (SEQ’s)Multiple Choice Questions
Assessment Methods:Assessment Methods:PrePre--ClerkshipClerkship
End of Block:Summative SEQ’s – 3-6National Board of Medical Examiners (NBME) Cumulative Exams
Every 3-4 months:NBME Professionalism assessmentPortfolio Reviews
Impact of AssessmentImpact of Assessment
Candid, formative feedbackProductive reflectionPerspective across the full range of competenciesRetention of learningPreparation for Board exams
Research in the New Research in the New CurriculumCurriculum
Mentored experience in research and scholarshipMinimum of 4 months protected timeEach student will identify a question, develop an approach and proposal, engage the project, and interpret findingsProduct: Thesis in the format of a journal manuscript
July Aug Sep Oct Nov Dec Jan Feb Mar Apr May June
Year 1 Vacation or
research
Year 2 Vacation or
research
Researchor
clinical rotations
Year 3 Research or
clinical rotations
Research or
clinical rotations
Year 4
Research and Scholarship
Foundations of Research and Scholarship (1-2 h/week)
Elective research opportunities
Opportunities in Opportunities in Biomedical ResearchBiomedical Research
Basic research
Population-based
research
Clinical research
Translational research
Teaching Clinical Skills before the Teaching Clinical Skills before the Clerkships: Clinical MasteryClerkships: Clinical Mastery
8/06-12/06 1/07-12/08 Jan 08
Introduction to clinical skills
Advanced Clinical Skills
RAMP (Rotating Apprenticeships in Medical Practice)
Clinical Preceptorships
Science of Clinical Practice
Health Policy, Leadership
Civic Professionalism, Ethics
Web Resources
The Clinical Curriculum:The Clinical Curriculum:Key ConceptsKey Concepts
Meaningful collaboration between Departments Well-thought out learning objectivesUniform, criterion-based assessment across hospital sitesDevelopmental modelBasic Science Correlation
Clinical Curriculum:Clinical Curriculum:Required ActivitiesRequired Activities
Basic Core I – 16 weeks: Internal Medicine, Surgery, Family MedicineBasic Core II – 16 weeks: Pediatrics, OB-Gyn, Psychiatry, NeurologyThesis Block (Research) – 16 weeksAdvanced Core rotations – total of 16 weeks (taken as 4 separate rotations)
TYPICAL OPTIONS FOR CORE CLINICAL ROTATIONS AND RESEARCH
Research
16 weeks(March-July)
Basic Core 1 or 2
16 weeks
Basic Core1 or 2
16 weeks
Advance Core
16 weeksFlexible
scheduling
Basic Core1 or 2
16 weeks
Research
16 weeks(July-
November)
Basic Core1 or 2
16 weeks
Advance Core
16 weeksFlexible
scheduling
Basic Core1 or 2
16 weeks
Basic Core1or 2
16 weeks
Research
16 weeks(November-
March)
Advance Core
16 weeksFlexible
scheduling
March 08 July 09
Clinical Curriculum:Clinical Curriculum:Friday Afternoon LearningFriday Afternoon Learning
Basic science correlation – three sessions/month (2 hours each)Advanced Clinical SkillsEvidence-Based MedicineAdvanced Science of Clinical Practice
Advanced Clinical and Scientific Advanced Clinical and Scientific StudiesStudies
Two Acting Internships – each 4 week intensive inpatient or ER rotationAreas of Concentration: 12 weeks of linked experiences integrating basic science and clinical experiences and intended to result in an area of expertiseFurther clinical and research electives
Clinical AssessmentClinical Assessment
Clinical Activity Scores– Basic and Advanced Core rotations– Patient logs and episode-specific feedback– Cumulative Clinical Activity reports
NBME Progress testingNBME Professionalism toolYear 4 OSCE
Clinical Assessment:Clinical Assessment:A Developmental ModelA Developmental Model
Basic Cores Advanced Cores
NBME Progress Test
Clinical Activity Score
Basic Science Correlation
OSCE
Year I Year II Year III Year IV
Core Clinical Rotations(48 weeks, flexible scheduling)
Research and Scholarship(4-month block plus electives, flexible scheduling)
Advanced Clinical and Scientific Studies
(10 months, flexible scheduling)
Foundations of Medicine and Health
(20 months, including vacation)
Medical Education at CWRU: A New Vision