VOL 1, No 1, FEB 1999

...from the Dean

Dr. Layton McCurdy

Welcome to the Medical Educator. The College of Medicine has launched this monthly newsletter to keep you, the college’s faculty, staff, residents and students, informed about the exciting curriculum changes under way in undergraduate, graduate and continuing medical education.

What are we trying to accomplish? Besides communicating what we’re up to, we want to stimulate dialogue; we want to hear about your ideas, objections, problems and triumphs as these significant medical education activities develop.

I encourage each of you to read this publication, share it with others, and allow it to become a point of discussion and feedback so all of us can have a hand in designing this curriculum.

The Medical Educator will be included in the last issue of The Catalyst each month.

Layton McCurdy, M.D. Dean, College of Medicine

Don't miss this

Upcoming Meetings:

March 4—7 AAMC Southern Region Group on Student Affairs, “Physicians and Social Responsibility,” Embassy Suites Hotel, Charleston; Call Dr. Carol Savage, 792-2085 for more information.

March 8, 5—6 p.m. “National Medical School Curriculum Change and Implications for Faculty Development,” M. Brownell Anderson, AAMC associate vice president of medical education; 2 West Amphitheater. Approved for one hour of CME credit.

April 29—May 1 AAMC Southern Group on Educational Affairs Annual Meeting, San Juan, Puerto Rico; Call Dr. Amy Blue, 792-3409 for more information.

Students shadow real life experiences

by Cindy A. Abole, Public Relations

First year MIX students Demetria Gordon, left, and Irene Petrou examine the rseults of an ultrasound at McClennan-Banks Clinic. The students honed early clinical skills by being matched with a pregnant mother.

For first year College of Medicine (COM) students Demetria Gordon and Irene Petrou, positive relationships and applied skills supplement two years of intense academic study.

This combination helps prepare physicians for a lifetime of continued learning.

Traditionally, the COM curriculum reserves the final two years of study for clinical science education and experience. As part of curriculum changes, freshman this year are participating in a hands-in learning experience called MIX, or Mother-Infant Experience, as part of their Introduction to Clinical Medicine I course.

MIX teaches students how to provide basic patient care by incorporating procedural skills training, patient interaction and clinical problem-solving.

Gordon's dream to attend medical school at MUSC included a long-held desire to be a “baby doctor.”

“I was excited about the MIX program when I first heard about it during orientation,” she said. She learned the program would introduce real-life experiences in pregnancy, birth and early childhood development.

Similar to the clinical core clerkships or rotations introduced during junior year, first-year COM students were each matched with a pregnant mother.

During the course of the program, the students developed friendly, professional relationships with the patient, newborn and family. They talked with their patient, attended clinic appointments and followed up on newborn clinic visits.

The MIX program develops skills essential to the delivery of good patient care. It challenges students to demonstrate communication skills, apply basic science and clinical concepts, and integrate the use of medical informatics skills throughout the experience.

“The idea of the program is to expose students to patients early-on so by their third year, they are more confident and better prepared for rotations,” said Amy Blue, Ph.D., curriculum and evaluation coordinator, COM Dean's Office.

Gordon was matched with her MIX mother, Rosie, a 25-year old single mother who was receiving prenatal care at nearby McClennan-Banks Clinic at Charleston Memorial Hospital. “The first day, I was really nervous,” said Gordon upon meeting Rosie during a clinic appointment in October.

Like other MIX students, Gordon spoke with her MIX mother by phone and occasionally accompanied her to appointments. MIX students were responsible for conducting patient interviews, recording medical and family histories, reviewing medical charts and conferring with physicians and staff regarding the patient. They were required to input patient information in the MIX segment database following clinic visits.

Petrou also shared a positive MIX program experience. Last fall, she was matched with Lillian, a 19-year old mother of two children. “I got really lucky,” said Petrou of her relationship with Lillian. “Knowing her has given me focus on some basic things in life—motherhood for Lillian, her fears and goals. It provided a different perspective for me that was inspirational.”

Petrou soon discovered the values of establishing a sound learning foundation of preclinical instruction seasoned with real-life experiences. “It gave me a whole, different view of subjects like embryology,” Petrou said. “Going through this experience made the class more enjoyable and brought everything home.”

Although both students were unable to witness the delivery of their MIX patients, both have easily shifted their focus from obstetrics and gynecology to pediatrics and well baby care appointments with their MIX mothers and newborns.

Petrou praises the opportunity for freshman students to interact with patients, physicians and clinic staffers. Her face beamed with pride as she described the pinnacle moment of her MIX experience—the opportunity to touch the baby's head during a pre-labor check-up. These “first” and other memories will help influence and inspire these new students as they evolve and aspire to become better physicians for the next century.

Curriculum responds to changes in medical practice

Facing unprecedented changes in the way medical care is organized, delivered and financed, medical schools across the country are reviewing and refining the way they educate future physicians.

Here at MUSC, the College of Medicine is undergoing a similar curriculum renewal—an effort aimed at ensuring physician graduates continue to enter the world of medicine well-prepared to meet the needs of the patients they serve.

“Society is telling us that they have lost some of their confidence in the altruism of physicians,” said Victor Del Bene, M.D., associate dean of students. “We’re looking at how we need to change the curriculum so when our students enter the world as physicians, in addition to being superbly trained in the science of medicine, they are prepared to meet society’s expectations in the new millennium.”

At the heart of the process is the Curriculum Coordinating Committee (CCC), a group convened in September 1998 consisting of 12 basic and clinical science faculty, two house officers, and two students. Led by David Garr, M.D., associate dean for primary care, the committee has the specific charge of guiding the evolution of the undergraduate curriculum.

With direction from the College of Medicine Strategic Plan for Undergraduate Education and information from other medical schools undergoing similar changes, the curriculum renewal effort is driven by several objectives:

• Integration of basic and clinical sciences throughout all four years

• Emphasis on self-directed learning

• Early exposure of students to patient care

• Emphasis on preparation of a generalist physician

• Use of multiple methods for learning and assessment.

Curriculum Year Coordinators (a basic and clinical scientist team) are responsible for each year of the curriculum. After a thorough examination of the curriculum and discussions with other faculty members, students, residents and course directors, coordinators will develop recommendations to attain these objectives.

Proposals for change are forwarded to the Undergraduate Curriculum Committee (UCC) for further discussion. Chaired by Del Bene, the UCC is a group of faculty and student representatives responsible for monitoring the effectiveness of the undergraduate curriculum and approving any substantiative changes.

“The curriculum renewal effort isn’t about starting over,” Garr said. “We seek to take a good curriculum and make it better.”

Though the curriculum renewal effort is guided by the UCC and CCC, its implementation and success depends on all College of Medicine faculty, Del Bene said. “Their endorsement and support is a vital part of the renewal effort.”

The first UCC approved change to the curriculum applies to third and fourth year students. Beginning in July, third-year students will participate in the Deans’ Rural Primary Care Clerkship—a month-long interdisciplinary experience which places students in rural areas throughout the state. “In the rural setting, students can begin to develop an understanding of the broader range of issues involved in patient care, such as cultural and socioeconomic influences.” Garr said. The rural clerkship also exposes students to areas strapped for health care providers.

Curriculum Coordinating Committee members are: back row, left to right, Dr. Gabriel Virella, Dr. Bob Mallin, Dr. Edward Brown; front row, left to right, Dr. Kathleen Wiley, Dr. Frank Spinale, Dr. Chris Fredericks, Dr. Amy Blue, and Dr. Victor Del Bene. Not pictured are: Dr. Dennis Cope, Dr. David Garr, Dr. Philip Privitera, Dr. Stephen Schabel, third-year student Julie Iannini, fourth-year student Michelle Hudspeth, and house officers Dr. Patrick Thomas and Dr. William Ward.

To make room for the clerkship in the student schedule, one of the two months of psychiatry traditionally completed in the third year will become a fourth-year requirement.

Before the overall curriculum renewal effort began, first-year course directors implemented minor curriculum changes. In fall 1998, the Class of 2002 became the first participants in the Mother-Infant Experience (MIX), designed to provide early clinical and patient-care experience.

And every three weeks during the spring semester, first-year students are spending several hours in the offices of community physicians. “Contact with the patient early in the educational experience allows them to see how what they’re learning in the classroom applies in the real world of medicine,” Garr said.

As restructuring continues, development sessions to help faculty become comfortable with new teaching and evaluation methodologies will be provided. Garr and Del Bene anticipate a full implementation of the new curriculum to be completed by fall 2000.

Changes follow AAMC learning guidelines

The objectives driving the curriculum change process at MUSC mirror learning objectives set forth by the Medical Schools Objective Project (MSOP), a recent initiative of the Association of American Medical Colleges (AAMC). MUSC College of Medicine is one of 20 schools nationwide participating in the project.

Concerns expressed by some members of the medical profession and medical education community about the ability of new doctors to meet society's expectations of them led to MSOP's creation in January 1996. Its goal is to help medical schools review their medical student educational programs and to suggest strategies that could be implemented when making changes.

The first report, “Learning Objectives for Medical Student Education,” presents attributes that medical students should possess at the time of graduation:

• Physicians must be altruistic
• Physicians must be knowledgeable
• Physicians must be skillful
• Physicians must be dutiful.

In the report, each attribute is followed by a set of learning objectives that reflect consensus on the contribution that the medical school experience should make toward achievement of those attributes.

These guidelines and subsequent reports will aid the College of Medicine and schools across the nation in the renewal of their undergraduate curricula to better meet the educational needs of future physicians.

For further information, see Academic Medicine, Vol. 74, Jan. 1999, pages 13 to 18.

Case studies, early patient contact important to parallel curriculum

As Class of 2002 parallel curriculum (PC) students anticipate interacting with real patients in an ambulatory care environment, they bring what they've learned from about 25 patient cases studied in small groups with faculty tutors.

In addition to short courses in gross anatomy, histology, pathology and biochemistry and physical diagnosis, students have completed two standardized patient evaluations and a half-day per week clinical experience with actual patients.

Students will complete an additional four-week clinical experience this spring. Plans are being finalized for their Intensive Community Experience (ICE), an opportunity to be mentored by a South Carolina practicing physician for six weeks while learning basic and clinical sciences.

Sophomore students have just begun the last phase of small group problem-based learning in the PC. To date, they have completed 73 patient cases within their small group learning environment.

They have completed numerous interviews/physical exams with patients. A course in Evidence-Based Medicine has helped them begin to learn how to incorporate the growing body of medical evidence into patient care.

These student learning experiences are made possible by superb teaching and mentoring by MUSC faculty. PC welcomes all faculty to serve as small group facilitators, evaluators, clinical preceptors and circuit riders for ICE.

Contact Imogene Smith, at smithik@musc.edu or 792-3208, or Sue Duckworth, at duckwosh@musc.edu or 792-3339 for information.

Continuing Medical Education

Conferences:

• March 6 Issues in African American Health Care, Storm Eye Institute Conference Room
• 7—10 Neonatal Nutrition Conference, Mills House Hotel
• 12—13 Alumni Reunion Weekend, MUSC Campus 14—17 PACS, Teleradiology and Computed Radiography "How To" Conference, Embassy Suites
• 29—30 8th Charleston Pulmonary and Critical Care Symposium, Charleston Place Hotel
• April 5—7 OB/GYN Spring Symposium, Charleston Place Hotel
• 9 Stroke Update ‘99, Sheraton Hotel, Columbia, SC
• 9—11 South Carolina Radiological Society Meeting, Charleston Harbor Hilton
• 29—May 2 Postgraduate Course in Surgery, Mills House Hotel For more information on Continuing Medical Education conferences call 876-1925.

Graduate Medical Education

Symposium: March 5, 8 a.m. to 5 p.m. “Surviving and Thriving in the World of Managed Care Medicine,” Gazes Auditorium

• Keynote Address: “Managed Care Across the USA: The View from 35,000 Feet,” Thomas Morrow, M.D., medical director, One Health Plan of Georgia.
• For more information, call the Office of Graduate Medical Education at 792-2575 or 792-0761.

Match Update: The 1999 Match process came to fruition at midnight on Wednesday, Feb. 17. For the first time ever, applicants and institutions were able to input their choices solely on the Internet. The National Resident Matching Program (NMRP) implemented the WebROLIC (Rank Order Listing and Input Confirmation System) system in an effort to allow for a more efficient and expedient match process. All match results will be posted on the NRMP web site on Thursday, March 18 at 1 p.m. EST.

March Internal Review Schedule General Surgery; Thoracic Surgery; Plastic Surgery

Teaching tips

LIMIT YOUR TEACHING to one or two teaching points per patient encounter. This prevents the trap of overwhelming the learner with too much information. ASK THE LEARNER (i.e., student, resident, or patient) to repeat back to you the information as they understand it. This demonstrates that the learner has fully comprehended your points.