the MEDICAL EDUCATOR VOL 2, No 3, April 2000  MUSC to pilot AMSA program emphasizing culture, diversity by Kristen Karig Public Relations  Physicians-in-training today will care for the increasingly diverse populations of tomorrow: By 2050, it’s expected that nearly half of the U.S. population will be composed of members of linguistic and cultural minority groups.  As part of the American Medical Student Association (AMSA) Foundation Promoting, Reinforcing and Improving Medical Education (PRIME) project, MUSC College of Medicine is one of three schools nationwide piloting a cultural competency training program to prepare students for the unique aspects of taking care of patients from all backgrounds.  The college received a $4,000 contract for the one-year project.  “MUSC provides care to a large number of the state’s underserved population, many of whom are from cultural backgrounds distinctly different from those of their health care providers, but there is little emphasis on culture and diversity in the medical school curriculum,” said Amy Blue, Ph.D., assistant dean for curriculum  evaluation.  Jimmell Felder, left, and Kathy Whitaker, are helping implement the PRIME Culture and Diversity Project in the College of Medicine. Blue, in collaboration with Kathy Whitaker, director of Multicultural Student Affairs for the Office of Diversity, and first-year doctoring curriculum faculty coordinators submitted the grant proposal.  The PRIME initiative, a four-year contract awarded by the U.S. Public Health Service, Bureau of Health Professions, Division of Medicine, aims to address major issues in medical education including diversity training and experiential service-based learning for students with career interest in primary care. Six schools were selected to pilot two model curricula beginning in fall 2000: The Culture and Diversity Curriculum Project and The Community Responsive Curriculum Project.  At MUSC, a Student Advisory Board made up of 25 medical students, representing all four classes, will help steer implementation of the new elements into the first-year curriculum.  Plans include incorporation, in the doctoring curriculum, of small group discussions that address culture and diversity in physician-patient interviews. During standardized patient interviews, students will ask questions about culturally-related health care practices or beliefs and how they impact the patient’s view of illness and treatment. Students will practice acquiring cultural profiles during visits to community physicians’ offices as part of the longitudinal patient care experience. Aspects of culture and diversity will also be added in the course's problem-based learning component.  A series of  lunchtime presentations open to all medical students, as well as those from other colleges, will offer information on topics related to culture and diversity as part of this curriculum project.  These additions to the curriculum, Whitaker said, will complement existing programs such as the two-hour diversity training program held during the College of Medicine general orientation for matriculating medical students. This two-hour session provides students training in essential culture and diversity definitions and concepts.  “As a medical student, I want an education that is all encompassing. I want to be able to give competent health care to people of all races, backgrounds and genders,” said Student Advisory Board member Jimmell Felder, a first-year student. “It’s important for students to know that there is more to the patient than just treating a disease.”  The goal of the PRIME Culture and Diversity Curriculum is to help physicians-in-training develop the attitudes, skills and knowledge base to effectively serve diverse populations that are different from their own in terms of race, ethnicity, sexual orientation, disability status or cultural background, especially the underserved and vulnerable.  “The extensive curriculum changes already under way in the College Medicine provides a wonderful opportunity to introduce culture and diversity elements for all medical students,” Blue said.  Whitaker hopes that the changes incorporated into the first-year curriculum will serve as a model for years two through four.  “Given the lack of culture and diversity curricula nationwide, the work associated with the PRIME project provides MUSC an exciting opportunity to demonstrate to other schools successful methods for introducing an emphasis on culture and diversity education into the medical school curriculum,” Blue said.  Other pilot schools in AMSA’s Culture and Diversity Curriculum Project are Wake Forest University and Kansas University Medical Center. Felder and Whitaker participated in a panel this March during AMSA’s national meeting to discuss planned implementation of the culture and diversity curriculum at MUSC.  For more information about The Culture and Diversity Curriculum Project at MUSC, or the Student Advisory Board, call Blue at 792-3409.  New exam format goes over well  by Kristen Karig Public Relations “It’s revolutionized the way we administer tests.” That’s how Bill Stillway, Ph.D., professor of biochemistry and molecular biology, describes the cumulative exam implemented into the first-year curriculum last fall.  This spring, first-year students are taking portions of their exams via computer. Students are also responding positively to the change, which translates into less exams and a dedicated study period.  Instead of taking separate exams for each course, material from all classes is integrated into a cumulative exam administered at three points during the semester. Before each exam is a one-week study period during which no scheduled activities take place.  With one semester under their collective belts, this January, Tim Fitzharris, Ph.D., asked the first-year class what they thought of the new exam format. With 100 percent of students responding, Fitzharris, professor and associate chairman, Department of Cell Biology and Anatomy, found that nearly 3/4 of the class (72 percent) were pleased with the cumulative exam.  When asked if they, given the opportunity, would change components of the format (reducing the time before the test, taking individual exams at any time during the week via computer, and/or taking the practical portion of the exam the same day as the written), more than 80 percent said they wouldn’t change the present arrangement. Fitzharris conducted the informal survey as part of a class profile to assess students’ scientific backgrounds and find out what they thought about the newly revised curriculum.  A key feature of the cumulative exam is that it breaks the cycle studying present in the previous format. “Progress in any other courses came to a grinding halt while the student body prepared for an exam in one class. It was clear that the students’ attention was directed only towards the upcoming exam,” Fitzharris said.  “The new exam format has made a big difference in terms of class attendance and attitude,” Stillway said.  Each cumulative exam takes place during a two-day period. Students are assessed on the skills they’ve learned through the doctoring curriculum, and evaluated on what they’ve learned in the lecture hall and lab. Tests are administered by the College of Medicine Dean’s Office instead of individual faculty members.  This spring, students are taking the laboratory portion of the exam related to cell tissue and organ biology and neurosciences via computer. Using the computer allows students some flexibility as to what time they take the test during the day and helps them become accustomed to this test-taking modality, which is how the National Board Exams are administered.  After studying for cumulative exams, students should begin to integrate the information on their own, seeing the relationships between physiology, neurology and other components—a skill they’ll need in the clinics and when they take the Boards.  The cumulative exam will be incorporated into the second year of the curriculum this fall.  From 1st-year students... “The cumulative tests are hard because of the large amount of information that is on each test, but I would rather have it that way. I feel that studying this way for our tests will help us later when we have to take the boards.”           —Robert Schoderbek “The cumulative exam format has made medical school a lot more bearable. I think as a whole it decreases our stress level because we have a week to study for one big test. Taking parts of the exam on the computer will also help us prepare for using a computer to take the Boards next year.”    —Leah Shutt   Principles of adult learning approach Adult learning theory is often discussed as the approach instructors should follow when working with medical and other health professional students. The assumption behind adult learning theory is that when individuals have the opportunity to take some initiative and perceive learning in the context of their own situations, they will internalize the information more quickly and permanently.  10 Principles of Adult Learning: 1. People learn only what they are ready to learn.  2. People learn best from what they actually perform.  3. People learn from their mistakes.  4. People learn easiest what is familiar to them.  5. People favor different senses for learning.  6. People learn methodically, and in our culture, systematically.  7. People cannot learn what they cannot understand.  8. People learn better when they can see their own progress.  9. People learn through practice.  10.  People respond best when material is presented uniquely for them. AMA changes PRA category 1 credit system  Don't miss this Don’t miss the following opportunities to share your medical education innovations: May 5 Submission deadline for small group discussion and mini-workshop proposals for the AAMC Colleges 111th Annual Meeting. The AAMC Annual Meeting will be held from Oct. 27 to Nov. 1 in Chicago.  Information and forms are available online at <http://www.aamc.org/about/gea/smallgrp.htm> (small-group discussion) and <http://www.aamc.org/about/gea/miniwrks.htm>  (mini-workshops).  June 2 Submission deadline for Innovations in Medical Education (IME) Exhibits for AAMC Annual Meeting.  Information and forms are available online at <http://www.aamc.org /meetings/annual/2000/exhibits/start.htm>.  Gradute Medical Eduction Core Curriculum Lecture Series Dinner is provided at Thursday sessions; lunch is provided at Friday sessions.  May 4 4 - 7 p.m.  Professionalism  2 West Amphitheater  5 Noon - 3 p.m.  Professionalism  2 West Amphitheater  12 Noon - 2:30 p.m.  Acupuncture and Chiropractic  Room 270 MUH Radiology  19 11:30 a.m. - 1 p.m.  Loan, Mortgages and Investments  Room 300 Clinical Science Building  26 Noon - 3 p.m.  Occupational Health  2 West Amphitheater  Preregistration is required. Call Angela Ybarra at 792-0761 or Sandra Murrow at 792-2575.  Continuing Medical Education The following conferences are sponsored by MUSC.  May  15 - 17 SE Regional Conference on Child Fatalities  Hilton Head  25 - 27 New Drug Update  Sheraton Charleston  26 - 28 Advanced Endoscopy Update at the Beach  Wild Dunes Resort  26 - 29 Medicine in the Vocal Arts  Westin Francis Marion Hotel  26 - 29  Nuclear Medicine: Moving into the Millennium  Charleston Harbor Hilton  31 - June 3 Cardiology Update for the Primary Physician  Charleston Place Hotel  June  1 - 3 Update in Psychiatry  MUSC Campus 12 - 17 Intensive Review of Family Medicine  Kiawah Island Resort  23 - 24 Endoscopic Ultrasonography  Tutorial  MUSC Campus July  13 - 14 Advanced ERCP Tutorials  MUSC Campus  September  7 - 9 Ophthalmology Update 2000  Kiawah Island Resort  25 - 30 Intensive Review of Emergency Medicine  Embassy Suites–Convention Center  28 - 29 6th Annual Diabetes Symposium  MUSC Campus Call the Office of Continuing Medical Education at 876-1925 for more information.

 

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