VOL 1, No 3, MAY 1999

Community learning experience completes parallel process

Donned in white coats with their pockets bulging with note cards and other reference materials, these young men and women are often mistaken for third or fourth-year medical students.

Intensive Community Experience (ICE) participants Leelie Selassie and David Horne review physiology information on a laptop computer, one of many learning tools used by parallel curriculum students. The program paired students with statewide preceptors for a six-week clinical experience.

The only giveaway is the portable laptops they tote around with them on campus or at community practice sites. Armed with a degree of confidence and determination, these students bring clinical skills, paired with a proficiency for clinical reasoning and a curious nature that distinguishes them as students who continue to broaden their scientific knowledge.

These 18 first-year students are participating in the Intensive Community Experience (ICE), an integral part of the College of Medicine’s Parallel Curriculum program.

ICE is a course which offers a unique six-week program that pairs Parallel Curriculum medical students who are completing their first year with primary care physicians in private practice.

While the course content of the parallel curriculum is similar to the traditional curriculum, the method of instruction is an alternative approach —problem-based learning derived from real patient cases.

Revisions currently under way in the College of Medicine are incorporating some of these elements, like problem-based learning, into the traditional undergraduate curriculum.

“I never really considered primary care medicine before,” said Leelie Selassie, a rising third-year parallel student from Chicago. Selassie completed her community experience last June with Daniel Brake, M.D., of Palmetto Primary Care in Summerville. “But the experience was empowering. It helped to validate my first year and the parallel program as a whole.”

Each student is matched with a physician/preceptor in South Carolina based on the physician’s requests and needs as well as housing availability, transportation and family considerations for the student.

“I was tremendously impressed with the quality and maturity of my parallel students,” said Brake, a preceptor for the College of Medicine and MUSC alumnus. “These students are required to learn through self-education. They are constantly evaluating themselves.”

There have been 43 preceptors located in 27 sites throughout South Carolina. These locations stretch from Cheraw to Westminster and Beaufort to Georgetown. This year, 10 of the 18 preceptor participants are MUSC alumni.

The preceptor must agree to schedule at least one patient for the student to interview and examine each half day for three-to-five days per week. As a senior colleague, a preceptor provides feedback to the student on his or her ability to perform histories and physicals, interpersonal skills, clinical reasoning processes, patient write-ups and self-assessment skills.

Charlotte native David Horne spent his community experience with Granville Vance, M.D., a family practice preceptor in Dillon. Vance has already established a reputation for providing an excellent program experience for students. “I knew it would be intense,” said Horne. “And it was. I learned an incredible amount in six weeks.”

Horne and Selassie not only learned about the various aspects of their preceptor’s practice but also what it means to live and work in a community. Horne was exposed to medical problems and procedures not typically seen or experienced until third and fourth-year rotations. He witnessed a colonoscopy, thoracentesis, esophogastroduodenoscopy and lumbar punctures. He learned basic science and physical diagnosis with a diverse range of patients with chronic diseases like diabetes and a sociocultural phenomena known as pica.

Additionally, preceptors guide students to learning resources on site and involve them in the other activities including managing an office, outpatient and inpatient experiences and business, medical and community meetings.

“The most important thing I think I learned is a whole new respect for family medicine and rural medicine,” said Horne. “I realize now how varied and exciting those practices can be.”

The program begins with a visit by an MUSC faculty member who lays the groundwork. Then, “circuit riders” or faculty members visit the site at least two additional times during the experience. The first visit occurs soon after the student arrives; the last, at the end of the six weeks.

“The role of the circuit rider helps to bridge the gap between student, preceptor and the university,” said Kathy Schwartzenburger, M.D., Department of Dermatology. A circuit rider for two years, Schwartzenburger believes that her role helps to validate the program by initiating feedback and verifying that students and preceptors are “in tune” with the program. “It promotes overall goodwill.”

Assessments are ongoing and feedback for the student comes from the circuit rider, the physician/preceptor and the patients. The final evaluation is shared between the circuit rider and the preceptor.

An added benefit to this student-driven program is MUSC outreach across the state. “It’s not only a link between the College of Medicine and the rest of the state, but we learn from the excellent medicine being practiced out there,” said Kathy Wiley, M.D., Department of General Internal Medicine and Geriatrics and medical director for the program.

And how do students rate the program?

“I feel I’m a better thinker,” said Selassie, describing how she and other students were quickly introduced to the challenges of managed care not typically addressed within a large tertiary-care environment. “The program has helped me realize that I can’t be all things to all people. I’ve discovered the importance of balance and finding a middle ground.

1st-year changes goal-driven

The first phase of a new undergraduate curriculum in the College of Medicine will be in place this fall when the next class of students arrive. Specific changes to the first year of the curriculum focus on achieving four goals:

Goal:

Integrate and redefine basic science core courses along thematic lines to create a more efficient interdisciplinary learning experience.

Action: Natural linkages between the content of various courses have been strengthened and redundancies minimized. Genetics has been eliminated as a stand alone course, with much of its content incorporated into biochemistry. Certain elements of physiology are now a part of neurosciences. Throughout the year, parts of physical diagnosis will be incorporated into physiology, neuroscience, anatomy (cell and organ structure) and biochemistry (systems and processes).

Goal: Increase self-directed and problem-based learning experiences, while reducing reliance upon large group lectures.

Action: During the first year, each student will be required to complete a series of learning experiences related to the achievement of certain core competencies. The choice of specific experiences and their achievement will be left largely up to the student. Their completion will be recorded in an academic logbook, similar to that used in clinical rotations. The biochemistry conference section, for example, has been broadened and will engage students in a variety of self-directed learning formats, such as small group discussions and independent research activities. Students’ informatics ability will be developed and demonstrated through successful completion of a variety of computer-based projects during the first year.

Goal: Provide students with earlier patient contact and clinical skills preparation.

Action: As part of the Doctoring Curriculum, the longitudinal patient care experience will provide opportunities for students to work with physicians in practices throughout the community. Physical diagnosis will be interspersed with the basic science across the first year.

Goal: Discontinue separate course examinations to promote a more integrated approach to studying and eliminate cycle studying.

Action: In each semester of the freshman year, a series of three integrated examinations will be held. These comprehensive exams will test the content covered in all core courses during the preceding portion of the semester. Prior to each examination, the student will have a week long period for studying and preparing, a time during which no other academic activities will be scheduled.

Curriculum Coordinating Committee (CCC) members Chris Fredericks, Ph.D., professor of physiology and Frank Spinale, M.D., professor of surgery, developed these goals after consulting with first-year course directors, department chairs, residents and students. Spinale and Frederick along with the Fall Semester Committee members, Bill Stillway, Ph.D., and Barry Ledford, Ph.D., professors of biochemistry and molecular biology; Timothy Fitzharris, Ph.D., professor of cell biology and anatomy; Paul O'Brien, M.D., professor of surgery; Ed Brown, M.D., and Bob Mallin, M.D., (also CCC members) are coordinating the implementation.

New students to have early contact with patients

Students starting their medical career this fall at MUSC will begin to see patients within their first few days of school. That’s a dramatic change from the traditional curriculum that kept students in the classroom for the first two years of medical school.

Ed Brown

The change is part of a sweeping movement across the country to revise medical education to better prepare students for the medicine in the next millennium.

Bob Mallin

The doctoring curriculum, developed by Curriculum Coordinating Committee members Ed Brown, M.D., and Bob Mallin, M.D., was approved by the Undergraduate Curriculum Committee on April 1. It will replace the current Introduction to Clinical Medicine structure.

Modeled after the Introduction to Clinical Medicine II course, which last semester sent students to physician’s offices in the community, the longitudinal patient care experience will expose students to the clinical setting during their first semester of medical school.

Instead of waiting until the second year of medical school, instruction in physical diagnosis will begin during gross anatomy, physiology and neuroscience blocks. Skills learned in the classroom will be reinforced through the longitudinal patient care experience.

“For example, the cardiovascular exam will be taught in a physiology laboratory when the students are learning cardiac physiology in class and performing the cardiac examination in the clinical setting,” Mallin explained.

“As a result,” Brown added, “Faculty in the third year will get students who are much better prepared to examine patients and handle the transition from the classroom to the patient care setting.”

Students’ skills in medical informatics will be honed through specific projects in biochemistry, genetics and neuroscience courses.

Like other revisions to the undergraduate curriculum, the doctoring curriculum focuses on acquisition of life-long, self-directed learning skills through the introduction of problem and case-based learning activities.

“When the students are working through the problem-based case concerning late life, they will be covering death, dying and bereavement in medical interviewing and discussing related topics with patients they are seeing in their physicians' offices,” Mallin said.

A 1998 survey of faculty, students and recent alumni provided the basis for several doctoring curriculum objectives.

Survey results can be viewed at <http://www2.musc.edu/MED/ED_Pol-folder/curriculum_coordinating_co.htm>.

Brown, assistant professor of medicine and Mallin, assistant professor of family medicine, hope to implement a number of these changes into the 1999-2000 curriculum.

Continuing Medical Education

Conferences:

June

2—5 Cardiology Update for the Primary Physician Charleston Place Hotel The intent of this conference is to bring the most recent advances in cardiovascular disease to the primary physician.

2—5 Orthopaedics at Spoleto Mills House Hotel This conference will assist orthopaedic surgeons in meeting daily challenges by presenting important key surgical tips and clinical results of primary and revision knee arthroplasty.

3—6 Ophthalmology Update Westin Francis Marion Hotel This program will update comprehensive and general ophthalmologists on the latest issues of common and sight-threatening ophthalmic disorders.

7—12 Intensive Review in Family Medicine Kiawah Island Resort Common problems in family medicine and practical approaches to prevention, evaluation and treatment will be reviewed.

10—12 Update in Psychiatry MUSC Campus This conference will include information on the process of behavioral sensitization, treatment of tic disorders in ADHD patients, successful pharmacologic and psychosocial treatments for schizophrenia, and new techniques that aid in the reduction of chronic pain.

For more information on Continuing Medical Education conferences call 876-1925.

Graduate Medical Education

June Internal Review Schedule

Pathology

Forensic Pathology

Teaching tips

While teaching in small groups, don’t always jump to answer a learner’s question. Rather, ask the group if they know the answer and proceed from there. (You may still find the need to give the correct answer, but can ground that answer in what the learners already know.)

Helpful clinical teachers explain the basis for their actions. Remember to take a brief moment to explain your decisions—this will enhance the learner’s understanding of the situation.

Be lively and enthusiastic in whatever type of teaching setting—research shows it is more effective than not being lively.

Don't miss this

June 7 is the submission deadline for the Innovations in Medical Education (IME) exhibit, a part of the 1999 Annual AAMC Meeting on Education Affairs. IME exhibits will highlight innovative ideas in medical education, from instructional design and evaluation of basic science courses to community-based health promotion/disease prevention programs. For more information, visit the AAMC home page at <www.aamc.org>.

If you have an event you would like to see included in Don’t Miss This, please fax it to Kristen Karig at 792-6723, send via e-mail to karigkd@musc.edu, or send via campus mail to Office of Public Relations, attn: Kristen Karig, room 106 Admin. Bldg.

On the web

The Deans' Rural Primary Care Clerkship information is now online at <http://www.musc.edu/deansclerkship/>. The site includes valuable information about clerkship sites, rotation schedules and objectives. Special thanks to Jeannie Oglesby and Donna Kern, M.D. for developing the site.