the MEDICAL EDUCATOR VOL 1, No 7, August 1999 Curriculum database helps manage change by Cindy A. Abole, Public Relations CurrMIT has arrived at MUSC. Before the image of a green, smooth-talking, movie star/frog comes to mind, think again. AAMC’s Al Salas, far right, instructs Dr. Victor Del Bene, associate dean for students, and other MUSC and USC medical faculty on customizing techniques using the new CurrMIT management database system.  The Association for American Medical Colleges (AAMC) has recently implemented a national curriculum database for medical student education programs in North America. Known as the Curriculum Management and Information Tool or CurrMIT, the program serves as an interactive resource and management tool that ties academic centers together for the purpose of sharing information about medical school curricula.  In late July, a handful of curriculum planners, staff members and faculty gathered in front of a bank of computer terminals at MUSC’s Public Services and Education Center to learn more about CurrMIT and discover its usefulness to educators. Participants from the University of South Carolina’s School of Medicine and MUSC met with senior staff associate and trainer Al Salas, AAMC Division of Medical Education, to review program basics and customizing features. CurrMIT’s roots originated from the successful text-based model used at the University of North Carolina-Chapel Hill School of Medicine. Their program was created to meet specific curriculum needs from listing academic courses, clinical programs and clerkships to tracking  other education-related activities.  North Carolina’s success helped launch AAMC’s national pilot program in 1995. The software was distributed and tested with 20 AAMC-member institutions. In fall 1997, a revised version of CurrMIT was released — incorporating valuable feedback learned and collected from the original program. It wasn’t until 1999 that the program was accessible as an online database for all medical schools to use.  “Much of the technology was very new to all of us,” said  Salas, speaking about the program’s quick progress within the past five years. Since much of CurrMIT’s technology and programming support was created by outside consultants, Salas and other project staffers completed training to learn program specifics. In addition to assisting with online support, Salas’ team will provide periodic upgrades, maintenance and  online help to users. With CurrMIT, medical schools in the United States and Canada can manage their own curriculum in great detail. The menu-driven program for data entry possesses a common database that can be recognized and used in more than 140 AAMC schools in the United States and Canada. More importantly, users will be able to compare their data to other programs—analyzing trends and learning new strategies that are helpful resources for continuing curriculum reform. For example, CurrMIT has already established Listserve, a communications tool linking more than 400 CurrMIT administrators nationally online. The program alerts administrators of improvements, system problems, etc. It is also designed to encourage discussion between schools of common or unique problems which can be resolved or applied.  “The database gives users a handle on where to get information,” Salas said. “However, it is not a place to learn about medicine.” Users are required to submit common information into a number of general entry fields. Course information, education methods, length of program and other specialized programs will be used to help create the annual AAMC curriculum directory. This guide will be distributed to all AAMC-member institutions as a hard copy reference source. CurrMIT information can easily be shared and retrieved under a secure, password-protected system. Although the database is accessible by medical faculty, only select individuals will have full editing access to information. On-site coordinators include Victor E. Del Bene, M.D., associate dean for students, College of Medicine and Amy Blue, Ph.D., curriculum and evaluation coordinator, Dean’s office.   “We’re very excited to be using this tool during our period of curriculum change and mission-based management,” Blue said. “CurrMIT is sure to provide more specificity for our faculty and help us devise better teaching methods.” 1st fourth-year students complete Clinical Practice Exam One hundred thirty-one fourth-year medical students were the first to complete the new Clinical Practice Exam (CPX) held from July 26 to August 6 at the MUSC Center for Clinical Evaluation and Training (CCET). Using a series of standardized patients—healthy persons trained to portray people with illnesses—the exam is designed to identify the strengths and weaknesses of student physicians. It will also help prepare students for the implementation of the USMLE Step II A exam in 2002 which will include standardized patients.  Shana Caporossi, CCET administrative assistant, organized the CPX so that eight students took the exam at the same time. Like a carefully directed eight-act play, each student interviewed eight patients, spending a maximum of 15 minutes per patient. After each patient interview, students completed an exercise such as evaluating an X-ray or answering a series of questions. Student reaction to the CPX was very positive overall, said Maura Carey, patient trainer. According to one fourth-year student, the CPX  “made me think about the disease process—(something that is) helpful for coming up with a differential diagnosis....Overall, the CPX is a good thing.  It will make me go back and improve.”  Another student said, “I’m looking forward to the feedback...a challenging experience.” Carey trained 16 people (two per standardized patient case) for the exam. Each patient received intensive instruction on how to portray the clinical problem and properly evaluate each student. After each student interview, patients completed a checklist of observable behaviors, including history taking, physical diagnosis, and interpersonal skills. Prior to the CPX, a faculty member or resident interviewed each standardized patient, just as the students would, and provided feedback on the patients believability and other aspects of the case.  Students will receive reports on their performance in early September. Those who scored significantly below the mean will be assigned a faculty advisor to guide their improvement efforts.  “This will provide students with an overall view of their strengths and weaknesses as they enter their final year in medical school,” said Imogene Smith, Ed.D., interim director, CCET. “Hopefully they will be better prepared for their internships having had this experience.” Answers to frequently asked curriculum change questions How will first-year students be tested in the new pre-clinical curriculum? Beginning this fall, students will take two integrated term examinations and a final examination in each semester. These examinations will be offered at the end of specific examination weeks during which all other academic activity will stop. (In the fall, week 9/27, week 11/8, and finals, week 12/13.) Monday—Wednesday will be set aside as study days; written exams and lab and clinical skills exams will be given on Thursdays and Fridays. Will students get exposure to patient care earlier in the curriculum? Yes. Beginning in the fall semester of the first year, students will go to community-based primary care physicians’ offices once every three weeks to practice their medical interviewing skills with patients. This activity is intended to continue during the spring semester and throughout the second year of the curriculum. Has problem-based learning been incorporated into the new curriculum? Yes. Problem-based learning is a feature of the Behavioral Science in Medical Practice Segment of the Doctoring Curriculum in Year 1. Students will work through four cases that discuss behavioral science and human growth and development issues. Students are expected to research learning issues outside of class to report back to the small-group during the next class session. How have the basic science courses changed for the first year of the curriculum? First, Genetics has been eliminated as a free-standing course, and the basic genetics component has been integrated into the Biochemistry course. The clinical genetics content will be incorporated into the sophomore year in fall 2000. The anatomy course will begin to move away from extensive dissection by students and include some prosections. Synchronization of the content of Cell Tissue and Organ Biology (CTOB) and physiology will occur as much as possible.  Finally, Gross Anatomy has been renamed Cell and Organ Structure, and Biochemistry has been renamed Systems and Processes. How will the basic and clinical sciences be better integrated in the first year of the curriculum? During the Doctoring Curriculum in both the fall and spring semesters, portions of the physical examination will be taught in synchronization with content from anatomy, physiology and neurosciences. Also, integrative Doctoring Curriculum lectures that combine basic science course topics with clinical issues will be held.  What is the self-directed activities log?  The purpose of the log is to provide first-year students a variety of experiences that integrate medical school course material with relevant clinical applications. The log is intended to be used in a self-directed manner, meaning that students are to complete of these activities on their own rather during pre-determined scheduled times. Friday afternoons have been dedicated as curricular time for these activities. However, students may complete these activities at any time.  A few activities are prescheduled to minimize the impact of student presence in the clinical area. Activities for the fall semester log include attending a medicine or surgery departmental grand rounds, attending a radiology reading conference or observing an endoscopy, spending several hours in the Emergency Room, and attending a forensic autopsy. Students are also expected to complete informatics curriculum activities, such as accessing the AMA student web site and a 3-D Anatomy/Embryology web site. (See sample log below.) All these changes appear to be affecting the first-year of the curriculum. Will any other parts of the curriculum change? Yes. Year 2 changes will occur in the 2000-2001 academic year. A Year 3 change is already underway with all students participating in the Deans’ Rural Primary Care Clerkship. Next year, all students will participate in a required fourth-year psychiatry clerkship.  Continuing Medical Education Conferences: All conferences will be held in Charleston, S.C. unless noted otherwise. September 9 - 10 Advanced ERCP Tutorial MUSC Campus 10 - 11 MUSC/Clemson CME Weekend Madren Conference Center Clemson, S.C. 16 - 17 Developments in Digestive Diseases Storm Eye Institute Auditorium MUSC 18 GI for the Primary Physician Embassy Suites Hotel 25 Sickle Cell Conference MUSC Campus 27 - Oct. 2 8th Intensive Review of Emergency Medicine Westin Francis Marion Hotel 30 - Oct. 1 5th Annual Diabetes Fall Symposium Charleston Hilton Hotel October 1-2 Spectrum of Mania Westin Francis Marion Hotel For more information on Continuing Medical Education conferences call 876-1925. Parallel Curriculum For the first time in its five-year history, the Parallel Curriculum accepted 24 students for its 1999 freshman class. In the past, 18 students were selected each year to participate in the program. According to Imogene Smith, Ed.D., education director, Parallel Curriculum, additional office space and the recruitment of more faculty members to serve as student mentors allowed for the expansion. “We’re excited to be able to offer more students the opportunity to engage in this style of learning,” Smith said.  Don't miss this The 110th AAMC Annual Meeting, Closing the Gaps—A Resolution for the Millennium, will be held Oct. 22 -28 in Washington, D.C. Participants will examine what medical schools and teaching hospitals can contribute to addressing three large gaps that continue to plague the American health care system: gaps in access to health care, disparities in health status, and inequities in educational opportunity. For the first time, the AAMC is offering four pre-conference workshops the day before the annual meeting to provide opportunities to learn about specific areas identified as essential for success in medical schools and teaching hospitals. For  information, visit <http://www.aamc.org/meetings/annual/1999>. This site is updated weekly. Teaching tips Tips for problem-based learning (PBL) tutoring and small-group teaching: If you think of something, don’t say it. The students usually say it. Think of what to say next. Give up control. Let the students, particularly with PBL, have control of the group. Ask questions and pose hypothetical problems that spark meaningful discussion and thorough evaluation of the information brought to the session.  Make sure the students feel that you are on their side as a colleague, and not an adversary.  When students are presenting misinformation, rather than confront the student or say “that’s wrong,” ask the student to back up his or her point or to back out of the statement gracefully by saying, “Are you sure?" Be enthusiastic and enjoy the group’s learning You may find yourself learning too! On the Web Missed an issue of the Medical Educator? Visit us online at  <http://www.musc.edu/catalyst/sub/mme.htm>. This month's issue is available, and all past issues are archived for easy reference.

 

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