MRRNSeptember 14, 2011

CMU College of Medicine

•Starting a new medical school• Accreditation – LCME• Strategic Planning• Educational Program design and development• Fund raising• Organizational change – the university• Getting the community on board• Managing politics – competing health systems, etc.• Recruiting faculty• And, lots more…

Medicine’s Challenges (Macy)•Accelerating pace of scientific discovery•Calls for more public accountability•The economy•Rising cost of health care•Shortfalls in health care quality•Racial/ethnic disparities•Rising burden of chronic illness/disability•Aging population

Challenges/needs• Re-define foundation sciences of medicine

• Psychology, social science, quality improvement, decision science, epidemiology, EBM, CQI…

• Facilitate problem solving and self-directed learning skills

• Certification and maintenance of certification• Assure students experience continuity of care• Students need skills in continuous improvement and safety

Challenges/needs• Increase emphasis on community-based education rather than the hospital

• Prepare students to work as team members (inter-professional teams)

• Increase knowledge of public health and non-biological determinants of health and disease

• Foster long-term relationships between students and faculty

• Develop teaching and mentoring skills of faculty

Needs Assessment - CMED• LCME• USMLE• AHRQ, HHS, CMS,IHI, IOM, etc. – care quality, safety,

patient experience, control costs, etc.• Other curricula (content, models, organization)• AAMC – HHMI- competencies• AAMC Training Physicians white papers• ACGME/ABMS – competencies, MOC, etc.• Local disease/health data• Literature of medical education

IHI Goal: Crossing the Quality Chasm• Care that is:• Safe, Effective, Patient-Centered, Timely, Efficient,

Equitable• Evidence-Based• Personal• Holistic, and CARING

Competencies – ACGME-plus1. Patient care

Consider procedural skills as a competency?

2. Medical knowledge3. Communication & interviewing4. Professionalism5. Practice-based learning &

improvement6. Systems-based practice7. Community and population health

Future Practice of Medicine• Patient-centered care

• Patients as individuals and member of population to be cared for supporting health assessment, patient outreach, illness prevention strategies

• Systematic assessment and improvement of quality indicators for physicians, hospitals, systems, patient populations

• Coordinates and delivers care through organized systems

• Places value on cost-effective care• Helps address constraints on health care resources

Helps to define physician skill set for future

Local needs/challenges• Physician shortage current – perhaps 1,000• By 2020 – 6,000• Closing the gap and the ongoing loss of physicians to

their communities through retirement, etc.• Distributional issue

• Recruiting to rural environment• Retaining physicians in rural environment• Who will come, who will stay?• Pipelines-AHEC

• Specialty distributional issue

Complexity of undertaking…

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What is unique about CMED?•Location•Mission, vision•Curriculum

Mission

•Prepare exceptional physicians• Improving access to individualized, essential care (health care delivery)

•Focus in rural and medically underserved regions of Michigan

• Rural/small community focus• Differentiated skill set• Generalist focus: (FM,IM, Peds, Gen Surg, Ob/Gyn, Psych, EM,

PM&R)

Vision• Excellence in instruction/active learning• Team-based learning experiences• Early patient contact • Student-centered environment/program• Patient-Centered care• Residencies (new, distributed)• Community-based, 11 affiliations thus far

Assess Needs

Develop Objectives

Develop Assessment

s

Design Instruction

Develop Instruction

Evaluate Instruction (Formative)

Pilot Instruction

Revise Instruction

Implement Instruction

Manage Instruction

Evaluate Instruction

(Summative)

Feedback & Revise

Iterative Process

Formal Knowledge/ Courses

Clinical Experience

Inquiry, Discovery, Innovation

Year I Year II Year III Year IV

LMCE: Integrated MD Curriculum

Course StructureYEAR 1

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46

47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94

95 96 97 98 99 100 101 102 103

YEAR 31 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

MED 640: REPRODUCTIVE/HUMAN DEVELOPMENT

(8 wks)

SPRI

NG

BREA

K

MED 650: CARDIO/PULMONARY: WELLNESS & DISEASE

(10 wks)

BREA

K (2

wks

)

MED 600 SOCIETY AND COMMUNITY MEDICINEMED 610 ESSENTIALS OF CLINICAL SKILLSMED 620 ART OF MEDICINE

ORI

ENTA

TIO

N MED 630: FOUNDATIONAL SCIENCES OF MEDICINE (21 wks)

WIN

TER

BREA

K (3

wks

)

MED 620: THE ART OF MEDICINE

MED 600: SOCIETY AND COMMUNITY MEDICINEMED 610: ESSENTIALS OF CLINICAL SKILLS

YEAR 2

MED 730: RENAL/ENDOCRINE: WELLNESS & DISEASE

(10 wks)

BREA

K (2

wks

.)

MED 740: NEUROSCIENCES/BEHAVIOR:WELLNESS & DISEASE

(12 wks)

MED 750: MUSCULO-SKELETAL/

DERMAL(4 wks)

MED 610: ESSENTIALS OF CLINICAL SKILLS MED 610: ESSENTIALS OF CLINICAL SKILLS

MED 620: THE ART OF MEDICINE MED 620: THE ART OF MEDICINE

BOARD PREP

RESEARCH PROJECT

MED 770: HEMATOLOGY/

ONCOLOGY (5 wks)

MED 600: SOCIETY AND COMMUNITY MEDICINE MED 600: SOCIETY/COMMUNITY MEDICINE SOCIETY/COMMUNITY MEDICINE SOCIETY/COMMUNITY MEDICINE

WIN

TER

BREA

K (

3 w

ks)

MED750: MUSCULO-SKELETAL/

DERMAL (4 wks)

MED 760: GASTRO-

INTESTINAL: WELLNESS &

DISEASE (4 wks)

SPRI

NG

BREA

K

MED 760: GASTRO-

INTESTINAL (3 wks)

ESSENTIALS OF CLINICAL SKILLS ESSENTIALS OF CLINICAL SKILLS

THE ART OF MEDICINE THE ART OF MEDICINE

LONGITUDINAL CLERKSHIPS

HOL I

DAY

BREA

K (2

wks

)

LONGITUDINAL CLERKSHIPSCC - A

(4 wks)CC - B

(4 wks)CC - C

(4 wks)CC - D

(4 wks)

YEAR 451 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100

CC/CE (4 wks)

LONGITUDINAL CLERKSHIPS

HOL I

DAY

BREA

K (2

wks

)

LONGITUDINAL CLERKSHIPSCC - A

(4 wks)

CC/CE (4 wks)

CC - B(4 wks)

CC - C(4 wks)

CC - D(4 wks)

CC/CE(4 wks)

CC/CE(4 wks)

CC/CE (4 wks)

CC/CE(4wks)

CC/CE(4 wks)

CC/CE(4 wks)

CC/CE (2 wks) 2

wk.

Ho

liday

br

eak CC/CE

(2 wks)CC/CE

(4 wks)CC/CE

(4 wks)CC/CE (4 wks)

Curriculum• College culture: respect, compassion, inclusiveness,

social responsibility, excellence, innovation, curiosity• Integration of foundation and clinical science

• Anatomy, biochemistry, physiology, pharmacology…• Psychology, decision science, continuous improvement…

• Early clinical experience• Continuing foundation science education• Schemata and Patient Presentation model, simulated

patients and families (relevancy)• Team-based learning (learning communities, in practices,

in the hospital, friendly competition-game theory)• Inter professional (PA, PT, et al.)• Self directed learning/cognitive science

    ANEMIA    

               MACROCYTIC

B12/Folate def.

Alcohol abuse

Chemotherapy

  NORMOCYTIC   MICROCYTIC

Iron deficiency

(diet, chr. Loss)

Sideroblastic

Knowledge Scheme for Anemia

                 PRODUCTION I

Aplastic anemia/rbc aplasiaMyelodysplasia/Malig.

CRF/Anemia of chr. Dis.

  INCREASEDDESTRUCTION (>2%

retics)

  BLOOD LOSSVisible/Occult

  INHERITED       ACQUIRED  

                   HbOPATHYSickle cell

ThalassemiaUnstable HB

  MEMBRANE/METABOLISM

SpherocyticHMO shunt, Glycolytic

  IMMUNECoombs pos.Drug related

Cold agglutinin

  InfectionMechanicalTTP/HUSMalaria

Causation/ Cases

Mechanism

Classification

1. Provision of schemata and

assigned readings

2. Students prepare for

instruction of coming week

3. Socratic session discussion of basic science principles

4. Large group discussion of clinical skills

5. Discussion of “Patient

Presentations” for the week

6. Review of relevant anatomy

and practice physical

examination

7. Socratic discussion of

diagnostic process

8. Socratic discussion of

treatment, focus on pharmacology

10. Discussion of patient management &

adherence challenges – Society/Community

11. Discussion of ethical &

professionalism issues

12. Open question & answer sessions

13. Journal club/EBM session relevant to

PP-diagnosis/ treatment

15. Formative assessments/

Discussion

Flow Diagram of the Learning Process

9. Small group/ team work to

identify and solve problems from PPs

14. Small group discussion of

problems/solutions clinical experience

 Orange: large group information sharing and discussion sessionsBlue: small group sessions Gray: clinical experienceYellow: large group Socratic sessions (questions based upon PPs)Green: student self-study sessions

Day Monday Tuesday Wednesday Thursday FridayTime          

8:00-8:50 Socratic discussion of algorithmic approach to condition classification, etiology, pathophysiology , diagnosis, treatment, etc.Learning Goals:  Interactive patient presentation-based session to help students assess their understanding of concepts presented in self-study preparationTeamsLarge Group BC

Diagnosis and Evaluation of relevant conditionsImaging & Lab Normal vs. AbnormalLearning Goals Large Group- C

Society Matters in Health CarePatient presentation- based: management, adherence issuesLearning Goals Large Group C

Art of MedicineEthical Issues relevant to patient presentations   Large Group C

Self-Study

9:00-9:50 Questions and answers on patient presentations – open student session

OptionalLarge Group BC

Questions and answers on patient presentations – open student session

OptionalLarge Group BC

Society Matters in Health CareEBM/Journal Review related to patient presentationsLarge Group C

Self-Study

9:50-10:00 Break Break Break Break Break10:00-10:50      

Essentials of Clinical MedicineHistory & Physical ExaminationLearning Goal - Socratic, role play, video, session. Patient presentations distributed:TeamLarge Group C

Applied PharmacologyManagement of relevant conditions –  Interactive patient presentation- based session to help students assess their understanding of concepts presented in self-study preparation Learning Goal Large Group B

Self-Study           

Clinical – Facilitator review of problem solving results for patient presentations       Team FacilitatorsSmall Groups

Self-Study

11:00-11:50

12:00pm-1:00pm  

Break Break Break Break Break

1:00-1:50 

Clinical: Review anatomy, practice physical exam, Facilitated Team1 hr B, Anat. Lab

1 hr C, LG B

Self-Study Self-Study Clinical session in family medicine practice Encounter with cardiac patient(s)   Practice V

Formative EvaluationLarge Group BC

2:00-2:50 Clinical – small group/team work on cases – identify and solve problems (2:00 – 5:00 pm)

Team

Clinical – small group/team work on cases – identify and solve problems(2:00 – 5:00 pm)

Team

FormativeEvaluation Feedback, Review plans for next week Large Group BC

3:00-3:50 

Self-Study Anatomy

Self-Study

4:00-4:50 Facilitator joins group from 4:00 to 5:00 pm

Facilitator joins group from 4:00 to 5:00 pm

Self-Study

Typical Student Schedule for a Week of Instruction for Years 1 & 2

Session & Schedule Monday Tuesday Wednesday Thursday Friday Saturday-Sunday

Morning

Pre-round if students have patients in hospitalInpatient rounds if students have patients in hospital

In-patient attending physician rounds

Total instructional hours/ week: 5 hours rounds, 6 hours small group sessions = 11/week

Patient Care work

Patient Care work

Patient Care work

Patient Care work

Community and Art of MedicineCurriculumTutorials in basic and clinical science

Afternoon

3-self-directed learning, based on patient panel, 2-small group case presentation/ discussion sessions. Patient

Care workPatient Care work and end-day rounds as appropriate

Example Student Schedule for a Week of Instruction for Year 3 Longitudinal Integrated Clerkship

Curriculum• Longitudinal clinical skills curriculum – integrated with

anatomy, imaging, physical examination, interviewing• Longitudinal courses: Art of Medicine, Society &

Community Health• Clinical and health services/delivery research• Lean, process and quality improvement – including as research, at

the practice and system levels• Population health, epidemiology, community health• Evidence-based medicine (proven practice)• Health system, care delivery, business of medicine, financing…

• Assessments: to facilitate success for individual and team (simulations, mannequins, simulated patients, actual patients)

Curriculum• Longitudinal, integrated clerkship• Gradual transitions as skills/knowledge develop• Focus on self assessment, lifelong learning, practice-

based learning and improvement…• Rural/small community emphasis

• Clinical experience based there• Community faculty as preceptors and facilitators• GME in the rural/small community setting• Patient Centered Medical Home

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CMU College of MedicineOffice of the Dean208 Rowe Hall

Phone: (989) 774-7547

Web site: www.cmich.edu/med