New York University School of Medicine

Curriculum Management and Governance Structure ♦ The dean has overall authority for the educational program of the School of Medicine. He has invested the vice dean for medical education with responsibility for the undergraduate curriculum. ♦ Oversight of the content and quality for each thematic unit resides with department chairs. The chairs appoint course directors and faculty for each thematic unit. ♦ The basic science courses have been organized into modules representing thematic content. Each of the modules is directed by a senior faculty member appointed by the dean. ♦ Open lines of communication and dialogue among the deans' office, department chairs, and faculty and regular meetings of leaders of the thematic units foster development of an integrated curriculum. ♦ In September 1999, at the direction of the dean, a reorganization and expansion of the dean's office was mandated in order to create the infrastructure necessary for central oversight of the curriculum. ♦ The former associate dean for curriculum was appointed vice dean for medical education. A faculty member who had served as a module and course director was appointed associate dean for medical education. In 1999 a new position for an associate dean for educational program development was created. ♦ Together, these individuals provide enhanced oversight and administrative leadership for the curriculum and development of new programs. The vice dean and associate deans have a strong leadership role in the process of curricular reform. They and other members of the dean's office focus attention on the areas that would benefit from change, initiate activities, and keep the change process moving forward. ♦ The dean's office provides leadership and oversight through a variety of other mechanisms. ♦ Module directors meet regularly with the deans' office to provide oversight and plan the evaluation of the interdisciplinary curriculum. ♦ The recent appointment of a new chair and co-chair of the Curriculum Committee has strengthened the educational governance of the curriculum; they represent both basic and clinical sciences and foster an active role for the committee. Through their leadership, the Curriculum Committee is currently focusing attention on a critical review of the clinical clerkships in conjunction with the curricular reform. Office of Education ♦ The office, under the direction of a medical educator, has been instrumental in creating a review of faculty teaching efforts. ♦ Currently, the office serves as an educational resource for faculty in development of course objectives, syllabi, and teaching modalities. ♦ The office maintains a centralized comprehensive plan for evaluation of all courses and the overall educational program. ♦ The office's faculty development activities include both one-on-one consultations and workshops to support the goals of the curriculum. ♦ The office has supported a series of Medical Education Colloquia involving a series of five to six lectures and workshops annually by nationally recognized experts in various aspects of medical education. Budget to Support Educational Programs ♦ After the self-study and site visit by a team representing the LCME in 1993, a formal budget allocated to the education program initiatives was developed. ♦ The budget is managed by the vice dean for medical education and is funded by tuition and fees. ♦ At the current time, there is no mission-based budget that directly allocates dollars to faculty teaching efforts. Valuing Teaching ♦ The school has begun to recognize faculty's contributions to medical education. Recent examples include a request for proposals for competitive awards to faculty in support of educational projects, and the Dean's Recognition Citations for Excellence in Medical Education, the first of which were awarded to course directors in the spring of 1999. ♦ The Task Force 2001 Report, which is guiding the current process of curricular change (see below), reinforced the importance of articulating that a major commitment to the education program has significant value to the institution. The report recognized that promotion to a higher rank is based on excellence and evidence of academic achievement and recommended that the criteria by which faculty are evaluated for promotion and tenure should be clear. ♦ A dean's committee to review policies of promotion and tenure, particularly as they pertain to the teaching faculty, was established to make formal recommendations in this regard. The Task Force Report recommended that policy development in this area involve assessment of the individual's contribution to the educational program, an element of peer assessment, and teaching portfolios. ♦ The school will use feedback from both faculty and students to create a mechanism to recognize and reward teaching efforts. CURRICULUM RENEWAL PROCESS New York University School of Medicine is currently in the midst of curricular reform and design of Curriculum 2001. The curriculum planning process at the School of Medicine evolved from a history of ongoing educational revision that has occurred within the context of national reform. The current plans for curricular revision are based on the work of the Task Force on Curriculum Policy 2001 and the institutional self-study that was performed in conjunction with the accreditation site visit in January 2000. These committees produced detailed recommendations in their reports, Task Force on Curriculum Policy 2001: Background and Recommendations and Report of The Committee on the Educational Program for the MD Degree. The plans for curricular renewal are characterized by three overarching goals and an action plan based on six curricular recommendations. ♦ Overarching goals The following goals guide the curriculum planning process: Develop a rich, evolving, contemporary curriculum, founded in the science of medicine, that unfolds over the four years of study Emphasize self-directed learning throughout the curriculum Identify and recognize our most qualified and excellent teachers ♦ Six-point plan The recommendations of the Curriculum 2001 Task Force are summarized in a six-point plan: Develop thematic content units that will promote vertical and horizontal integration throughout the four years of instruction Enrich the teaching of basic medical science in the clinical years Ensure that the core clinical clerkships provide equivalent and high-quality learning experiences across sites Cultivate a culture of scholarship, mentoring, professionalism, and humanism throughout the curriculum Develop uniform methods of formative and summative assessment that are consistent with course objectives across all four years Create policies to specify teaching expectations and recognize the faculty's teaching role ♦ The new NYU Master Scholars Program is a significant feature of curricular renewal. The overall mission is creating a fabric of learning that promotes principles of humanism and professionalism throughout all aspects of the education of physician—scholars. Learning Outcomes ♦ The faculty has not prepared a formal list of specific outcomes that students must demonstrate prior to graduation. ♦ During the past year, all preclinical and clinical courses have articulated specific learning objectives for knowledge, skills, and behaviors. ♦ The school is moving toward refining the systems for assessment of student performance with the goal of linking performance-based assessments to these objectives. Changes in Pedagogy ♦ Since the institutional self-study in conjunction with the LCME visit in 1993, there has been progressive modification of the curriculum towards increased small-group teaching and self-learning. ♦ Changes have included an increase in small-group teaching (currently approximately 55% of total preclinical contact time). ♦ Cases are used to introduce concepts to students. In addition, there has been a reduction in the total amount of direct contact time in order to increase the opportunities for independent learning. ♦ Standardized patients are used for teaching/assessment in the ambulatory care clerkship; their use may increase in Curriculum 2001. Application of Computer Technology ♦ Students are required to have computers. ♦ The use of computers in learning will increase dramatically in Curriculum 2001. ♦ Since 1996, the school has increased the emphasis on computer applications in the curriculum to enable students to understand the use of computers in both clinical practice and biomedical research. ♦ More independent-learning activities have been introduced to deliver core content, and greater emphasis on computer technology for information gathering and searching of the medical literature. ♦ Significant progress was made in this area through a working collaboration between the school's Erhmann Medical Library and the Division of Academic Computing. ♦ All basic science courses present material on the Web, including handouts, lecture slides, and specialized learning exercises. ♦ During the ambulatory care and pediatrics clerkships, students record their patient activities on hand-held computers. This permits the capturing and analysis of each student's clinical experiences. ♦ Based on the success of this experience the school plans to move to Web-based technology for other courses. Changes in Assessment ♦ Assessment of students during the first two years is based on a variety of measures: Examinations. All courses administer written examinations. The formats of the written examinations vary widely and include USMLE-format multiple-choice questions, true—false questions, essays, and free-response items. Exams are given in class, on computers, and as take-home exercises. Examinations have become more integrative as courses within modules have become more interdisciplinary. In general, cumulative final exams are not offered, and USMLE shelf examinations are not widely used. All preclinical courses have small-group sessions and/or laboratories where performance is observed and evaluated. Instructors give feedback to students based on their participation and performances in the smallgroup sessions. Other means of formative assessment include practice examinations, take-home laboratory exercises, self-assessment problem sets, self-assessment, computer-assisted instruction modules, computer-based modules, and test-item banks for study and self-assessment. Several preclinical courses assign other written work, including papers, essays, projects, and laboratory writeups. Some courses offer opportunities for self-assessment in the form of study aids and as practice for graded exercises. Mechanisms include question banks and computer exercises; the latter are generated internally and also come from external academic and commercial sources. A number of exercises involve students working together in groups, where faculty evaluate their performances. Elements of professional behavior are also part of the formal assessment system in some preclinical courses. ♦ Clinical curriculum In each clinical clerkship (except ambulatory care), students take a final examination (shelf exam) prepared by the National Board of Medical Examiners (NBME). The NBME grades the exam and students' scores are compared with those of others around the country who have taken the same exam. During the clinical clerkships, faculty preceptors observe students and provide feedback during smallgroup sessions and on teaching rounds. The ambulatory care clerkship uses an OSCE at the beginning of the clerkship to provide formative feedback to students. Students develop a learning plan with their faculty mentors for their activities in the ambulatory care clerkship based upon their performances on the OSCE. Each student is expected to be observed performing the core skills required in a particular clerkship, e.g., history and physical exam (medicine clerkship), mental status examination (psychiatry clerkship), and procedures appropriate for medical students (e.g., venipuncture). A new objective structured clinical exercise has been introduced this year as part of the funded NYU Macy Initiative in Health Communication; currently, this activity is centered in the third year, but it will be extended throughout the curriculum. In the clinical years, the NBME shelf examinations combined with faculty and house officer assessments of students' clinical performances provide information about their knowledge, skills, and behaviors. Clinical Experiences ♦ Students' clinical experiences begin in the first year. ♦ Over the four years, they spend time in physicians' offices, clinics, and inpatient wards. ♦ A new four-year course “The Physician, the Patient and Society” will integrate clinical experiences and relevant issues, e.g., ethics, prevention. ♦ Over the past years, the school has continued to refine its required clinical curriculum for the third and fourth years. ♦ During the 1996-97 academic year, a four-week rotation in ambulatory care medicine was added to the six clerkships that comprised the core clinical curriculum. ♦ Students now are required to complete 48 weeks of clinical rotations on the following services by November of the traditional fourth year: medicine (ten weeks), surgery (ten weeks), pediatrics (eight weeks), obstetrics—gynecology (six weeks), psychiatry (six weeks), neurology (four weeks), and ambulatory care medicine (four weeks). ♦ Prior to graduation, all students must complete a six-week advanced medicine clerkship (subinternship). ♦ Students rotate on the clinical services of the three major, on-site teaching hospitals of New York University School of Medicine (Bellevue, the VA, and Tisch Hospital), at its affiliated hospitals (North Shore, Lenox Hill, HJD, Gouverneur, NYU Downtown), and at the practice offices of the faculty on campus and the University Health Center at Washington Square. Curriculum Review Process ♦ In 1995, the dean appointed a task force with a charge of formally assessing the state of the educational program. Over 100 faculty and students met throughout the 1995-96 academic year. ♦ In the spring of 1996, their recommendations were endorsed by the Curriculum Committee and approved by the dean. ♦ The recommendations focused on the preclinical curriculum and addressed three areas: (1) organization of basic science courses into modules, (2) development of a common weekly schedule, and (3) increased emphasis on computer applications in the curriculum. ♦ In the winter of 1998-99 the current dean appointed the Task Force on Curriculum Policy 2001 to reassess the school's success in accomplishing the objectives of the 1996 task force plan and to make further recommendations. ♦ Task Force 2001 included members of the Deans' Office, basic and clinical science faculty, and students. ♦ The group began their work with a series of evening retreats in January and February 1999. These sessions focused on defining unresolved issues and learning about successful educational models at other institutions. ♦ At an all-day off-campus retreat in March 1999, the task force reviewed its work over the past two months and made detailed recommendations for further change. ♦ The work of this group and the results of the institutional self-study are guiding the current process of curricular reform. ♦ The overall goals and specific recommendations are described above. ♦ The school uses a variety of mechanisms to review the educational program: Through careful analysis of this information by many constituencies, the institution makes every effort to use these indicators to improve the curriculum. ♦ The Deans' Office and Curriculum Committee rely extensively on students' feedback about the educational program. Current student evaluation activities involve ♦ written evaluations completed at the end of the course/clerkship; these include both formal surveys from the deans' office and more detailed departmental surveys ♦ active participation on the Curriculum Committee and its subcommittees ♦ feedback sessions held regularly by course and module directors with students during ongoing courses ♦ collection of data about patient and educational experiences with the use of hand-held computers in the ambulatory care and pediatrics clerkships ♦ The faculty's input is considered highly important and their perspectives are valued. ♦ Course/module and clerkship directors communicate frequently with one another and with the deans' office about the curriculum through formally structured committees, e.g., the Curriculum Committee and its standing subcommittees working sessions to plan and monitor courses/modules/clerkships regular meetings, e.g., module directors with the vice dean for medical education and other Deans' Office faculty/staff; quarterly meetings of basic science course directors ♦ Data reflecting student advancement and graduation rates are closely scrutinized and serve as the subject of regular discussion at the preclinical and clinical examining board meetings. Since there have been no significant problems affecting substantial numbers of students, these have not had a direct influence on curricular change. ♦ The school uses feedback from residency directors to gain information regarding the performance of our graduates. This feedback is generally quite positive. ♦ Since 1993, the school has carefully analyzed the responses to the AAMC Matriculation and Graduation Questionnaires to look for additional indicators from students that help evaluate the strength of the educational program. ♦ Student scores on written exams (other than the USMLE) and performance-based assessments are used primarily by the specific courses, where they play a role in the evaluation of individual students and also as a means to assess the success of the course in adequately conveying key course material. Module and course directors review these outcomes in their internal assessment and planning. ♦ The school regularly reviews the specialty choices and academic/research careers of graduates, but this information is generally not used for short-term modifications of the curriculum. ♦ The school continually watches these trends in order to judge success in meeting its central objective—training physician scholars and meeting the expectations of the primary stakeholders, the students. Future Goals ♦ Over the next five years, we expect to address the following issues in the educational programs: Enhancing horizontal and vertical integration Promoting active learning and problem solving Developing performance-based assessments that are linked to course objectives Establishing mission-based budgeting Increasing recognition of faculty teaching efforts