Michigan State University College of Human Medicine

Beginning in 2005, the College of Human Medicine (CHM) set out to reinvigorate itself and community-focused medical education through a scientific and educational expansion in Grand Rapids, Michigan. This created growth of the academic program throughout all seven College of Human Medicine communities. The greater Grand Rapids community and the institutions of the region of West Michigan have partnered with MSU to build a medical education facility and a robust research portfolio. Overall, more than 150 million was contributed to the education and research missions of the college. The goal of the project is to bring the health, intellectual, and economic benefits of academic medicine to a vigorous region of the state. This expansion brings the College of Human Medicine an opportunity to broaden and deepen its mission in otherwise difficult economic times. The college will double its class size in 2010 and has already hired in funded, senior investigators to substantially increase the university's federal grant support and build intellectual capacity for the medical school and university. The expansion brings considerable attention and energy to the college's new headquarters in Grand Rapids, and the new resources and vigor allow the college to expand its sphere of influence, and that of the community voice, across the state and nation. Curriculum Management and Governance Structure ♦ The College of Human Medicine is a community-focused medical school whose mission is to create the best of discovery and science, primary and specialty care, diversity in our medical systems, and enhancement of service for the underserved. We bring the standards of excellence of a Big Ten university and world class research institute to the most relevant point of our health care system, the community in which most of the people of Michigan receive their medical care. ♦ The curriculum is divided into three blocks. Block I is focused on clinical skills and introductory basic science during the first year of the curriculum. Block II focuses on advanced clinical skills; systems-based medical science using a PBL methodology; and a sequence of societal courses including ethics, health policy, epidemiology, and medical humanities. Block III is composed of the core clinical clerkships, a year-long core competency series, and clinical electives. ♦ The curriculum committee of the college has direct responsibility for the content and delivery of the College of Human Medicine curriculum. The committee reports to the assembled college faculty through the elected College Advisory Council. To allow for detailed review of all curricular activities, the Curriculum Committee has subservient Block committees comprising relevant course directors. ♦ The majority of the curricular work in the College of Human Medicine occurs as an iterative, yearly improvement cycle between the department/course faculty, curricular Block committees, and the assistant deans and Block directors in Academic Affairs as represented in the curriculum management diagram (Figure 1). The course faculty present their course's performance and their plan for improvement to their peers in the Block committees. The faculty of the other courses in the Block and the Academic Affairs staff review, alter, and accept each course report and plan. This cycle is shown as a feedback triangle in the curricular management diagram. FIGURE 1: : Curriculum Management Relationships Office of Education ♦ The medical education program is centrally managed by Academic Affairs, which includes units for Admissions, Academic Programs (Blocks I and II, preclinical years), Block III (clinical years), College-Wide Assessment, International Programs, Graduate Studies, MD/PhD, Program in Public Health (MPH), Student Affairs, The Office of College-Wide Diversity, the community campuses, and the Office of Medical Education Research and Development (OMERAD). ♦ OMERAD was founded in 1966 and is the oldest continuously operating medical education office in the country. ♦ OMERAD has seven faculty, three adjunct faculty, and four staff with practical and scholarly expertise in curriculum design, teaching skills, program evaluation, medical simulation, student assessment, faculty development, and the integration of technology in curricula. ♦ Faculty of OMERAD serve on each of the curricular oversight committees of the college to help departments and courses with curricular design, student assessment, and program evaluation. ♦ OMERAD faculty work closely with the Office of College-wide Assessment to establish the reliability and validity of testing strategies and to analyze and provide assessment results to course directors and students. ♦ OMERAD has a long-standing, federally funded Primary Care Faculty Development Fellowship, with hundreds of graduates across the globe. More than 100 graduates of the program teach in the seven community campuses of the College of Human Medicine, http: //omerad. msu. edu/fellowship/index. php. ♦ To help college faculty develop their teaching and research skills, OMERAD has a well utilized seminar series focused on specific teaching and curricular skills, http: //omerad. msu. edu/seminars/index. php. ♦ As the college has developed more on-line offerings for students and residents, OMERAD created the Blended Curricular Learning Resources group to facilitate faculty integration of high quality computer-based material in the college's courses, http: //omerad. msu. edu/bclr/index. php. Financial Management of Educational Programs ♦ The college has focused its energies on investing strategically to maximize potential growth in research, clinical practice, and education. Importantly, the dean and college have acted to maintain units important to the educational and scholarly culture of the college, while still focusing on areas of revenue growth. ♦ Developing partnerships with the communities of the College of Human Medicine, most notably in Grand Rapids, has systematically improved the resources available to the college. ♦ The class expansion and new community funding in Grand Rapids make it possible for the college to grow in spite of decreasing state support for higher education. Valuing Teaching ♦ The college and university have created a Human Health Professions (HP) track for physicians. ♦ The track has four areas of focus (clinical, scholarship, teaching, and administration) in which faculty can excel. ♦ The promotions and tenure requirements spell out promotion requirements for physician faculty, all of which include education and teaching. ♦ These requirements are applied to clinician faculty regardless of their employer across the College of Human Medicine statewide system. ♦ The College of Human Medicine was founded as an institution dedicated to and designed for teaching. ♦ The first departments were structured to facilitate teaching, and much of the early innovation in the college was directed at bringing new rigor to the education of physicians. This cultural focus continues today. Curriculum Renewal Process ♦ In 2002-03, the college created a new strategic plan for medical education. That plan included a shift to competency-based education (SCRIPT) and a new focus using student assessment to guide curricular renewal (the Gateways). ♦ The SCRIPT competencies, and the objectives within the competencies, have led to a new emphasis on evidence-based medicine, patient safety, and information management. ♦ The new Gateway assessments provide competency-specific feedback to students, faculty, course directors, and administrators. This improved data allow deeper and more useful evaluation of the curriculum and strategic investment in the educational priorities of the college (see http: //humanmedicine. msu. edu/cwa/index. php). Learning Outcomes/Competencies ♦ In 2005-06, the College of Human Medicine faculty created and adopted a set of competencies linked to the ACGME Outcomes Project. These are Service, Care of Patients, Rationality, Integration, Professionalism, and Transformation (SCRIPT). (see http: //humanmedicine. msu. edu/about/documents/SCRIPT. php). ♦ SERVICE/No ACGME-related competency Participates in the provision of beneficial services within the community Demonstrates preparation and planning to provide services that respond to community need Demonstrates reflection on participation in service activities ♦ CARE OF PATIENTS/Patient Care and Interpersonal and Communication Skills Demonstrates kindness and compassion to patients and their families Collects complete and accurate patient data Synthesizes patient and laboratory data to formulate reasonable assessments and plans Demonstrates the incorporation of patient values into illness assessment and care plans Communicates effectively in writing and orally Effectively counsels and educates patients and their families ♦ RATIONALITY/Practice-Based Learning and Improvement Identifies personal strengths and weaknesses and develops ongoing personal learning plans Demonstrates receptiveness to faculty and peer/colleague feedback as a means of facilitating personal and professional improvement Locates, appraises, and assimilates evidence from scientific studies related to their patients' health problems ♦ INTEGRATION/Systems-Based Practice Demonstrates awareness of cost and access issues in the formulation of patient care plans Demonstrates respect for all members of the health care team Demonstrates understanding of the principles of, and functions as a member of, a fail-safe team Demonstrates knowledge of differing types of medical practice and delivery systems and their implications for controlling health care allocation and cost Demonstrates knowledge of how social and economic systems in which people live impact health, delivery of health care, and well being ♦ PROFESSIONALISM/Professionalism Demonstrates receptiveness to feedback from faculty/peers/colleagues/team members Contributes actively to group/team process Demonstrates respect to patients, colleagues, and team members Fulfills responsibilities in courses and on clinical rotations Takes responsibility for patient outcomes and is accountable to the team, the system of delivery, the patient, and the greater public ♦ TRANSFORMATION/Medical Knowledge Applies essential basic, social, clinical science, and systems knowledge in the care of patients Creates new knowledge through research Participates in lifelong teaching and learning with peers, trainees, and patients New Topics in the Curriculum Since 2000 Patient safety ♦ Patient safety content and assessment were included in the College's offerings at the undergraduate and graduate medical education level beginning in 2004. Introductory topics include the 1999 IOM report, medical error genesis, and physician responsibility for improving patient safety. ♦ The material deepens in the year-two systems (PBL) courses with failure mode effect analysis, human factors engineering, root cause analysis, and error analysis in the cases, self assessment questions, and summative examinations. ♦ An HRSA-funded curriculum on Medication Safety was added to the Family Medicine clerkship, and a “gateway” examination in the fourth year provides students with feedback on their knowledge and provides an ongoing curricular needs assessment. ♦ Objective Structured Clinical Examinations (OSCEs) at the end of the second and the third years of medical school include stations assessing each student's patient safety interaction with a health care team member. Underserved populations ♦ The College has interwoven curriculum and assessment related to underserved populations into major courses and clerkships in a program called “The Contract for Social Commitment. ” Components include teaching students how to determine what financial barriers exist for patients and their families, working with interpreters, and patient education (see http: //journals. lww. com/academicmedicine/Fulltext/2008/07000/OneMedicalSchoolₛEffortₜoReadyₜheWorkforce. 5. aspx). ♦ The College grants a certificate in Leadership in Medicine for the Underserved to students who elect to complete didactic and community service work in Saginaw focused on community needs analysis and program development. These students spend 10 weeks of their clinical years in Central America as part of clinically based service and research projects, http: //www. synergymedical. org/LMUV/index. html. Shared decision making ♦ The two-year clinical skills sequence provides students with a conceptual understanding of the importance of the patient/family member's illness concerns and explanatory model. The skills of this negotiation are practiced in the clerkships and assessed during the Family Medicine clerkship. Information management ♦ In 2003, the college added epidemiology courses in each of the first two years. Critical appraisal and EBM domains were added to the core competency series of the third year. ♦ Content of systems-based practice, patient safety, and other Integration competency material was added to Clinical Skills, PBL, and the clinical clerkships. ♦ The students are assessed in Rationality and Integration competency Gateways. The students' scores on the relevant portions of USMLE examinations markedly improved after the new curriculum. Changes in Pedagogy ♦ The College of Human Medicine has a long history of active learning exercises, small group work, and PBL. ♦ Many didactics are now available on-line, and OMERAD is dedicated to helping faculty create blended learning materials. ♦ Notable examples include http: //omerad. msu. edu/bclr/showcase. html and http: //justintimemedicine. com/index. htm. ♦ Since 2000, the clerkships use some form of simulation to provide formative feedback to students. Some clerkships use central resources for an “Education Day” held at the Learning and Assessment Center, and some use community resources for specific skills training. Changes in Assessment ♦ In 2003, the report of the Innovations in Medical Education Task Force called for a competency-based curriculum and assessment system that utilized multiple types of testing, including simulation, to measure student and curricular success. ♦ Beginning in 2005, the HRSA-funded initiative “Gateway Assessments in Undergraduate Medical Education” developed a number of “gateways” related specifically to our SCRIPT competencies in the second, third, and fourth years of the curriculum. ♦ The Gateways include multiple-choice, short answer, and essay tests, performance-based assessments of integrated clinical skills utilizing standardized patients, standardized family members, and health care team members, as well as task-trainers, computer simulations, and full patient mannequins. ♦ In 2007, the college created the Office of Collegewide Assessment (CWA) specifically charged with creating a “seamless, competency-based assessment system across UME, GME and CME. ” ♦ CWA is responsible for establishing the validity and reliability of College assessments and is the hub of student performance data from each of the Gateway examinations. ♦ Data are analyzed and fed back into the curricular governance structure for curricular innovation and improvement. Students receive their individual and class results to inform their own personal learning plans. The Office of Collegewide Assessment exists to provide “better data for teachers, better data for learners” in the hopes of facilitating the “best patient care” (see http: //www. chm. msu. edu/cwa/index. php). ♦ Simulation is growing as both a curricular and assessment strategy, made possible by our state-of-the-art Learning and Assessment Center (www. lac. msu. edu) and the simulation laboratories at the Secchia Center in Grand Rapids. Learners have simulated patient, standardized patient and family member, standardized health care team member, partial task trainer, whole patient mannequin, computer, and haptic simulation experiences beginning in the first week of medical school. Clinical Experiences ♦ The college was the first fully accredited community-based school and provides clinical education in 7 communities and 13 hospitals and health care systems across Michigan. ♦ The college has a robust peer review system for clerkships. The Block III committee is made up of clerkship directors and community faculty representatives. This committee meets monthly and systematically reviews each clerkship for quality and comparability across campuses. ♦ Finding and maintaining quality clinical training sites have long been a part of the daily activity of the clinical clerkships and dean's office. Larger class sizes and competition for clinical education sites from other U. S. and offshore schools increases the need for superb quality control, communication, and feedback among all of our campuses. ♦ The Gateway assessment results have led to faculty development in coaching skills and documentation of direct observation of student clinical skills in the clerkships. Regional Campuses ♦ The college has seven clinical sites for education of the third- and fourth-year medical students. ♦ Flint: The Flint campus works with Hurley Medical Center, McLaren Health Care, and Genesys Health System care systems to provide clinical education for our students. The Flint program currently has approximately 30 students in each of the third and fourth years (see http: //humanmedicine. msu. edu/future/mededflint. php). ♦ Grand Rapids: Grand Rapids is the headquarters of the College of Human Medicine as of 2010. It has grown from a two-year clinical campus to a full four-year program. Clinical education will increase from approximately 30 students to approximately 75 students per year through partnerships with Spectrum Health and St. Mary's Health Care (see http: //humanmedicine. msu. edu/future/mededgr. php). ♦ Kalamazoo: Currently, approximately 24 students are placed in each of the third and fourth years in Kalamazoo in partnership with Bronson Healthcare and Borgess Health (see http: //humanmedicine. msu. edu/future/mededₖzoo. php). ♦ Lansing: Approximately 24 students per class are placed in the Lansing community. Most of the sites are either with college faculty or associated with the college's affiliated hospitals, Ingham Regional Medical Center and Sparrow Hospital (see http: //humanmedicine. msu. edu/future/mededₗansing. php). ♦ Marquette: This campus encompasses the entire 16, 000 square miles of the Upper Peninsula of Michigan. The Rural Physician Program was one of the first of its kind in the country and continues to provide an excellent education for students with a focus on rural health care. Approximately one third of the physicians of the Upper Peninsula, a large, underserved geographic expanse, received their undergraduate or graduate medical education through the Rural Physician Program or the college's affiliated residency at Marquette General Health System (see http: //humanmedicine. msu. edu/future/mededₘarquette. php). ♦ Saginaw: The Saginaw campus is home to the college's Leadership in Medicine for the Underserved (LMU) program. The campus has approximately 18 students per year. The LMU program is an elective program that provides added qualifications beyond the standard clinical education. The students are placed in the community at St. Mary's of Michigan and Covenant Healthcare (see http: //humanmedicine. msu. edu/future/mededₛaginaw. php). ♦ Traverse City: The College of Human Medicine opened its first new clinical campus in nearly 35 years with the creation of the Traverse City campus in 2009. The campus is a partnership with Munson Healthcare and provides students an excellent clinical opportunity across the northern half of the Lower Peninsula of the state. This is a wide geographic expanse that is largely underserved (see http: //humanmedicine. msu. edu/future/mededₜraverse. php). Highlights of the Program/School ♦ Bringing the concept of community-based medical education into the top tier of medical schools. The College of Human Medicine is broadening and deepening its educational and research mission throughout the state through the generous support and of the institutions of our communities. The for in medicine is by the capacity of the community-focused medical school to out to and populations of The need for people to have access to the best of medical care within their own communities is by establishing superb education and research across the state. ♦ physicians who service to the underserved. The educational program has itself to teaching students to care for underserved The Contract for Social curriculum work all students to care for underserved the new Leadership in Medicine for the Underserved a new of physicians for and medical The College of Human Medicine was one of the first medical schools to focus on the care of rural and the Rural Physician Program in the Upper Peninsula continues to and excellent students for with rural populations across the state and nation. ♦ Collegewide assessment. 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