Mission: To prepare physicians who are relentlessly curious, who are determined in their efforts to

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Mission To prepare physicians who are
relentlessly curious, who are determined in their
efforts to improve patient outcomes, and who
apply their knowledge and skill with judgment and
compassion
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The Four Is of The Carnegie Foundation
Preparation for the Professions
ProgramImplications for Humanistic Medicine

• Molly Cooke MD
• Senior Scholar, CFAT
• Director, Haile T. Debas Academy of Medical
  Educators
• Professor of Medicine, UCSF

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The Four Is of the Medicine PPP
Formation of Professional Identity
Insistence on Excellence
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Why individualize?

• Respect learners previous experience and goals
• Increase educational efficiency
• Expand breadth of learner mastery

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From Process-Based to Outcome-Based
Carracio et al. Shifting Paradigms From Flexner
to Competencies. Academic Medicine 2002,
77361-367.
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Competency-based assessment and the duration of
residency training
Long 2000 Acad Med
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Competency-based assessment and the duration of
residency training
Long 2000 Acad Med
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3 Forms of Integration

• Multiple Roles of Physicians

Formal Experiential Learning
Holistic Perspective on Patients Patient Care
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Integration of the roles of a physician

• Physician-citizen, scientist, leader-manager,
  policy maker-advocate
• Areas of concentration and Pathways

Gruen 2004 JAMA
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General Patient Care in an Integrated Model

• AB 63 year old established patient in my
  practice w/ remote HD, ADPKD, renal failure on PD
• Events over year incarcerated hernia in exp lap
  incision, new Dx NSC lung cancer
• Learning points molecular basis of cyst
  formation, giving bad news, interpretation of
  isolated prolonged aPTT, cross-specialty
  collaboration

• MM 40 year old with spina bifida, chronic
  pain, depression, and poly-substance abuse
  referred from neurology in September for primary
  care
• Events over year Doctor-shopping, suicide
  attempt, residential rehab
• Learning points Embryology of neural tube
  defects, folate and methylation hypothesis,
  principles of pain management, pharmacology of
  buprenorphine, setting limits and managing
  boundaries

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Integration of Formal Experiential

• Formal Knowledge facts, concepts,
  theories
• Experiential Knowledge performing tasks and
  activities in context
• Integration through
• -Guided Participation
• -Iterative Sequencing

Modified from http//e-archive.vanderbilt.edu/bit
stream/1803/216/18/spirallearning.doc Accessed
3/31/2008
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The Four Is of the Medicine PPP
Formation of Professional Identity
Insistence on Excellence
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Medical education in the Dreyfus model of skill
acquisition
Expert
Expert
Proficient
Experienced non-expert
Competent
Advanced beginner
Novice
Medical school
Residency
Early in practice
Batalden Health Affairs 2002
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Insistence on Excellence
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The Four Is of the Medicine PPP
Formation of Professional Identity
Insistence on Excellence
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Identity Formation

• Formation
• Process of becoming a physician and taking on
  identity
• Commitment to values and dispositions of the
  profession
• Learned through
• Participation in a community of practice and
  adoption of professional behaviors, identity and
  values
• Observation of role models and peer interactions
• Coaching, instruction, assessment and feedback

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Curricula and HumanismCurriculum Content

• Doctoring courses
• Humanities courses, including ethics
• Pathways-type opportunities
• Presentation of science in an historical context

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Curricula and HumanismCurriculum Design

• Individualized
• Developmental
• Learner-focused
• Contextualized

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Pedagogies and Humanism

• Active learning
• Inquiry driven, with guidance
• Dynamic interplay between formal and experiential
  knowledge-building

Modified from http//e-archive.vanderbilt.edu/bit
stream/1803/216/18/spirallearning.doc Accessed
3/31/2008
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Assessment and Humanism

• Multi-dimensional and multi-source
• Emphasis on self-assessment
• Aspirational framework

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Institutional culture
Assessment
Curriculum
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Oath of Lasagna in 23 Languages
2008 Anatoly Urisman - Russian Cindy Oparah
- Ibo Raymund Dantes - Tagalog Nina Hansra -
Punjab Tim Joseph - Malayalam
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Mission To prepare physicians who are
relentlessly curious, who are determined in their
efforts to improve patient outcomes, and who
apply their knowledge and skill with judgment and
compassion
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Carnegie Team
Bill Sullivan PhD Molly Cooke MD David Irby
PhD Lee Shulman PhD Anne Colby PhD Bridget
OBrien PhD
http//www.carnegiefoundation.org/