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DEVELOPING NEW MODELS FOR MEDICAL STUDENT EDUCATION ASSOCIATION OF PATHOLOGY CHAIRS ANNUAL MEETING J

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Title: DEVELOPING NEW MODELS FOR MEDICAL STUDENT EDUCATION ASSOCIATION OF PATHOLOGY CHAIRS ANNUAL MEETING J


1
DEVELOPING NEW MODELS FOR MEDICAL STUDENT
EDUCATIONASSOCIATION OF PATHOLOGY
CHAIRSANNUAL MEETINGJULY 24, 2004DEBORAH E.
POWELL, M.D.DEAN OF THE MEDICAL SCHOOL
2
CONTINUUM OF MEDICAL EDUCATIONCOLLEGE
UNDERGRADUATEPREREQUISITES MEDICAL
EDUCATION (UME) GRADUATE
MEDICAL EDUCATION (GME)
CONTINUING MEDICAL
EDUCATION (CME)
3
ELEMENTS OF THE MEDICAL SCHOOL CURRICULUM1910 TO
PRESENT
  • 2 YEARS PRECLINICAL BASIC SCIENCE
  • 2 YEARS CLINICAL SCIENCE

4
MODIFICATIONS IN UNDERGRADUATE MEDICAL EDUCATION
  • CHANGING COURSES (ADDING BUT NOT SUBTRACTING)
  • GENETICS
  • MEDICAL ETHICS
  • CHANGING ORGANIZATION
  • CLINICAL EXPERIENCES IN PRECLINICAL YEARS
  • ORGAN BASED CURRICULUM
  • CHANGING METHODOLOGY
  • PROBLEM BASED LEARNING
  • STANDARDIZED PATIENTS

5
RECENT DRIVERS OF CHANGE INMEDICAL EDUCATION
  • 1. CONCERNS ABOUT HEALTH CARE QUALITY AND SAFETY
  • IOM REPORTS
  • 2. INFORMATION EXPLOSION
  • FOR PHYSICIANS
  • FOR PATIENTS
  • 3. EDUCATING FOR PRACTICE AND COMPETENCY
  • ACGME OUTCOMES PROJECT

6
INSTITUTE OF MEDICINETHREE REPORTS
TO ERR IS HUMAN BUILDING A SAFER HEALTH SYSTEM
(1999) CROSSING THE QUALITY CHASM A NEW HEALTH
SYSTEM OF THE 21ST CENTURY (2001) HEALTH
PROFESSIONS EDUCATION A BRIDGE TO QUALITY (2003)
7
TO ERR IS HUMANCONSEQUENCES
  • PERVASIVE CONCERNS ABOUT MEDICAL ERRORS AND
    PATIENT SAFETY
  • RESIDENT WORK HOUR RULES
  • CLINICAL SKILLS EXAM
  • REGULATORY CHANGES
  • (JCAHO - JOINT COMMISSION ON ACCREDITATION ON
    HEALTHCARE ORGANIZATIONS PATIENT SAFETY
    STANDARDS)

8
INFORMATION SYSTEMS
  • SOME BUT NOT ENOUGH HEALTH CARE LAGS BEHIND
    OTHER INDUSTRIES
  • PUSH FOR COMPUTERIZED MEDICAL RECORDS, PHARMACY
    SYSTEMS, ETC DIFFER AMONG HOSPITALS
  • PROBLEM OF INFORMATION MANAGEMENT

9
ACGME OUTCOMESPROJECT 1997
  • CONCEPT THAT RESIDENCY TRAINING WOULD BE
    EVALUATED ON OUTCOMES NOT PROCESS
  • PROGRAMS WOULD EVALUATE GRADUATES IN SIX
    COMPETENCY AREAS

10
ACGME GENERAL COMPETENCIES
  • 1. PATIENT CARE
  • PROVIDE COMPASSIONATE, APPROPRIATE EFFECTIVE
    PATIENT-FOCUSED (CENTERED) CARE
  • 2. MEDICAL KNOWLEDGE
  • APPLY KNOWLEDGE OF ESTABLISHED AND EVOLVING
    BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL AND
    SOCIAL-BEHAVIORAL SCIENCES TO PATIENT CARE
  • 3. PRACTICE-BASED LEARNING IMPROVEMENT
  • EVALUATE PATIENT CARE PRACTICES, APPRAISE AND
    ASSIMILATE SCIENTIFIC EVIDENCE AND IMPROVE
    PATIENT CARE PRACTICES

11
ACGME GENERAL COMPETENCIES CONTINUED
  • 4. INTERPERSONAL COMMUNICATION SKILLS
  • DEMONSTRATE EFFECTIVE INFORMATION EXCHANGE AND
    TEAMING WITH PATIENTS, THEIR FAMILIES, AND
    PROFESSIONAL ASSOCIATES
  • 5. PROFESSIONALISM
  • DEMONSTRATE COMMITMENT TO PROFESSIONAL
    RESPONSIBILITY, ADHERENCE TO ETHICAL PRINCIPLES,
    AND SENSITIVITY TO A DIVERSE PATIENT POPULATION
  • 6. SYSTEMS BASED PRACTICE
  • DEVELOP AWARENESS OF AND RESPONSIVENESS TO THE
    LARGER CONTEXT AND SYSTEM OF HEALTH CARE AND
    UTILIZE THIS EFFECTIVELY TO PROVIDE CARE OF
    OPTIMAL VALUE

12
SOURCE ACGME BULLETIN, NOVEMBER 2003
13
AMERICAN BOARD OFMEDICAL SPECIALTIES
  • ENDORSES SIX ACGME COMPETENCIES AS THOSE NEEDED
    BY PRACTICING PHYSICIANS IN EVERY SPECIALTY
  • EACH SPECIALTY BOARD WILL REQUIRE RECERTIFICATION
    OF ITS DIPLOMATES
  • RECERTIFICATION SHOULD INCLUDE EVALUATIONS OF THE
    SIX CORE COMPETENCIES

14
WHAT IF...
WE MADE THE SIX CORE COMPETENCIES THE
COMPETENCIES FOR THE EDUCATION OF A PHYSICIAN ?
15
(No Transcript)
16
85 OF UNDERGRADUATE MEDICAL EDUCATION HAS BEEN
SPENT ON TWO OF THE SIX COMPETENCIES
  • MEDICAL KNOWLEDGE
  • PATIENT CARE

17
IN THE PAST DECADE, SOME EDUCATIONAL TIME HAS
BEEN DEVOTED TO TWO OTHER COMPETENCIES
  • PROFESSIONALISM
  • INTERPERSONAL AND COMMUNICATION SKILLS

18
HOWEVER LITTLE TO NO TIME HAS BEEN SPENT ON TWO
COMPETENCIES
  • PRACTICE BASED LEARNING AND IMPROVEMENT
  • SYSTEMS BASED PRACTICE

19
University of Minnesota Medical
School Educational Program Objectives

20
UNDERGRADUATEMEDICAL EDUCATIONRUMBLINGS
  • AAMC MEDICAL SCHOOL OBJECTIVES PROJECT QUALITY
    OF CARE PANEL (2001)
  • IHI-MEDICAL SCHOOL COLLABORATIVE (2003)
  • AAMC INSTITUTE FOR MEDICAL EDUCATION (2003)
  • DEANS REPORT ON VISION FOR MEDICAL EDUCATION
    (2004)
  • AAMC INSTITUTE FOR CLINICAL EXCELLENCE (2004)

21
MSOP QUALITY OF CARE EDUCATION PANEL CHARGE
  • WHAT SHOULD MEDICAL STUDENTS LEARN ABOUT QUALITY
    OF CARE ISSUES (LEARNING OBJECTIVES)?
  • WHAT KINDS OF EDUCATIONAL EXPERIENCES WOULD ALLOW
    STUDENTS TO ACHIEVE THOSE LEARNING OBJECTIVES?

22
MSOP PROPOSED EDUCATIONAL EXPERIENCES
  • MEDICAL STUDENTS SHOULD
  • EVALUATE THE RIGOR OF TREATMENT STUDIES
  • KNOW BEST PRACTICES FOR SPECIFIC CASES
  • IDENTIFY VARIATIONS IN CARE BETWEEN THEIR CASE
    (OR CASES) AND BEST PRACTICES
  • DEVELOP A STRATEGY TO IMPROVE THE CARE GIVEN

23
MSOP LEARNING OBJECTIVES
  • THE ABILITY TO CRITICALLY EVALUATE THE KNOWLEDGE
    BASE SUPPORTING GOOD PATIENT CARE
  • AN UNDERSTANDING OF THE GAP BETWEEN PREVAILING
    PRACTICES AND BEST PRACTICES AND THE STEPS
    NECESSARY TO CLOSE THAT GAP
  • PARTICIPATE IN CLOSING THE GAP BETWEEN PREVAILING
    AND BEST PRACTICES

24
IMPLEMENTATION STRATEGIES SUGGESTED BY THE PANEL
  • PILOT PROGRAMS AT A FEW MEDICAL SCHOOLS TO
    IMPLEMENT QUALITY CURRICULUM
  • COLLABORATIVE FACULTY DEVELOPMENT PROGRAM
  • DEVELOP TEACHING CASES AS PART OF AN ELECTRONIC
    CLEARINGHOUSE
  • SINGLE POINT OF ACCOUNTABILITY FOR COMPETENCY
    ASSESSMENT WITHIN THE CURRICULAR STRUCTURE

25
MEDICAL STUDENT EDUCATION COLLABORATIVE FOR THE
IMPROVEMENT OF CAREMEETING 3/12-13/2003
  • DARTMOUTH
  • MAYO
  • MICHIGAN
  • MINNESOTA
  • MISSOURI
  • TENNESSEE
  • OREGON
  • OBSERVERS ABIM, AAMC, ABP, ACGME

PARTNER INSTITUTE FOR HEALTHCARE IMPROVEMENT
(IHI)
26
OBJECTIVES OF THIS COLLABORATIVE
  • HELP MEDICAL SCHOOLS FOSTER MEDICAL STUDENT
    LEARNING AND FACULTY DEVELOPMENT IN THE
    IMPROVEMENT OF QUALITY OF CARE
  • FACILITATE COLLABORATION AND COMMUNICATION AMONG
    INTERESTED SCHOOLS TO SPEED EDUCATIONAL CHANGE
  • IDENTIFY SOURCES OF EXTRAMURAL SUPPORT FOR
    INNOVATIVE APPROACHES

27
A FEW KEY POINTS
  • IMPROVING QUALITY AND SAFETY MUST BE INTEGRATED
    INTO THE EXISTING CURRICULUM AND THE CULTURE OF
    THE MEDICAL CENTER
  • VERTICALLY INTEGRATING IMPROVEMENT EFFORTS FROM
    MEDICAL SCHOOL ORIENTATION THROUGH THE FOURTH
    YEAR EXPERIENCE HAS BEEN AN IMPORTANT CONCEPT
    IN BUILDING THIS LEARNING INTO THE EXISTING
    CURRICULUM
  • MEASURING OUTCOMES OF CARE AND SHOWING
    IMPROVEMENT IN OUTCOMES SHOULD BE INTEGRAL TO
    TEACHING MEDICAL STUDENTS ABOUT IMPROVEMENT
    PRINCIPLES
  • COMPUTER BASED MODELING HAS BEEN EFFECTIVE IN
    INTRODUCING STUDENTS TO QUALITY IMPROVEMENT
    EFFORTS

28
IHI MEDICAL SCHOOL COLLABORATIVE
  • INITIAL MEETING MARCH 2003 CHICAGO
  • SEVEN MEDICAL SCHOOLS DARTMOUTH, MAYO,
    MICHIGAN, MINNESOTA, MISSOURI, TENNESSEE,
    OREGON
  • SECOND MEETING OCTOBER 2003 CHICAGO
  • ADDED OTHER SCHOOLS CONNECTICUT,
  • PENN STATE, AND VANDERBILT
  • THIRD MEETING MAY 2004 MINNEAPOLIS
  • ADDED SCHOOLS AND DROPPED OTHERS
  • THREE CATEGORIES OF PARTICIPATION, INCLUDING
    OBSERVER
  • FOURTH MEETING OCTOBER 2004 - MEMPHIS

29
IHI MEDICAL SCHOOL COLLABORATIVE SIX THEMES
  • 1. INTERPROFESSIONAL LEARNING
  • 2. STUDENT INITIATED LEARNING
  • 3. FACULTY DEVELOPMENT
  • 4. VERTICAL INTEGRATION (ASSESSMENT AND
    EVALUATION)
  • 5. ENVIRONMENTS OF CARE
  • 6. ORGANIZATIONAL COMMITMENT

30
NEXT STEPS
  • CREATE THE INFRASTRUCTURE FOR RAPID COMMUNICATION
    AND INFORMATION SHARING ACROSS THE COLLABORATIVE
  • ADD NEW MEMBERS
  • COORDINATE WITH KEY ORGANIZATIONS (AAMC, ABIM,
    AMERICAN BOARD OF PEDIATRICS, ACGME)
  • OBTAIN FUNDING TO HELP SPEED THE RATE OF CHANGE
  • IDENTIFY OPPORTUNITIES FOR FACULTY DEVELOPMENT
  • EXPLORE OPPORTUNITIES FOR SEAMLESS IMPROVEMENT OF
    BOTH EDUCATION AND PATIENT CARE IN CLINICAL
    MICROSYSTEMS
  • WORK IN TEAMS OF SCHOOLS ON THE IDENTIFIED THEMES
    TO DEVELOP AND SHARE BEST PRACTICES

31
THE NEW MEDICAL CURRICULUMPARADIGMS FOR
PREPARING THE WORKFORCE
  • A NEW QUALITY HEALTH CARE SYSTEM REQUIRES A NEW
    HEALTH CARE WORKFORCE
  • EDUCATED WORKFORCE THAT UNDERSTANDS
  • PRINCIPLES OF QUALITY AND SYSTEMS BASED
  • PRACTICE AND VERY IMPORTANTLY PROCESS
  • IMPROVEMENT

32
PRINCIPLES FOR A NEW MEDICAL EDUCATION PARADIGM
  • DEVELOP VALID METHODS FOR ASSESSING COMPETENCE
  • BE WILLING TO INDIVIDUALIZE EDUCATION AROUND
    COMPETENCE
  • RECOGNIZE WHERE WE EDUCATE IS AS IMPORTANT AS HOW
    WE EDUCATE
  • EDUCATE FOR COMPETENCE AND CAPABILITY

33
(No Transcript)
34
  • COMPETENCE
  • WHAT INDIVIDUALS KNOW OR ARE ABLE TO DO IN TERMS
    OF KNOWLEDGE, SKILLS, ATTITUDE
  • CAPABILITY
  • EXTENT TO WHICH INDIVIDUALS CAN ADAPT TO CHANGE,
    GENERATE NEW KNOWLEDGE, AND CONTINUE TO IMPROVE
    THEIR PERFORMANCE
  • Brit. Med. J. 323799-803, 2001

35
PRINCIPLES FOR A NEW MEDICAL EDUCATION PARADIGM
  • DEVELOP VALID METHODS FOR ASSESSING COMPETENCE
  • BE WILLING TO INDIVIDUALIZE EDUCATION AROUND
    COMPETENCE
  • RECOGNIZE WHERE WE EDUCATE IS AS IMPORTANT AS HOW
    WE EDUCATE
  • EDUCATE FOR COMPETENCE AND CAPABILITY

36
GUIDELINES FOR A NEW MEDICAL EDUCATION PARADIGM
  • DEVELOP SEQUENTIAL CURRICULUM OF PRACTICE AS WELL
    AS CURRICULUM OF KNOWLEDGE
  • EDUCATE FOR KNOWLEDGE MANAGEMENT, NOT JUST
    KNOWLEDGE ACQUISITION
  • INCORPORATE PRINCIPLES OF PRACTICE IMPROVEMENT
    AND SYSTEMS BASED PRACTICE INTO OUR CURRICULUM IN
    MEANINGFUL STAGES
  • REASSESS ADMISSIONS PRE-REQUISITES
  • DESIGN UME AND GME TOGETHER, UTILIZING ACGME
    COMPETENCIES AS THE FRAMEWORK

37
REFORMING MEDICAL EDUCATION? AN OPPORTUNITY FOR
PATHOLOGYPATHOLOGISTS ARE TEACHERSPATHOLOGISTS
ARE AT THE INTERFACE OF BASIC AND CLINICAL
SCIENCEPATHOLOGISTS UNDERSTAND PRACTICE
IMPROVEMENT AND SYSTEMS BASED PRACTICE
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