Oct. 23, 2012
Over 200 members of the School of Medicine community attended the Oct. 9 M.D. Curriculum Transformation retreat. Spanning the breadth of the school, faculty from nearly every department attended, and were joined by students, school and Foundation staff and alumni.
The goals of the retreat were to set the stage for curricular transformation, to seek input from our community and get ideas flowing, to gather information which will inform the next stages of the process, and to keep the community informed and involved. Dean Mark Richardson opened the day by reminding us of the 125-year heritage of the School of Medicine, and the pivotal role of the school and the state of Oregon in health care today.
"I want everybody to think about what the future will look like for our education mission, and to take the time to use your imagination to help design that future," said Dean Richardson. "Let's take what is unique about Oregon and the School of Medicine and incorporate that into a new curriculum."
Dean Richardson reflected on his recent meeting of the Blue Ridge Academic Health Group and challenged attendees to also imagine the health care delivery system of the future. "Remember that patients are going to have access to an unbelievable amount of information," he said, and physicians will also need to consider social determinants and developmental origins of health, which are increasingly recognized to be major factors in population health. At least four elements will distinguish the future physician: critical thinking, use of data, understanding complex systems, and leading through effective communication.
He shared a model for medical education that would have a foundation of core critical knowledge, similar to that in all medical schools, but delivered in ways that are unique to OHSU, and enhanced by emphasizing some of our areas of excellence. The final component of that model is the flexibility to allow opportunities for personalized, "deeper dives" for students, to allow them the opportunity to focus on areas of their individual interest. View Dean Richardson's slides here.
George Mejicano, M.D., M.S., senior associate dean for education, then provided a foundation of information on learning theory, developmental stages, and educational outcomes across the continuum from medical student education through residency and continuing medical education.
"What I'm going to do today is begin to stir the pot. We have to think about big ideas and bring them forward," he said. "We can try to conceive wonderful things, but it's the implementation and the challenges and the tremendous opportunities ahead that will make this curriculum transformation a mark of distinction."
Using a learning pyramid to demonstrate the enhanced student retention rates of information when the format moves from lecture to demonstration, discussion, practice doing, and teaching others, he urged attendees to incorporate more active learning modalities in the new curriculum. He closed by reminding the audience that acquisition of knowledge is only the first step in a medical education; assimilating and applying knowledge are also key steps, and evaluation and assessment can happen along the way.
"I believe OHSU has the people, the willingness and the talent to create lightning in a bottle...to produce the competent, compassionate physicians and physician-scientists of the future," said Dr. Mejicano. View Dr. Mejicano's slides here.
Next, Leslie Kahl, M.D., associate dean for strategic initiatives and leader of the M.D. Curriculum Transformation Steering Committee, shared a progress report on the committee's work. She began by defining the factors leading to a need for a curriculum revision: explosion of medical information, evolving health care delivery methods and patient characteristics, and students who learn and relate to technology in new ways.
Dr. Kahl outlined the steps the Steering Committee has taken in the spring and summer.These include gathering information from the LCME self-study and Student Survey and other sources, as well as reviews of the curricula of all U.S. and Canadian medical schools, with identification of shared themes in 21st century curricula; developing a strategy for communication and engagement with the OHSU community; and a committee retreat during which the guiding principles of the Curriculum Transformation process were developed, and six work groups were outlined. The groups – which each met for a working session during the retreat – will create reports that will serve as resources for the subsequent steps in the transformation process.
"As we look back and think about where we've come over 125 years, we need to celebrate the journey and also imagine the future, and I'm delighted you've chosen to be part of this," said Dr. Kahl. View Dr. Kahl's slides here.
The keynote speaker was Maryellen Gusic, M.D., executive associate dean for education at Indiana University School of Medicine. Dr. Gusic outlined four goals which should guide change in the school's M.D. curriculum. These are:
Standardization of learning outcomes while maintaining individualization of the learning process. This includes competency-based assessment, both formative and summative, with defined developmental milestones.
Integration of the learning process with clinical experiences, which reinforce the information just learned.
Helping students develop habits of inquiry, life-long learning, and motivation.
Fostering the development of professional identity through mentoring and service learning.
"I know with the level of engagement in the room that you can conceive and achieve a great transformation in your curriculum," said Dr. Gusic. "There will be days when it will be overwhelming, but you can do it. Think big, start big, and you can do it." View Dr. Gusic's slides here.
David Heil, founder of David Heil & Associates, the facilitator of the work of the Steering Committee, then led a discussion on what the ideal attributes of an OHSU graduate should be, producing a visual representation of the audience's input on this topic. View David Heil's slides here.
Later in the day he shared feedback from focus groups he had conducted with members of all four classes of medical students. Themes from the student groups included an appreciation of the dedication of the faculty, early clinical exposure, anatomy taught with dissection, simulation opportunities and living in Portland. Areas the students felt could be improved included integration of the curriculum, inclusion of technology, active learning opportunities, classroom and study spaces, and tuition costs.
In his last session, Mr. Heil shared an analysis of the strengths, weaknesses, opportunities, and threats to the curriculum that had been performed by the Steering Committee, adding items from the audience, and asking for a rating of these items.
There were two breakout sessions during the day, and these led to lively discussions among the participants. First, at lunchtime, each of the six work groups held open sessions, welcoming retreat attendees who might not be part of the group roster. Later, attendees split into three groups, and in an interactive session gave their feedback on a series of possible new curricular models. The models posed possibilities for enhanced curricular integration, earlier clerkship exposure, longitudinal experiences, and opportunities for students to explore areas of their own interest in more depth, all while providing excellent preparation for residency training.
For the final interactive session Dr. Mejicano led a lively audience in sharing their innovative ideas for inclusion in the new curriculum. More than new 60 ideas were offered, with a prize awarded to the one deemed most innovative by audience vote. The retreat closed with a recap of the day's themes and an invitation to stay involved in the process.