Introduction - Dr. Deborah E. Powell
Dr. Powell challenged the faculty to think creatively and in new ways. She spoke of longitudinal themes, academic tracks, and a revitalized M.D./Ph.D. program. Regarding teaching methods, she urged the faculty to consider different learning styles and different learning formats such as small groups, problem-based learning, case studies and computer-assisted instruction.
Dr. Powell noted that new clinical teaching locations are available in the six Medical Education Network sites, as well as the new Silver City Clinic. She encouraged the faculty to develop opportunities for interdisciplinary education, so that individuals from different health professions can learn to work together.
Dr. Powell asked that the faculty not be tied down by questions such as "Do we have enough small group rooms, faculty, patients, etc." She encouraged faculty to ask instead "What would we like to do?" She said that she would work on finding the resources to make it happen.
Dr. Powell stated that our primary mission is education, and that we participate in a continuum of medical education. She concluded, "We are poised on a new century and need to design programs for physicians of the next century. We need to use the retreat today to think of what might be possible and to ask the question ‘What would excite you and your students?’
Learning Environment - Dr. George Enders
It was suggested that a voluntary advising/mentoring program be established so that students would have more direct interactions with faculty. Relationships might continue after the students graduate.
The participants noted that establishing a mechanism to foster greater interaction between students and faculty is very difficult due to the large size of the medical class. Suggestions included: subdividing the class into "societies" by clinical interest groups, having the program occur during working hours, increasing social interaction between junior and senior students, and involving more clinical faculty in basic science courses and teaching clinical skills within the first two years. A student remarked that the faculty should step back and develop principles that foster a better learning environment, one that is not based on "fear". The feedback received from students indicate they are more motivated by interactive learning than by lecture.
Teaching Methods in Years 1 & 2– Dr. Allen Rawitch
The discussion centered on self-directed learning versus lectures. A suggestion was made to expand problem-based learning (PBL) or small group study techniques. Introduction to Clinical Medicine (ICM) and Pathology plan to experiment with PBL and case-based learning. Issues raised include having the resources necessary for training and the resources to produce teaching materials. Written case materials can be developed or purchased to save faculty time.
Computer-based learning continues to develop. Various departments have developed syllabi and other materials for students. It was suggested that some students may need guidance to access materials on the Web. More terminals may be needed for student access. A recommendation was made to have computer knowledge as a pre-requisite for admission to medical school. This issue would have to be reviewed by the Admissions Subcommittee and the Education Council.
In comparing the scheduled hours in years one and two with the AAMC national averages, the year one hours are very close and K.U.’s year two hours are only 10% higher. If self-paced activities are initiated, scheduled hours will need to be reduced.
A suggestion was made to use the same small group case for several different courses. Courses should continually solicit feedback from students and faculty. Evaluations should be shared broadly with faculty, especially the end of year evaluations. It was noted that the class size impacts the learning environment and faculty resources need to reflect this.
The role of clinical faculty in years one and two was discussed. ICM Clinical Skills is searching for clinical faculty to teach in the first and second years. It was asked if clinical faculty could be encouraged to help teach. A course director remarked that some sessions had to be cancelled because clinicians were unable to attend. Another department remarked that they have had excellent results with the use of fellows and fourth year students as facilitators. In another course, the students say the experience was not any different when working with a nurse practitioner than a physician.
Student Evaluation in Years 3 & 4 – Dr. Garold Minns
A standard evaluation format for all clerkships was discussed, but the topic was too large for the time allowed and a follow-up discussion was suggested. It was noted that clinical knowledge, as well as skills, should be evaluated and that departments should develop the objectives for their clerkships and the tools. An OSCE (objective structured clinical examination) was suggested as one of the tools and faculty interest in OSCEs was noted. An OSCE could assess clinical skills and be done at the end of the third year to evaluate those skills that might need improvement.
Participants suggested that the issue of whether students should have to pass Step 2 for graduation needs more discussion. Concern was expressed that the Shelf and Step exams measure only didactic components. The group also felt that professional behavior and attitudes need more discussion and that an external monitoring tool besides Step 2 might be needed.
It was suggested that the student-faculty relationship needs improvement. Clearly defined learning objectives and more formative feedback were discussed as possible strategies to improve the relationship.
Comments on Sessions One–Three – Ms. M. Brownell Anderson
M. Brownell (Brownie) Anderson, Associate Vice President, AAMC commented that Dr. Powell used some key words in her welcome, such as creativity and opportunity. Ms. Anderson described curriculum renewal as an ongoing, dynamic process that is never completely "done".
Ms. Anderson noted that the focus of the learning environment discussion was on student feedback and the development of a mentoring program. She concurred that the learning environment could be fostered in a variety of ways: a voluntary mentoring program, academic societies, and relationships with preceptors and the community. A plan for student needs and involvement and clear and concise expectations were suggested.
In regards to teaching methods in years one and two, Ms. Anderson commented on the theme of a student-centered, case-based learning environment. Lectures need to play a role, as do computer-assisted instruction, small group teaching and distance learning.
Ms. Anderson stated that evaluations are critical to everything and concurred with the themes from the discussion of student evaluation in years three and four. The Medical School Objectives Project (MSOP) has drafted general curriculum outcomes with the help of many schools, including the University of Kansas. These objectives, addressing knowledge, skills, and behaviors/attitudes, need to be assessed. Standardized patients can be used to assess these objectives, as well as for teaching purposes. Other issues to be considered are the development of an objective structured clinical examination (OSCE) as part of the USMLE Step 2 exam and the computerization of the Step exams. Ms. Anderson suggested that the licensing exams not be used for promotion. She expressed concern that the licensing exams may not meet the objectives of the curriculum and that they decide only minimum competencies.
Final comments from Ms. Anderson focused on the need for faculty to be acknowledged and rewarded and for teaching to be valued. She gave the example of the University of Florida which has mission-based budgeting that rewards faculty for teaching.
Longitudinal Themes in the Curriculum – Dr. Doug Woolley
Many reasons for using themes emerged from this discussion. They allow students to watch real life unfold and develop relationships with families, patients, etc. They can also integrate previous related knowledge and skills, which allows them to see the big picture.
The support needed to implement longitudinal themes includes a faculty group across the disciplines with interest and abilities across curriculum, key teaching cases to which many contribute, and a support unit to coordinate the themes and cases.
Specific topics for longitudinal themes included doctor-patient relationship, professionalism, evidence-based medicine, family issues, social medicine, medical economy, prevention, and population-based health issues.
Positive aspects of tracks included their ability to accommodate diverse interests and the opportunity to develop a "society" with a special flavor. The loss of a general education and premature differentiation were two concerns that were expressed.
Student Evaluation in Years 1 & 2 – Dr. Christine Moranetz
The frequency of exams administered in the first two years was discussed. The faculty expressed concerns if the intervals between exams were increased or the number of tests was decreased. These concerns included decreased feedback, increased stress (each test is worth more), too much material to master, and "forgetting" older information as intervals between exams increase.
Suggestions for improving the testing environment include more "active" learning one day post-test, exploration of the role of computer testing, increased study time (i.e. no new information the day before), and the role of test modalities other than multiple choice.
Evaluation of student performance in small groups should be consistent with learning objectives. Quizzes were mentioned as an evaluation tool. It was noted that grading small groups pass/fail is not popular with students and that some small group points help students with borderline grades.
Approximately 30% of medical schools have a grading system like K.U.’s. There was a discussion of advantages and disadvantages of percentage vs. categorical grading methods. Participants were polled and over half supported the current grading system, about half supported a percentage system, and a few advocated pass/fail. It was suggested that grading methods be uniform across departments and based on learning objectives.
The pros mentioned for the use of USMLE for promotion from second to the third year included that it is the best time for students to take the test for licensure and it may be beneficial in the accreditation process. The disadvantages of using the USMLE for promotion include difficulties with the upcoming computerization of the test and that it is not specific to the curriculum.
The effect of computerization of the USMLE exams must be monitored. The group suggested that K.U. become a testing site for the computerized exam. There might be a need to consider allowing students to proceed to M3 clinics as they wait to take Step 1 on computers. This may create the need to extend the promotion deadline.
Clinical Teaching Sites – Dr. Ken Kallail
In order to expand the number of clinical teaching sites in Kansas City and Wichita, the following needs were identified: better coordination between departments, centralization of policies and procedures, faculty appointments, and tracking of students and experiences. Several questions arose such as "Who pays for the expenses like housing and travel?", "How do didactic components get delivered?", and "Should we pay community faculty or should full-time faculty be sent out?"
During the discussion of network sites and the development of a rural track, several needs were recognized. The curriculum needs clear learning objectives and students should have many paths in fulfilling those objectives. We need to determine what students need and send them there. Network sites and a rural track may fulfill the need for more patients, as well as rural and primary care exposure.
Comments on Sessions Four–Six – Ms. M. Brownell Anderson
Ms. Anderson began her commentary with the assurance that all of the issues that arose during the retreat are faced by other institutions nationally. With regard to student evaluation in years 1 and 2, Ms. Anderson recommended that KU develop its own assessments to match its learning objectives and teaching methods and to assure quality.
Ms. Anderson noted that the discussion in the group dealing with longitudinal themes touched on clinical experiences and relationships with faculty/peers, as well as specific topics. Themes should be reinforced by clear objectives and assessment activities.
Ms. Anderson noted that the MSOP report has identified four attributes that a physician needs to meet society’s expectations. Physicians must be altruistic, knowledgeable, skillful and dutiful. Students can use "parallel charts" to record their experiences and feelings as they treat patients.
In regards to clinical teaching sites, Ms. Anderson suggested expanding them both regionally and locally. K.U. needs to determine what its own goals are regarding clinical teaching sites. She suggested involving the CME office to foster and promote preceptorships.
She commented on the need to pay more attention to population health issues and exposing students to community resources. Students could have community-based assignments and/or projects of several weeks in duration.
Ms. Anderson commented that faculty development/support for teaching, the Dean’s support and leadership, and an Office of Medical Education were important. She noted that KU has many opportunities and that much is happening here, which needs to be promoted internally and externally through newsletters, publications, presentations, etc.
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