Winter GRIPE 2007

USFCOM Curriculum &

Year II: Integration Through Collegiality

USF College of MedicineDon E. Wheeler, MDAssociate Professor

Pathology and Cell Biology

Winter GRIPE 2007

Winter GRIPE 2007

Winter GRIPE 2007

Winter GRIPE 2007

Winter GRIPE 2007

Winter GRIPE 2007

1st Year Curriculum atUSF College of Medicine

Winter GRIPE 2007

1st Year Curriculum

• Professions of Medicine - This three-week course at the beginning of the medical school curriculum will introduce students to principles that will be used through the entire medical school education and beyond.

• Basic scientists and clinicians present it in an integrated approach. Topical areas include:– The use of information resources: Library and Computer– An Introduction to Evidence Based Medicine– Effective Study Techniques– An Introduction to the Physical Examination– Cultural Diversity and Competency– Ethics and Professionalism– State of the Arts Presentations with Associated Basic

Science Correlations

Winter GRIPE 2007

1st Year Curriculum

• Ethics and Humanities • Molecular Medicine • Physical Diagnosis I • Colloquium I• Anatomy • Imaging for Anatomy • Physiology • Longitudinal Clinical Experience I • Medical Neuroscience• Introduction to Behavioral Medicine

Winter GRIPE 2007

3rd year curriculum

What if you bypassed the traditional department-based clerkships, but instead determined what the expected competencies and objectives students should achieve, and then designed the 3rd year around that?

Winter GRIPE 2007

3rd Year Curriculum

• Primary Care and Special Populations – (16 weeks)

• Integrated Internal Medicine-Pediatrics – (8 weeks)

• Newborn and Maternal Health – (4 weeks)

• Emergent and Urgent Care – (4 weeks)

• Neuropsychiatry – (8 weeks)

• Surgical Care – (8 weeks)

Winter GRIPE 2007

Primary Care and Special Populations (16 weeks)

• This interdisciplinary clerkship introduces students to the various specialties involved in primary care, and teaches the principles of ambulatory care in the primary care setting.

• Core clinical work includes ½ day each week in a continuity clinic experience with a family physician, general internist, and general pediatrician (for a total of three sessions per week).

• It also provides experiences with patient populations that might require special care or consideration, including – adolescents, – patients with disabilities, – geriatric, and – gender specific diseases.

• ambulatory gynecology, • a men’s health clinic.

• Contributing Departments: Family Medicine, Internal Medicine, Pediatrics and Ob/Gyn

Winter GRIPE 2007

Integrated Internal Medicine-Pediatrics (8 weeks)

• Introduces students to the basic principles and practices of hospital-based internal medicine and pediatrics.

• Students participate as a member of a hospital ward team, take overnight calls with their team, and are responsible for direct care of both adult and pediatric hospitalized patients.

• Didactic essentials are taught in an integrated life-spectrum approach.

• The clerkship has a special emphasis on – medical ethics, – the practice of evidence-based medicine, and – the promotion of and evaluation of professionalism.

• Contributing Departments: Internal Medicine and Pediatrics

Winter GRIPE 2007

Newborn and Maternal Health (4 weeks)

• This interdisciplinary clerkship is designed to expose students to the unique maternal fetal unit within the context of obstetrics and newborn health.

• Three weeks of this rotation focuses on the Women’s Health Care obstetrical component.

• An emphasis is placed on achieving clinical skills and a fund of knowledge across the continuum of ante partum, labor and delivery, and post partum care.

• The rotation is complimented by incorporating – a pediatric knowledge base of skills and efforts at the

time of delivery, – newborn exam, and – relevant aspects of the newborn nursery and NICU.

• Contributing Departments: Pediatrics and Ob/Gyn

Winter GRIPE 2007

Emergent and Urgent Care (4 weeks)

• This clerkship is an introduction to Emergency Medicine, integrating clinical skills and evidence-based medicine through – didactic lectures, – observation, – performance of clinical procedures, – hands-on clinical experiences and – direct interaction with faculty, individual patients, and families.

• Students– will learn and practice on mannequins, simulators, and in a

cadaver lab. – will learn patient management through the “team approach,” which

involves EMTs, nurses, and physicians. – are expected to evaluate patients, address their presenting

complaints, initiate workups, and provide definitive therapies. • This rotation will develop history-taking abilities, physical exam

assessment, and diagnostic and management skills. • This clerkship emphasizes a caring, compassionate, and

empathetic attitude in dealing with patients and their families. • Contributing Departments: Emergency Medicine

Winter GRIPE 2007

Neuropsychiatry (8 weeks)

• This interdisciplinary clerkship includes the following experiences: – 4 weeks on a general psychiatry adult inpatient service, – 2 weeks on the psychiatry consultation liaison service, and – 2 weeks general neurology.

• The psychiatry portion is designed to provide the student with opportunities – to become comfortable interacting with patients with psychiatric

illnesses and – to gain proficiency in obtaining a psychiatric history and

performing a mental status examination. • The experiences for the neurology portion are designed

– to help students recognize major neurological diseases, – be able to take a history regarding neurological symptoms, and – demonstrate proficiency with performing a neurological exam.

• Contributing Departments: Neurology and Psychiatry

Winter GRIPE 2007

Surgical Care (8 weeks)

• Surgical Care is an interdisciplinary clerkship with core experiences in general, subspecialty, and gynecologic surgery.

• This clerkship provides the student with an opportunity to acquire the fundamental principles of surgery in addition to learning basic procedures.

• There is an emphasis on – gaining knowledge of common surgical diseases, – performing common procedures, – developing communication skills and – professionalism.

• Core clinical competencies include the – initial assessment of acutely ill patients, – observation and participation in a variety of surgical procedures,

and – ward management of patients.

• At the completion of the clerkship, students are expected to identify, understand, and management basic surgical problems in addition to being able to perform basic surgical procedures.

• Contributing Departments: Surgery and Ob/Gyn

Winter GRIPE 2007

Winter GRIPE 2007

4th Year Curriculum

• Skin & Bones 4 weeks

• Interdisciplinary Oncology 4 weeks

• Critical Care 8 weeks

• 5 Required Electives

• 8 weeks unscheduled– Residency Interviews/USMLE Prep

Winter GRIPE 2007

Skin and Bones (4 weeks)

• This innovative, interdisciplinary senior clerkship is designed to meet a nationwide curricular need for improved musculoskeletal education for graduating medical students.

• Students develop a familiarity with the diagnosis and treatment of common musculoskeletal and dermatologic conditions as well as with indications for referral in more complex cases.

• Clinical experiences include – orthopedics, – primary care sports medicine, – rheumatology, – dermatology, and – physical therapy.

• Students also get hands-on workshops on – casting and splinting, – joint injections, and – physical examination skills.

• Contributing Departments: Family Medicine, Internal Medicine, Dermatology, Orthopedics, Physical Therapy

Winter GRIPE 2007

Interdisciplinary Oncology (8 weeks)

• An innovative, interdisciplinary senior clerkship in which the fundamental principles of oncology and the interdisciplinary approach to the care of cancer patients, from prevention, diagnosis, treatment, rehabilitation, and end-of-life care are taught.

• Students will rotate in one of the clinical programs at the H. Lee Moffitt Cancer Center and will participate in a core curriculum consisting of student "mock" tumor boards, journal clubs, seminars, and evidence-based presentations.

• They will be exposed to all cancer treatment modalities including – surgery, – radiotherapy, – chemotherapy, – immunotherapy, and – endocrine therapy.

• One unique experience is a role-playing exercise designed to teach students how to convey difficult news.

• Contributing Departments: Interdisciplinary Oncology

Winter GRIPE 2007

Critical Care (8 weeks)

• This interdisciplinary senior clerkship is designed to foster acquisition of the foundation of critical care knowledge, skills, and attitudes.

• The clerkship curriculum is grounded in a philosophy that emphasizes problem solving and clinical skills to be taught at the bedside.

• Through simulation technology, the student is afforded a unique opportunity to combine biomedical and clinical sciences through applied human physiology, pharmacology and disease states.

• Regardless of future career path, knowledge and skills attained during this clerkship will be invaluable to the appropriate care of critically ill patients in the future.

• Contributing Departments: Anesthesiology, Internal Medicine, Surgery, Pediatrics (Basic Sciences)

Winter GRIPE 2007

Courses in the Sophomore Year

• Principles of Medical Immunology and Infectious Diseases

• Pharmacology• Pathology and Laboratory Medicine• Evidence-Based Medicine• Clinical Diagnosis and Reasoning• Physical Diagnosis II• Clinical Problem Solving• Longitudinal Clinical Experience II• Colloquium II

Winter GRIPE 2007

Division of the Sophomore Year

Block Subject

1 Core Principles

2 Neoplasia, Infectious Organisms, Antimicrobials

3 Hematology and Immunology

4 Nervous System

5 Cardiovascular

6 Pulmonary and Renal

7 Endocrine/Women’s Health/Pediatrics

8 Men’s Health/GI

9 MS/Dermatology/Eye/Toxicology

Winter GRIPE 2007

Pharmacology (Pharm)

• provides a learning experience designed to provide a current knowledge base and to promote and encourage life-long learning in pharmacology.

• Methods utilized to stimulate and to evaluate the knowledge base of students in the discipline of pharmacology include:– Lectures, – clinical conferences, – laboratory demonstrations, – problem-solving sessions, – interactions with faculty, and – examinations.

• In an effort to provide a cohesive approach to the learning process, prototypical agents in each class of therapeutic compounds are presented and discussed in detail, emphasizing: – the pharmacokinetic profile, – mechanism of action, – therapeutic use, – pharmacological and – toxicological effects, and – contraindications of these compounds.

Winter GRIPE 2007

Winter GRIPE 2007

Principles of Medical Immunology and Infectious Diseases (PMIID)

• This course consists of lectures, laboratory, and small-group conferences in which principles of infectious disease are presented with emphasis on both – the characteristics of the causative agent

and – the host response to colonization

activities.

Winter GRIPE 2007

Evidence-Based Medicine (EBM)

• An essential course for learning the principles of applied clinical epidemiology and how to use an evidence-based approach to the practice of medicine.

• “Evidence based medicine is the integration of best research evidence with clinical experience and patient values”

Sackett, Straus, et al – Evidence Based Medicine: How to Practice and Teach EBM, 2nd Ed.

Winter GRIPE 2007

Winter GRIPE 2007

Winter GRIPE 2007

Clinical Diagnosis and Reasoning (CDR)

• to provide the student with the opportunity to "think like a physician."

• to provide the venue to integrate clinical diagnostic and reasoning strategies with complementary aspects of clinical problem solving, physical diagnosis, and evidence based medicine.

Winter GRIPE 2007

Winter GRIPE 2007

Physical Diagnosis II (PD2)

In this course, students gain knowledge of the physical exam

• using a Web-based course that contains lecture material, assessment tools and online testing.

• participating in small group sessions to develop physical exam skills.

• second-year students learn advanced skills, maneuvers, and techniques, building on the foundation skills taught to first-year students

Winter GRIPE 2007

Clinical Problem Solving (CPS)

• multidisciplinary course offered during the organ system blocks.

• students learn clinical reasoning through tutorial sessions and student case conferences

Winter GRIPE 2007

Longitudinal Clinical Experience (LCE)

The mission is to introduce students to clinical medicine during the first two years of medical school.

• The program pairs first and second year medical students with faculty and private medical practice preceptors, for ½ day each week in a clinical setting.

• Over the course of two years, each student works with three different preceptors, beginning in observation mode and working up to evaluating patients at a pace determined by the preceptor.

• Preceptors represent specialty areas as well as primary care which provides students with a unique opportunity to explore medicine in a variety of practice areas early in their medical education

Winter GRIPE 2007

Colloquium II

During years one and two, the colloquia

• will emphasize clinically relevant topics related to the basic sciences and areas of medicine that cross-traditional boundaries.

• Sessions will involve interaction between year one and year two students.

Winter GRIPE 2007

Pathology and Laboratory Medicine (PLM)

• to provide the students with – basic concepts of general and systemic

pathology, – general principles of clinical pathologic

correlation, and – principles and interpretation of laboratory

tests.

• The course involves integrated lectures in pathology and laboratory medicine including laboratory hematology and cytopathology.

Winter GRIPE 2007

PLM

• The course includes – lectures – all video-streamed on demand

• general and systemic pathology• laboratory medicine

– case presentations – lecture hall presentation of unknown cases to students to help synthesize material and sharpen skills at generating differential diagnoses

– clinicopathologic conferences – autopsy presentations emphasizing the differential diagnosis and encouraging further study

– laboratory sessions that involve the Clinical-case based study of gross and microscopic (glass slide) pathology

– small group discussions – case based – Autopsy Experience

• “man in the pan” • Medical Examiner's office.

Winter GRIPE 2007

PLM

• Grading– 84% average from total questions from 9

blocks– 15% Pathology Shelf Exam– 1% CPC paper

• Group Scores

• Pathology-specific Evaluations after each block via BB

Winter GRIPE 2007

Opportunities for Integration in the 2nd year

• “The Calendar”

• Question review sessions

• Interdisciplinary Conferences

• Blackboard

• Attendance at each other’s lectures

Winter GRIPE 2007

Opportunities for Integration in Development

• “Post-Mortems” after each block to look for – Unplanned redundancies

• Open up time for other teaching modalities, such as team-based learning

– Omissions of important material– Further opportunities for integration

• Focus on specific blocks each year for close examination and possible changes.

Winter GRIPE 2007

Pathology Integration in the 3rd and 4th Years

• 1st year– Pathology in the dissecting lab– Histopathology correlations throughout anatomy

course

• 3rd and 4th years– Introduction to Clerkship

• Medical Examiner and Death Certificate

– Surgical Care Clerkship• Pathology integrated in some surgical teaching cases

– Critical Care Clerkship• Basic Science seminar – patient with Congestive Heart

Failure

Winter GRIPE 2007

Integration by Collegiality

• Enhancing integration while maintaining separate, generally department based courses

• Takes a lot of careful planning and time, but worth every minute.

Winter GRIPE 2007

PLM wouldn’t be the awesome course it is at USFCOM, except for the efforts of . .

• Dr. John Balis

• Dr. David Rowlands

Winter GRIPE 2007

Winter GRIPE 2007

Winter GRIPE 2007

Winter GRIPE 2007

Winter GRIPE 2007

Winter GRIPE 2007

Winter GRIPE 2007

Winter GRIPE 2007

Winter GRIPE 2007

Winter GRIPE 2007

USFCOM Curriculum &Year II: Integration Through Collegiality

USF College of MedicineDon E. Wheeler, MDAssociate Professor

Pathology and Cell Biology