Building a socially accountable medical school: A layered analysis of the Hackensack Meridian School of Medicine.

BACKGROUND: If medicine fundamentally exists to care for the wellbeing of individuals and societies, there should be a direct and comprehensive link between a medical school's social mission and its educational programme. We have not found a description of development or reform that utilises social mission to guide the comprehensive development of the educational programme. As a new school, we utilised a systematic mission-driven approach to develop the curriculum, pedagogical methods and structure of the programme. Using layered analysis, this paper demonstrates how a school's mission can drive all aspects of the educational programme. This supports the transferability of this work to other schools so that they can achieve their unique missions. APPROACH: Layered analysis is used for reporting an intervention through three tiered lenses: philosophies, principles and techniques. This provides a structure to guide implementation and evaluation. It can also be used to transfer the innovation to other contexts. EVALUATION: Each principle guiding the school's development is linked to context specific techniques and drives the focus of programme evaluation. Evaluation approaches using these principles are described, including an example of composite student performance data in a core area of focus. IMPLICATIONS: Through layered analysis of a medical school that developed and implemented a mission-driven curriculum, this can enable other schools to transfer this approach to achieve their missions through the design and implementation of their programmes.

Competency-based and less time-bound: a new approach to the macro-structure of a medical school curriculum.

Shifting to a competency-based (CBME) and not time-bound curricular structure is challenging in the undergraduate medical education (UME) setting for a number of reasons. There are few examples of broad scale CBME-driven interventions that make the UME program less time-bound. However, given the range of student ability and varying speed of acquisition of competencies, this is an area in need of focus. This paper describes a model that uses the macro structure of a UME program to make UME curricula less time-bound, and driven more by student competency acquisition and individual student goals. The 3 + 1 curricular model was derived from the mission of the school, and includes a 3-year core curriculum that all students complete and an individualized phase. Students have an 18 month individualized educational program that meets their developmental needs and their educational and professional goals. This is achieved through a highly structured advising system, including the creation of an Individualized Learning Plan, driven by specific goals and targeted Entrustable Professional Activities (EPA). Students who struggle in achieving core competencies can use individualized time to support competency development and EPA acquisition. For students who have mastered core competencies, options include obtaining a masters degree, clinical immersion, research, and community-based experiences. Students can also graduate after the 3-year core curriculum, and enter residency one year early. Structural approaches such as this may contribute to the norming of the developmental nature of medical education, and can advance culture and systems that support CBME implementation at the UME level.

Expanding the scope of problem-based-learning at Hackensack Meridian School of Medicine; integrating domain-general skills with domain-specific content.

The Master Adaptive Learner is a model used to develop students to become self-regulated and adaptable lifelong learners to practice medicine in a complex and ever-changing environment. The Hackensack Meridian School of Medicine (HMSOM) proposes a new course, Patient Presentation Problem-Based Learning Curriculum (PPPC), a dynamic and integrated course that goes beyond the scope of traditional Problem-Based-Learning (PBL). PPPC allows students to build domain-general skills in tandem with domain-specific content learned during a pre-clerkship curriculum. An integrated case provides weekly scaffolding, such that the course takes place throughout the week and is not isolated from the rest of the curriculum. Students receive iterative feedback and structured assignments which allows development of self-directed learning skills along with integration and consolidation of weekly curricular content. A layered analysis approach was used to outline the philosophies, principles and techniques that link to our course objectives. Techniques used could easily be translated to other pre-clerkship curriculum to promote development of self-directed learning and clinical reasoning skills, as well as promote more meaningful learning of basic, clinical, and health system science content.

Introducing Life-long Learning Skills in a Patient Presentation Problem-Based Curriculum: The Case for Librarian Integration.

Medical students must learn how to find, critically appraise, and apply high-quality information to support their clinical decisions. To reinforce these skills, the Hackensack Meridian School of Medicine embedded medical librarians into a longitudinal case-based, problem-based learning curriculum, where they provide individualized feedback on student's skills in this area.

Finding Information Framework: A Tool to Teach Life-Long Learning Skills.

INTRODUCTION: In this age of rapid information expansion, medical education can no longer be taught solely by information acquisition, but rather requires information management and information mastery at both the point of learning as well as at the clinical point of care. We must teach our trainees how to ask, categorize, and answer their own questions-skills required to be a life-long learner. We developed the Finding Information Framework (FIF), a conceptual algorithm as well as web-based tool and app, to guide medical students in asking and categorizing their questions and to link them directly to the most appropriate information resource for their questions. Here we assess the functionality of the FIF following its implementation in the first-year medical school curriculum problem-based learning (PBL) course. METHODS: First-year medical students (n=126) utilized the FIF in their longitudinal problem-based learning course discussion groups and completed an anonymous survey. RESULTS: Qualitative and quantative data suggest that the FIF was easy to use (86.5%), supported the course curriculum (80%), and helped students find relevant information to answer their questions (77%) from trusted reliable resources (70%). Qualitative comments also suggest that the FIF is initially a helpful tool during the PBL course but becomes less useful over time as students become more familiar with resources. CONCLUSION: The FIF assists students in identifying trusted resources and in efficiently and effectively finding answers to questions at the point of learning. These data suggest that students are internalizing the tool's conceptual algorithm over time, reinforcing the teaching of information management and information mastery.

The One Minute Learner: Evaluation of a New Tool to Promote Discussion of Medical Student Goals and Expectations in Clinical Learning Environments.

BACKGROUND AND OBJECTIVES: The transition from pre-clerkship to clerkship curriculum in medical school presents many challenges to students. Student roles and supervising physicians' expectations vary widely. Efforts to ease this transition have included third-year orientations, skills sessions, field- specific training, and peer-to-peer communication/support. We developed a new tool, called The One Minute Learner (OML), to promote and structure discussion of student goals and expectations and empower student ownership of learning. The OML can be used quickly and easily by students and faculty to facilitate integration of medical students into the clinical setting. This paper describes the OML and reports evaluation of its effectiveness through student evaluations. METHODS: We compared student responses to two end-of-clerkship questions for the academic year before the OML was implemented to the first year of implementation. Students rated their orientation to their roles and responsibility and rated the communication of what was expected of them. RESULTS: The percentage of students rating these highly increased dramatically: for "I was oriented to my responsibilities and role," the percentage rating it highly (4--5 on a 5-point Likert scale) increased from 47% to 82%. For "Expectations of my role were communicated to me clearly" the percentage rating it highly increased from 66% to 89%. CONCLUSIONS: The OML is a new tool that can promote and structure a proactive discussion between student and teacher about goals and expectations, leading to better integration of students into the variety of clinical setting in which they rotate.

The perceived effects of faculty presence vs. absence on small-group learning and group dynamics: a quasi-experimental study.

BACKGROUND: Medical education increasingly relies on small-group learning. Small group learning provides more active learning, better retention, higher satisfaction, and facilitates development of problem-solving and team-working abilities. However, less is known about student experience and preference for different small groups teaching models. We evaluated group educational dynamics and group learning process in medical school clerkship small group case-based settings, with a faculty member present versus absent. METHODS: Students completed surveys after cases when the faculty was present ("in") or absent ("out") for the bulk of the discussion. 228 paired surveys (114 pairs) were available for paired analysis, assessing group dynamics, group learning process, student preference, and participation through self-report and self-rating of group behaviors tied to learning and discussion quality. RESULTS: Ratings of group dynamics and group learning process were significantly higher with the faculty absent vs. present (p range <0.001 to 0.015). Students also reported higher levels of participation when the faculty member was absent (p = 0.03). Students were more likely to express a preference for having the faculty member present after "in" case vs. "out" case discussions. (p < 0.001). There was no difference in reported success of the case discussion after "in" vs. "out" cases (p = 0.67). CONCLUSIONS: Student groups without faculty present reported better group dynamics, group learning processes, and participation with faculty absent. Students reported that they feel somewhat dependent on faculty, especially when the faculty is present, though there was no significant difference in students reporting that they obtained the most they could from the discussion of the case after both "in" and "out" cases.

FaMeS: an innovative pipeline program to foster student interest in family medicine.

BACKGROUND AND OBJECTIVES: There is a national shortage of primary care physicians; many medical school departments of family medicine are searching for new ways to attract and retain students who may be interested in primary care. In 2004, our department began a "pipeline" program targeted at entering first-year students that incorporates curricular, extracurricular, summer, and career-planning elements. METHODS: The program was evaluated and data collected on the numbers of students who were regular attenders of events, who expressed intent to apply in family medicine at the end of third year, and who ultimately matched in family medicine. Qualitative measures of program success were also noted (comments from students outside the department and the influence of the family medicine interest group). RESULTS: Data are preliminary but suggest that the Family Medicine Student Track (FaMeS) has increased the numbers of students matching in family medicine from Boston University (BU) during a period when the national average was decreasing. The odds of a BU student matching in family medicine were nearly double (1.94) the odds compared with before the program. The family medicine interest group substantively increased its presence at the medical school and won a national Program of Excellence award. CONCLUSIONS: The FaMeS program appears to be associated with a significant increase of numbers of students matching in family medicine during a time period when the national average decreased. The program is young, and results may be most generalizable to schools, like BU, with a strong specialist presence.

Teaching geriatric assessment: use of a hybrid method in a family medicine clerkship.

BACKGROUND AND OBJECTIVES: We addressed a lack of geriatric content in our third-year family medicine clerkship. Adding this content posed a challenge in that students are dispersed to clinical sites across New England. Our goal was to promote student skill in functional assessment of elderly patients. METHODS: We used multiple formats: a workshop, a small-group case discussion, an online video, and an online discussion of a new geriatric case. Students were directed to use five assessment tools on actual patients in the office and on a home visit. RESULTS: A total of 155 students participated in the new curriculum. Students completed a required home visit on an older patient and evaluated geriatric patients in an office setting. They performed the Mini-Mental State Exam (MMSE), Activities of Daily Living Scale (ADL), Instrumental Activities of Daily Living Scale (IADL), Geriatric Depression Scale (GDS), and Get-Up-and-Go tests in patients in both settings. There was significant improvement from before to after the clerkship in identification of the appropriate geriatric assessment tool to use (MMSE 86% to 96%; ADL/IADL 32% to 94%; GDS 71% to 94%, and Get-Up-and-Go 4% to 58%). Students evaluated the curriculum positively. CONCLUSIONS: We were able to successfully increase the correct selection of and document high rates of use of geriatric functional assessment tools in our third-year family medicine clerkship using a mixture of teaching methods.