Mapping Medical Education Curricula

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Presentation transcript:

Mapping Medical Education Curricula Robby Reynolds, AAMC Cindi Hasit, Cooper Medical School of Rowan University Tomo Ito, Oregon Health and Science University Rebecca Keller, Albany Medical College Lynn Romrell, Florida State University Terri Cameron, AAMC

What we will cover: How to engage faculty in mapping, thinking of educational outcomes Use of NBME ‘GEMS’ Tool Linking learning objectives to assessment New School common vocabulary Curriculum Renewal and Mapping Curriculum Transformation – moving toward CBLA Curriculum Mapping vs Student Performance Curriculum Inventory Options for Mapping

A New School’s Perspective Cindi Hasit, PhD, Cooper Medical School of Rowan University

Cooper Medical School of Rowan University Cooper Medical School of Rowan University (CMSRU) is located in Camden, NJ with a mission to serve the underserved. “Camden is our classroom: Camden is our home.” CMSRU’s first class entered in August 2012.

Curricular Highlights Vertical and horizontal integration Interprofessional education Early clinical exposure Focus on active learning Case-based learning is 50% of class time Flipped classroom model for select lecture topics

Organ- or discipline-based curriculum Year 1 - PHASE I/Foundation & Integration Year 1 - PHASE I/Foundation & Integration 1 8 4 5 9 Summer Elective Orientation Clinician’s Clinic Fundamentals W O Lifestages ID Heme-Onc Skin-Musc-Skel Basic or Clinical Research Ambulatory Clerkship Community Svc Scholar’s Workshop Population Health Foundations of Medical Practice Year 2 – PHASE I/Foundation & Integration 8 1 6 3 5 4 Cardiovasc-Pulmonary W O GI-Endo Selective Renal-Uro Women’s Health ENT-Allergy Neuro-Psych Prep for Step 1 Intro Phase II Ambulatory Clerkship Scholar’s Workshop Foundations of Medical Practice IPE: currently USP pharmacy students; will include nursing, social work, psychology, possibly PA and possibly law students Organ- or discipline-based curriculum Longitudinal courses: Amb, SW, FMP

The Challenge: Need to ensure curriculum is comprehensive Complex curriculum – Need to know what others are teaching Need to speak a common language Creating curriculum de novo.No gaps or unwanted redundancies Must address topics outside of basic sciences – LCME sociobehavioral economic topics LCME accreditation must be able to show where a topic is covered in the curriculum

Curricular Mapping Faculty Development sessions on curriculum development: Objectives –-- Assessments ---Content Creation of Excel File Templates Date Format Title Objectives Keywords Took many sessions Need to review Keywords – limit to 5 per session + prepopulated columns for Sociobehavioral Economic topics and Biomedical Science topics Overview of Oasis system

Process for entering data Course Directors submit spreadsheets with information from their courses CD’s then meet with library staff to align keywords with MESH terms – Common vocabulary Information entered into OASIS

Challenges Culture change about curriculum development Lack of understanding about key words (as opposed to all topics that were addressed) Time commitment Completion and monitoring of spreadsheets Meetings to identify MESH terms Process for entering data Lack of experience with OASIS system

What will success look like? Easily searchable curriculum Clear reports for: Alignment of session level objectives with course and institutional objectives Identification of gaps and redundancies Compelling data for success of our curriculum in meeting our goals.

Curriculum Mapping OHSU Today and Beyond Presented by: Tomo Ito, MSEd Oregon Health & Science University

Current curriculum structure 2 + 2 Current curriculum structure 2 + 2. In 2014, new curriculum will be introduced.

Current mapping in E*Value is limited to… Course title/duration Event title Event date/time/duration Event facilitator Instruction method Assessment method Resources Handout/PowerPoint Physician Competency Reference Set OHSU SoM Competencies and Objectives Course Objectives OHSU has been using E*Value for the past 2 years. Data coordinator is responsible for entering data. Faculty course/clerkship directors link event objective to course objective. And Course objective to SoM Program Competency and objective. Event Objectives

LCME ED-10 Hot topic: Cultural Competency Term search What the report looks like: LCME Ed10 asks schools to identify in which course/clerkship each content area is converged and the number of sessions/hours in required courses

Find where we teach Medical Knowledge #1 Schools can ensure that each competency/objective has been covered by running a report. Show my where we cover Medical Knowledge, Objective #1, Identify the normal anatomy, histology, and embryology of major tissues, organs, and organ systems.

What’s Next? Student Outcome Assessment Result from various systems (MCQ/Essay/OSCE /CPX /rating/narrative evaluation, etc.) must tie back into Curriculum Mapping Each question can be tagged to either session level objective, course objective or UME program objective. Outcome of students could potentially inform us content/instruction method, assessment method and assessment items. Could be utilize as a part of comprehensive review on course/clerkship.

Remediation Insight/ Self-reflection/ Life-long learning Students miss Exam question 2 System pinpoints resources/modules to review Students complete the modules and take additional exam on the topic System recognizes attainment of competency/objective Part or Whole Insight/Self-reflection/life-long learning  between #1 and #2, we want to give learners opportunities to self-reflect. It’s a great opportunity for students to acquire the competency, Practice-based learning and improvement. So instead of the system pinpointing, students seek out information. Then, the system will be used as the secondary source. Push/Pull (pushing  we require them to remediate) (Pull  we offer them but students have choice to either look at it or not) Academic Advising A system will trigger notification to academic advisor automatically At what level, students should self-reflect and seek out help. Part or Whole? Do we except students to re-do the whole or a part? Academic Advising

Competency-based Education Things to consider: Competency-based Education Not a time-based education “Testing out” or “pre-assessment” Indexing curriculum (Sequence or parallel) Individualization of learning methods (not all learners learn the same way) Quality attributes (how do we tag quality) Assessment mapping Lerner centered education. Differing experience and knowledge base. True competency-based education looks at attainment of pre-defined benchmark/competency. If a student worked as a Nurse Practitioner prior to entering MD program, the level of knowledge will most likely differ from a student who just graduated from Sociology degree. All learners do not learn the same way. All learners do not learn at the same pace. Measuring attainment of competency becomes a focus.

A few more things… Educators’ teaching contribution Voice recognition functionality Automatic feed to E-Folio from curriculum mapping, evaluation, assessment results, procedure logs, EHR, API to LMS, registration system

Mapping Medical Education Curricula How to use the Data in Assessment Rebecca S. Keller, PhD Assistant Dean of Medical Education Albany Medical College

Albany Medical College Curriculum Organ System Based with Longitudinal Themes Year 1: Normal Systems – biochemistry, molecular biology, physiology, anatomy, histology, nutrition, embryology, immunology, microbiology – Longitudinal: Clinical Skills, Evidence Based Medicine, Informatics, Health Care & Society Year 2: Pathophysiology of Systems – pharmacology, infectious disease, pathology, clinical presentation, nutrition - Longitudinal: Clinical Skills, Evidence Based Medicine, Informatics, Health Care & Society 2 week Orientation Clerkship Year 3: Required Clinical Clerkships – Medicine, Family Medicine, Pediatrics, Surgery, OB/GYN, Psychiatry - Longitudinal: Clinical Skills, Evidence Based Medicine, Informatics, Health Care & Society Year 4: 5 Required Clerkships (Emed, Neurology, Critical Care, Acting Internship, Teaching to Learn), 4 Electives - Longitudinal: Clinical Skills, Evidence Based Medicine, Informatics, Health Care & Society

Mapping the Curriculum Curriculum has been mapped using older techniques for many years – CurrMIT and in house paper files Changed in 2008 with the database as developed at George Washington Added data to the Curriculum Database starting in the Academic Year 2009-2010 We have data for the last 4 academic years – currently working on the 2013-2014 database

AMC Goals for using a Database Map our Graduation Objectives with our Theme/Clerkship Objectives for assessment Searchable – to look for intentional overlap and for missing topics Engage the faculty in curriculum assessment and development All faculty, staff and students have access to the database Theme Leader and Clerkship Directors were trained and provided data – one main person enters the data with back up (myself) Identify both horizontal and vertical integration

Assessment of Data Combined Theme Leader/Clerkship Director Meetings Case Based Discussion using data CAT (Curriculum Assessment Team) – 3 year process for assessing all themes/clerkships Use data from the curriculum database for assessment – along with theme leader/clerkship director reports, student evaluation, graduation questionnaire, STEP 1/2 scores, Match results, etc Exams – use GEMS to map session learning objectives with exam questions – closing the loop on curriculum mapping

Challenges Time investment for faculty Faculty development Writing learning objectives Writing exam questions that are 2nd or 3rd order Engagement of Students Use the database for studying in Year 3/4, for board review

“Curriculum Mapping” at a School … in the Process of Curriculum Redesign Lynn J. Romrell, Ph.D. Florida State University College of Medicine Associate Dean for Medical Education

“Events”

Curriculum Map – Event “Tags” Required for Compliance with LCME Standards ? Medical School Defined “Tags” Physician Competency Reference Set Competencies Institutional Objectives “Event” Instructional Method Assessment Method Resources – Faculty, Staff, Room, etc. Time MedBiquitous

Curriculum Map – Event “Tags” Required for Compliance with LCME Standards Medical School Defined “Tags”: Organ System “Discipline” “LCME Topics” “Themes” “Mission Specific” Primary Topic(s) - “Emphasis” - “Time” “Clinical Presentation” ? Medical School Defined “Tags” Medical Education Competency Reference Set Competencies Institutional Objectives “Event” Instructional Method Assessment Method Resources – Faculty, Staff, Room, etc. Time MedBiquitous

LCME Standards ED-33 “There must be integrated institutional responsibility in a medical education program for the overall design, management, and evaluation of a coherent and coordinated curriculum.” ED-35 … “Provide evidence that the school monitors the content covered in the curriculum … ” ED-37 … “faculty committee … must be responsible for monitoring the curriculum, including the content”

$ $ $ $ Resources $ Balance of … Desire for innovation Reality of costs and available resources $ $ $ $ $ $

Instructional and Assessment Methods Methods of assessment impact “how and what students learn” Link assessments to competencies

What Do We Want to Map? What Event “Tags” Would Be Helpful? Medical School Defined “Tags”: Organ System “Discipline” “LCME Topics” “Themes” “Mission Specific” Primary Topic(s) - “Emphasis” - “Time” “Clinical Presentation” Quantitative Measure Qualitative or Frequency Measures* “Event” *Items can be a assigned as a “Primary Topic”

Quantitation: “Primary Topic” Fields Fields to be used to determine actual time of coverage List up to four or five topics Topics listed share the time equally unless level of emphasis is indicated May indicate level of emphasis - 2X, 3X, or 4X Topic Emphasis Time on Topic Structure - Radiology 10 min Respiratory System 4X 40 min Shortness of Breathe

“Metadata” – Event Tags Have been left in the “hands” of the medical schools Specific tags can be used to emphasize integrative thinking rather than classical disciplines “Structure” instead of “gross anatomy” “Development” instead of “embryology” “Cellular function” “Pathophysiology” “Translational Medicine”

Qualitative or Frequency Measures* *Items can be a assigned as a “Primary Topic”

“FSUCOM Mission Specific” “… responsive to community needs … through service to elder, rural, minority and underserved populations.”

“Patient Presentation” Tag H. Mandin, University of Calgary Faculty of Medicine 1. Abdominal Distension 2. Abdominal Mass 3. Abdominal Pain 4. Abnormal Chest X-Ray 5. Abnormal Heart Sounds Etc.

“LCME Survey Topics in MSQ Part II” “Hot Topics” Biostatistics End-of-Life Care Domestic Violence Global Health Issues Palliative Care Patient Safety Etc.

“Themes” in the Curriculum Nutrition Biostatics/Epidemiology Life stages Ethical or Cultural Issues Interprofessional Education Population Health Psychosocial Issues Etc.

Standardized Patient Assisting the Learner

Curriculum Inventory Options for Mapping Terri Cameron, Director of Curriculum Programs Association of American Medical Colleges

Curriculum Inventory Mapping Expectations (Competencies, Learning Objectives, Outcomes Objectives) PCRS Program Sequence Block Event

Curriculum Inventory Mapping Integration Sequence Block Themes Humanities Informatics Genetics Public Health Disciplines

Curriculum Inventory Mapping Keywords LCME ED-10 (Hot Topics) Special Details of Instruction USMLE Content Outline(s) MESH / SnoMED / UMLS Integration Terms

Curriculum Inventory Mapping Documenting Keywords Faculty Checklists / Templates Enter into database Course Documentation As metadata for teaching materials Students Documenting top 5 or 10 concepts Checklist Staff Drafting from syllabus / other teaching materials Meeting with / following teaching faculty

Curriculum Inventory Mapping Curriculum Inventory Reports from Mapped Data Competencies linked to content How content is taught How content is assessed Where in curriculum content is taught Required Elective

Curriculum Mapping Case Study

Discussion Questions Has your school embarked on a curriculum mapping process? What are the goals for your mapping process? What challenges have you faced or do you anticipate? What solutions have you developed? How did you train/educate/involve your faculty? How are you assessing your mapping project?