Community Based Faculty Meeting Curriculum Update May 10, 2014

History of Medical Education Prior to 1920: Apprenticeship 1920-1960: Standardization and scientific investigation Emphasis on the patient and their presentation Case studies and case series 1960-2000: Genetic and molecular medicine Emphasis on laboratory and imaging Bench research and randomized controlled trials 2000-present: Comprehensive physician Integration of scientific background and patient presentation Clinical productivity Comparative effectiveness, patient safety, ethics

Randomized Controlled Trials in PubMed

Meta-Analyses in PubMed

“He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.” Sir William Osler

Our Approach Block schedule One of the first medical schools to offer Intensive, concentrated exposure to each area Emphasis on patient presentations and management Flexible afternoon scheduling Basic science courses scheduled in the mornings

Curriculum Goals Integrate biomedical and clinical science Promote critical thinking Develop problem-solving skills Develop clinical reasoning skills Apply a biopsychosocial model to patient care

Pre-Clinical Years First two years of study Hybrid Curriculum Begin with essential principles of core knowledge Integrated content based on organ systems Focus on integrative thinking Necessary for the clinical years of medical school Successful modern physicians

Introduction to Clinical Medicine 1 First Year Anatomy Introduction to Clinical Medicine 1 Biochemistry & Genetics Foundations of Disease, Infection & Therapeutics Neurosciences Behavioral Basis of Medicine

Discipline Specific Anatomy Biochemistry & Genetics Core gross and microscopic anatomy Integrated with embryology Basics that will be further developed throughout the curriculum Biochemistry & Genetics Core biochemistry, genetics and cell biology Biochemical and genetic inheritance Actual patient clinical correlations of human disease

Foundations of Disease, Infection & Therapeutics Basis of all human disease Integrated approach Microbiology Immunology Pharmacology Pathology True “foundation” on which remaining courses will build

Neurosciences Nervous system functions in health and disease Integrated approach Neuroanatomy Neurochemistry Neurophysiology Neurology Neurosurgery Ophthalmology Otolaryngology

Behavioral Basis of Medicine Introduction to psychiatric conditions Integrated study Psychiatry Behavioral science Pharmacology Modes of treatment Pharmacologic Psychotherapeutic Psychosocial

Introduction to Clinical Medicine 1 Longitudinal clinical experiences Communication training and interviewing skills Practice with “actor” patients, then with actual patients Small-group seminars Medical Humanities Medical Ethics and Professionalism Developmental Pediatrics Geriatrics Cultural and Social Aspects of Health Care Evidence-Based Medicine

Introduction to Clinical Medicine 2 Second Year Musculoskeletal & Integumentary Systems Introduction to Clinical Medicine 2 Hematologic & Lymphatic Systems Endocrine & Reproductive Systems Renal & Urinary Systems Cardiovascular System Respiratory System Gastrointestinal System & Nutrition Multisystem & Integrative Concepts

Organ System-Based Courses Diagnostic and therapeutic approaches to disease Integrative approach Pathology Physiology Pharmacology Histology Radiology Microbiology/Immunology

Integrative Course Integrate knowledge among organ systems Analyze multisystem diseases Review material essential to licensing exam

Introduction to Clinical Medicine 2 Focus on physician skill set Small group sessions History-taking Physical exam techniques Ultrasound as an adjunct to physical exam Clinical reasoning skills Clinical Content Medical Humanities Medical Ethics and Professionalism Cultural and Social Aspects of Health Care Evidence-Based Medicine

Curriculum Comparison M1 Year M2 Year Anatomy Histology Biochemistry Genetics Neuroscience Physiology Infection, Immunity & Disease Pathology (included Psychiatry) Pharmacology Introduction to Clinical Medicine 1 ICM 2 ICM 3 M1 Year M2 Year Anatomy Biochemistry & Genetics Foundations of Disease, Infection & Therapeutics Neuroscience Behavioral Basis of Medicine Musculoskeletal & Integumentary Hematologic & Lymphatic Endocrine & Reproductive Renal & Urinary Cardiovascular Respiratory Gastrointestinal & Nutrition Multisystem/ Integrative Introduction to Clinical Medicine 1 Introduction to Clinical Medicine 2

Third Year Broad exposure to major disciplines Clinical exposure Integrate pre-clinical learning into patient care “Art of doctoring” Balanced experiences Involvement with patient care Study Assimilation of information

Third Year Curriculum Clinical Neurosciences – Neurology & Psychiatry Two separate four-week rotations Family & Community Medicine Four-week rotation Internal Medicine and Emergency Care Integrated 16-week rotation in inpatient and outpatient settings Obstetrics & Gynecology Pediatrics Eight-week rotation Surgery

Fourth Year Further development of clinical skills Prepare for residency in their chosen specialty. Curriculum Acting Internships Two four-week rotations, one primary and one secondary Advanced Clinical Pharmacology and Anesthesiology Four-week course Intern Prep Practical knowledge of the intern role Elective rotations Four four-week rotations At the University of Kentucky or another approved site

Match 2014 29, 671 residency positions in the Match 17,374 US allopathic seniors in the Match 1,662 previous US allopathic grads in Match 2,738 US osteopathic students/grads in Match 5,133 US citizens students/IMGs in the Match 7,334 non-US citizens in the Match

Match 2014 40,394 registered for the Match in 2014. The Match offered 29,671 positions. Overall match rate was 75%. 94.4% of US seniors matched into a residency position, with 79% getting one of their top three choices. 54% US seniors matched to 1st choice. ~1000 unmatched US allopathic medical students at the end of the match

UK Match 2014 Of the graduating seniors, 37% are entering primary care specialties. Primary Care includes Family Practice, Internal Medicine, Pediatrics and Medicine-Pediatrics. Of the graduating seniors, 31% elected to remain at UKMC, and another 4% are staying at programs in Kentucky. Matched into 22 different specialties.

UK Match 2014 Top specialty choices for UK COM seniors were (listed in decreasing chronological order): Internal Medicine 20% Anesthesiology 12% Pediatrics 8% General Surgery 7% Emergency Medicine 6% Med/Peds, Neurology 5% Radiology, Family Medicine, Orthopedic surgery 4%

Charles H. “Chipper” Griffith, MD Senior Associate Dean for Medical Education University of Kentucky College of Medicine cgrif00@email.uky.edu