1. Carol Motley MD, Allen Perkins MD, Amanda McBane MD University of South Alabama Dept of Family Medicine

2. Objectives Upon conclusion of this talk the participant will: Be familiar with the process of curriculum change in a medical school Be knowledgeable regarding creation of a pre-clinical service learning requirement Be able to discuss the risks and benefits of multidisciplinary instruction

3. Allopathic Medical School Curriculum Traditional vs Problem Based Learning vs Competency Based Biomedical vs Biopsychosocial Role of ACGME Outcomes Project Concept of the continuum Pre-med Medical school Residency CME

4. Hidden agenda Learning environment Role of faculty Role of peers How clinical care is valued Concept of professionalism

5. Why this is important when…

6. Pre-clinical “clinical” curriculum LCME Collaborative Curriculum Project ACGME Outcomes Project AMA Initiative to Transform Medical Education

7. Process of curriculum change Formal process Curriculum committee External mandates LCME Other external influences Informal process

8. Process of curriculum change

9. Fundamentals of Doctoring Multidisciplinary course COM I and COM II years Replaced Medical Practice in Society, Behavioral Medicine, Medical Ethics Added professionalism Did not incorporate ICM course Service-learning requirement 8 hours per semester Experiences chosen off pick list

10. Fundamentals of Doctoring Format Lecture-discussion Physician(Psychiatry, Family Medicine, Pediatrics, Ob/Gyn, Internal Medicine, Pathology, Critical care, Palliative care) Non-physician(IRB director, hospital administrator, patients, sociology, psychology, counselor education, Migrant worker clinic, COM administration, ministers, others) Small group Essay Online case studies Panel discussions Multimedia Service learning

11. Fundamentals of Doctoring Overarching themes Medical professionalism Doctor-patient communication Biopsychosocial model of patient care Normal and abnormal development Physicians at risk Medical ethics

12. Problem solving Multidisciplinary instruction Scheduling Commitment Maintaining integrity of instruction Use of clinical resources Use of non-medical outside resources Cultural competence of learners and instructors Process Creating a multidisciplinary milieu

13. Leadership Creative process Maintenance Handling changes inherent in Medical Education Incorporation of new resources Leadership changes at Dean level Political issues

14. Problem solving Service-learning project Clarifying goals Faculty goals vs student agenda Specific experiences Involved much initial contact “We’re from the medical school and here to help you” Assessment of value of experience Changes in value over time

15. Outcomes Ability to create and maintain multidisciplinary course Working through Dean of Students office as opposed to departmental silo Many departments willing to participate Leadership team created and meeting regularly Effect on clinical knowledge

16. Outcomes Changes in professionalism educational experience Ongoing monitoring and discussion of effect of course Use of surrogate measures of professionalism Attendance Participation Using essay to assess class needs Identification of students with professionalism deficits

17. Outcomes Service learning experience Clinical vs non-clinical Variety of exposures important (?) Emphasis on intent of experience Found to be rewarding

18. Future directions Expand service learning into 3 rd year clerkship Longitudinal emphasis on professionalism over all 4 years Assess impact on specialty choice Improve evaluation process Ongoing review of content Spirituality and cultural competence