1. LCME SiteVisit Preparedness for Course Directors: Marc Zumberg American Society of Hematology Course Directors Breakfast December 2015

2. Show of hands Who is currently involved in preparation for a LCME site visit? Who has been through a visit in the last 5 years?

4. Overview

5. Timeline DCI=data collection instrument

6. Timeline

10. UF COM LCME Self-Study Goal: To identify the institution’s strengths, areas for improvement, and strategies to address any concerns 5 Areas with 128 accreditation standards –Institutional Setting –Educational Program –Medical Students (services and learning environment) –Faculty –Educational Resources Began March 2013 – Database draft completed Jan. 2014

11. AAMC GQ 2014 – scale 1 to 5 UFCOMNational Office of the Dean for Curriculum: Responsiveness to student problems 4.63.9 Office of the Dean for Students: Responsiveness to student problems 4.74.0 Satisfaction with: Career planning services4.43.7 Faculty mentoring4.54.1 Programs that promote well being, effective stress management, balanced lifestyle 4.33.9 Academic counseling4.53.9 Personal counseling4.64.0 Financial aid services4.54.1

12. Challenges and Recommendations for Future Action 1. Information Technology Functionality (e.g., Wi-Fi). Action: updating hardware and software with HSC and University IT Implement University supported Canvas CMS 2015-16. 2. Active Learning. variability in the quality of newer active learning methods - inconsistency in course quality. Action: Changes in courses - new course directors, faculty development Year 1 course evaluations increased from 2012-13 to 2013-14: overall satisfaction increased from 3.83 to 4.42. 3. Clerkship Grade Reporting. Final grades within 6 weeks of end of clerkships. Action: Currently in compliance - continue to monitor closely.

13. 4. Faculty “protected time” for education. Action: Direct support to required clerkship directors, key course and discipline directors, and CLG facilitators. Approximately $35M distributed to departments based on teaching effort. SADEA when informed of concerns, works with faculty and chairs to resolve issues. 5. Faculty and resident diversity. Action: Dean charged a Diversity Committee to develop recommendations to enhance the recruitment and retention. Success reviewed as part of annual evaluations of department chairs. 6. Student debt. Action: The UFCOM continues to work to limit tuition increases (2014-15: 0% increase) and student scholarships remain a top three philanthropic goal. 7. Student health insurance. High cost of UF health insurance Action: Students can enroll in non-UF insurance plans and are informed of options including www.healthcare.gov and AMA.www.healthcare.gov

14. Functions and Structure Guidelines

15. 12 Standards

16. Standards: example

17. TIPS for Site Visit Review self study materials and the following –Medical Curriculum Overview: Central governance: Curriculum Committee https://oea.sites.medinfo.ufl.edu/files/2010/10/M edical-Education-Program1.pdf https://oea.sites.medinfo.ufl.edu/files/2010/10/M edical-Education-Program1.pdf –Medical Education Program Policies and Procedures: https://osa.sites.medinfo.ufl.edu/files/2014/10/P olicies-and-Procedures-Handbook.pdf https://osa.sites.medinfo.ufl.edu/files/2014/10/P olicies-and-Procedures-Handbook.pdf

18. –Florida Department of Education Code of Ethics & Principles of Professional Conduct for the Education Profession (page 26) - http://www.fldoe.org/edstandards/code_of_ethics.asp http://www.fldoe.org/edstandards/code_of_ethics.asp –COM Strategic Plan: http://med.ufl.edu/about/administrative-resources/ http://med.ufl.edu/about/administrative-resources/ –UFCOM Conflict of Interest Policy - http://coi.med.ufl.edu/ http://coi.med.ufl.edu/ –UFCOM Statement on Diversity - https://com- main.sites.medinfo.ufl.edu/files/2013/02/Statement_ on_Diversity.pdf https://com- main.sites.medinfo.ufl.edu/files/2013/02/Statement_ on_Diversity.pdf

19. Do you have enough administrative/staff support? Should be yes – if not let us know – from Deans office and sometimes department (this varies) What type of work are the staff responsible for? Deans office staff help scheduling, uploading course material, formatting exams, exam scoring and analysis ?

20. Standards: example

21. Possible questions Who is the chief official responsible for the educational programs in the COM? Dean Good How is faculty teaching effort supported? A. Direct FTE support for course directors, CLG small group leaders and discipline coordinators – B. Funds allocation model (eRVU system) with approx. $35 M distributed to departments based on teaching effort - model is formula driven – 3 eRVUs per contact hour in whole class, lab or small group – 10 eRVUs per student week in required clinical experiences, 5 eRVUs per student week in elective clinical experience, 4 eRVUs for student in research lab fulltime – model applies to all teaching in COM courses – model a modification of State University System Instructor Work Load (IWL)– modified with faculty input

22. Standards: example

23. Give an example of unprofessional student behavior and what was done to correct it? 1.Student was late and missing from required assignment – referred to ASC, required to write a reflective paper and assigned a mentor – depending on the severity and repetitive nature this may documented in the course/clerkship evaluation and MSPE 2.Arrogance and condescending behavior of student to others – counseled and referred for psychological evaluation – mentor and reflective paper – documented in clerkship evaluation

24. What happens if you have a lecturer who doesn’t perform well? They are usually counseled by course director for improvement and may be referred to a specific faculty development workshop for remediation– if poor performance persists the CD has authority to replace the faculty Do you have the authority to remove lecturers? YES Do you receive sufficient support for being a course director? YES – FTE from Deans office – departments get eRVUs for faculty teaching effort

25. What is the procedure for students who have a concern about their grade? Review Grade grievance policy in Handbook, page 13: First course director, then grievance committee If a student came to you and wants confidentiality about a sexual assault, what would you do? University policy – tell student if informed you must report to the University per policy

26. Is there any central monitoring of student mistreatment? What is your policy about sexual harassment? How are courses reviewed? How often do you get data from student assessments?

27. Questions: Diversity, Inclusion & Health Equity What is your schools definition on diversity? “ The College is committed to nurturing greater inclusion of African Americans, Hispanics and Native Americans as well as the socioeconomically disadvantaged (rural and urban) as a primary objective for the achievement of excellence through Diversity. The College of Medicine however recognizes that inclusion of other ethnic minorities and groups underrepresented in medicine is essential to the promotion of excellence in healthcare and achievement of health equity for residents in the state of Florida.”

28. Standards: example

29. Possible questions Are there institutional (or school-wide) objectives? Yes - Approximately 100 linked to the six ACGME competencies Who is responsible for defining the institutional objectives? Curriculum Committee (CC) Who is responsible for the overall design, management and evaluation of the curriculum? CC

30. Possible questions Who is responsible for approving the objectives in courses and clerkships? CC Who is responsible for offering admissions to COM? Medical Student Admissions Committee!!!! Who is responsible for ensuring that students meet the institutional objectives for promotion and graduation? Academic Status Committee – Executive Committee approves graduation based on ASC recommendation

31. How do you know if there are gaps or redundancies in the curriculum? National org. recommendations (e.g., IOM), USMLE content outline, CD discussions, AAMC GQ, performance USMLE, Residency program director surveys, student surveys, search engine, course debriefings

32. How does the Curriculum Committee provide oversight to gaps and redundancies in the curriculum? Review student performance USMLE exams, AAMCGQ, Residency Program Director Evaluations, and internal exams including Clinical Skills Exams How are lecturers evaluated? Student surveys and student performance on exam items – when necessary peer evaluation

33. Where is ethics/ebm/others? taught in the curriculum? Longitudinal thread through 4 years – check other topics How many hours of pre-recorded lectures are students required to watch in a week? 0-3?? They are included as a structured learning activity (guideline is max. 25 hrs/wk) What faculty development have you participated in within the last 2 years? Med Ed week, monthly ed. workshops from Office Faculty Affairs,– others?? How do you ensure that students receive mid-course feedback? Quizzes in Phase 1 (first 19 months) of the curriculum

34. Standards: example

35. New Curriculum: Fall 2012 3 phase curriculum: ACGME Competency based with ~ 100 Institutional Learning Objectives (developed by faculty) Phase 1: Foundations of Medical Practice (68 weeks, years 1 and 2), integrates clinical skill development and social and behavioral determinants of health with an organ systems model Phase 2: Principles of Medical Practice (48 weeks, year 3), comprises the required clinical clerkships Phase 3: Advanced Medical Practice (36 weeks, year 4), includes electives and capstone clinical experiences (e.g., Sub- Internship, Anesthesiology-Life Support and Perioperative Medicine, Emergency Medicine, Geriatrics and Rehabilitative Medicine, and Internship 101)

36. New Curriculum: Implemented Fall 2012 Patient-centered and integrated (organ system for Phase 1) Increased collaborative and active learning and interprofessional educational experiences Longitudinal threads through 4 years (e.g., evidence based medicine, ethics, patient safety/QI) Expanded clinical preceptorship(s) Phase 1 Collaborative learning groups (8 students +1 faculty meet weekly for 2 years during Phase 1, 5 times Phase 2) 12 week continuity clinic Phase 2, expanded Geriatrics /Rehab Med and Critical Care in Phase 3

37. Standards: example

38. How do you decide what basic science to keep and what should be removed? Use AAMCGQ data, AAMC MSOP, IOM and other reports, USMLE Content Outline and discussions among faculty with recommendations from course and clerkship director committees submitted to CC What type and how much communication do you have with the clerkship directors? Occurs through participation of Chairs of course and clerkship committees on monthly CC and facilitated by the ADME who is on all 3 committees

39. Who has final approval of course content? Course directors and Faculty – must be aligned with course and curriculum objectives (approved by CC) How do you know what students have been taught prior to your course? Discussions among faculty and Course Dirs. & search engine How do you use the institutional (school-wide) objectives to guide your content? Course objectives are linked to institutional objectives – learning activities are linked to course objectives and content is linked to learning activity and course objectives

40. Provide an example of a linkage between the institutional objective, course objective, and assessment. How are courses reviewed? Student surveys, student performance data, student/faculty course debriefings, Evaluation Committee and CC review

41. Which courses use narrative evaluations? The CLGs provide opportunity for narrative feedback (both oral and written) - CLGs are a learning tool that any course can use for active or engaged learning activities including clinical skills, ICM for history/physical diagnosis- Clinical Skills Exams – others?? Do CLG leaders assess students? They provide formative assessment of professionalism, team skills, clinical skills and narrative feedback on student performance in these activities – they do not assign grade – the associated course assigns grades

42. How is anatomy integrated within the new curriculum? In ICM with physical examination – coordinated with organ systems Students noted a dissatisfaction with quality and consistency of the anatomy instruction. What is being done to address their dissatisfaction? This was due to faculty turnover and an unexpected absence of a faculty member for FMLA – faculty has returned and evals. increased How do you know whether anatomy is successfully covered? USMLE Step 1 scores actually higher, internal exams

43. What concerns do you have about the COM or the COM students? If you had to come up with strengths and areas of improvements, what would they be?

44. TIPS for Site Visit Be on time Be positive (including body language) Don’t be defensive Defer question to the person with the most expertise –May be at a different session Succinctly answer specific question asked Only provide examples when asked If you do not understand the question or language; ask the site visitors to re-phrase the question Review Materials

45. LCME Attitude