1. Curricular “Revitalization” of Year 1 Frazier Stevenson, MD Associate Dean for Undergraduate Educational Education Stanley Nazian, PhD Year 1 Faculty Lead

2. Rationale for change in Year 1  Enhance integration of basic science courses  Enhance compliance with LCME  Desire to improve monitoring of students’ performance as the year progresses, rather than at the end of the year  Desire to provide opportunities for remediation in a more timely fashion

3. Basic Science Education in Year 1 Actions taken:  Gross Anatomy, Physiology, Neuroanatomy, and Behavioral Science now will be taught as part of 4 organ system interdisciplinary block courses with grades issued every 8-9 weeks.  Content sequence reorganized but topics are the same.  Traditional disciplines (e.g. anatomy) tracked across the year. Students need acceptable competency to advance to Year 2.  Students have opportunity to remediate failing grade after 1-2 weeks study and re-examination.

4. Clinical Education in Years 1 and 2  Review of clinical skills education revealed:  fragmentation of instruction in current structure  desire to improve student readiness for the third year clerkships.  Actions taken:  Unification of Physical Diagnosis, Longitudinal Clinical Experience, and On Doctoring into a single year-long course (“Doctoring”)  Pairing of Clinical Problem Solving and Evidence Based Medicine to create a new course: (“Evidence Based Clinical Reasoning”)

5. Current Year 1

6. New Curriculum: Designed March 2010 Doctoring Evidence Based Clinical Reasoning Core Principles & Musculoskelet al System Core Principles & Musculoskelet al System Communicatio n: Neurologic & Endocrine Systems Cardiovascular & Pulmonary Systems Renal, Gastro- intestinal and Reproductive Systems Molecular Relationships Competency (e.g. molecular biology) Functional Relationships Competency (e.g. physiology) Structural Relationships Competency (e.g. anatomy) Human/Behavioral Relationships Competency (e.g. behavioral science) 2 wks 8 wks 8 wks 8 wks 8 wks Aug w Oct Jan March

7. Proposed Realignment  Physical Diagnosis I+II  Longitudinal Clinical Experience I+II  On Doctoring / Ethics  Clinical Problem Solving  Evidence Based Medicine (from EBCP)  Current EBCP without the EBM formal curriculum  “Doctoring I and II”  “Evidenced Based Clinical Reasoning I and II”  “Introduction to Clinical Medicine” (Year 2)

8. “Doctoring”  Enable a smooth transition into third year by improving longitudinal skill development  Integrate small groups across multiple courses  Develop a longitudinal small group to pull together multiple competencies  Teach ethics and professionalism in clinical context  Link PD and LCE  Increase communication teaching

9. “Evidence Based Clinical Reasoning”  Informatics, statistics (Year 1)  Clinical Problem Solving (Year 1 latter half)  Evidence Based Medicine fundamentals (literature review, types of articles) (Year 2 start)  Clinical Problem Solving (Year 2) integrating organ systems with literature review

10. “Introduction to Clinical Medicine”  Old name = Clinical Diagnostic Reasoning  Pathophysiology not covered in Pharmacology, Pathology, PMIID  Examples: ECGs, electrolyte disorders, psychiatric disorders, liver and renal failure

11. A month in Doctoring and EBCR for an MS1 during the cardiopulmonary course WEEKMondayTuesWedThursdayFriday 1AM: Lecture demo on cardiac exam Free PM: Small Group in CACL: examine heart PM: traditional LCE 2 FreeAM: Humanities presentation 1 PM: Communication presentation 2 PM: Small Group communication with SP PM: LCE skill visit--CV exam in office 3 Free PM: Small Group Ethics cases PM: traditional LCE 4 Free 1 PM: Informatics lecture 2pm: Small Group: CPS case Free (pre- exam)

12. A month in Doctoring and EBCR for an MSII during the cardiovascular block WEEKMondayTuesWedThursdayFriday 1AM: Lecture demo on abnormal cardiac exam FreePM: Small Group in CACL: simulator heart murmurs, examine heart PM: Inpatient complete H and P 2AM: EBCR Lecture on Randomized Controlled Trials FreeAM: Humanities presentation 1 PM: Ethics presentation 2 PM: Small Group communication with SP PM: meet inpatient preceptor to go over H and P, presentation 3FreePM: Small Group: Presentations from complete H and Ps PM: traditional LCE 4FreePM: Small Group: CPS case PM: traditional LCE