Latha Chandran MD, MPH Feroza Daroowalla MD, MPH

Howard Fleit PhD

And members of the Curriculum Evaluation Working Group

STONY BROOK SCHOOL OF MEDICINE CURRICULUM REFORM INITIATIVE 2012-2015

INTRODUCTION •  The curriculum Committee in the SOM has adopted 14 principles to change

the curriculum for the MD degree •  The goal of the change is to enhance active learning, establish early

professional identity formation, and develop physician competencies in an integrated and contextual manner while allowing for individualized learning experiences for the millennial student with access to unprecedented resources for learning

•  Many schools have changed their curriculum in this direction already

14 GUIDING PRINCIPLES FOR CURRICULAR REFORM Teaching and its formats: •  Provide high quality e- resources to students •  Adapt existing institutional or other resources to create organized syllabus for

every course •  Increase use of interactive techniques during lectures •  Offer at least half of a course in an active learning format. These may include

TBL, CBL, PBL, Simulations, OSCEs, lab work, CPCs etc. •  Support and train faculty and students in developing skills in new pedagogic

approaches Learning and its formats: •  Shift the emphasis of the curriculum to student learning •  Give students the primary responsibility of learning with faculty serving as

facilitators

14 GUIDING PRINCIPLES FOR CURRICULAR REFORM Curriculum and Evaluation: •  Derive 50 + 10 percent of a student grade from a course using non MCQ methods

•  Mandate sessions involving active learning, involving three SOM competencies and using higher levels of learning in Bloom’s taxonomy

•  Use AAMC curriculum inventory standards to define our teaching and assessment methods

•  Use peer assessments as an integral component of assessment

•  Integrate basic/clinical and behavioral sciences from the beginning after a brief period of foundational courses by creating organ systems based interdisciplinary teams

Time frame:

•  Start clinical clerkships in March of Year Two and facilitate contextual reinforcement of basic sciences in the clinical years with “translation pillars”

•  Plan for adequate resources for the change and evaluate the outcomes of the change

ACTION PLAN STAGE   FOCUS   TIME FRAME & DEADLINE   COMMENTS  

ONE   ACTIVE LEARNING FACULTY DEVELOPMENT  

JAN- JUNE 2013 JULY 2013  

Need Faculty Development, Retreats  

TWO   PLAN THE NEW CURRICULUM STRUCTURE   JAN - DEC 2013 DEC 2013  

LCME prep type approach Retreats  

    IMPLEMENTATION PLANNING   JAN- JUNE 2014   Update policies, resources, websites  

    IMPLEMENTING THE NEW CURRICULUM   JULY 2014   Prepare for overlap of Phase 1 and Year two students in 2016 And phase II and year 3 in 2016  

THREE   CLINICAL YEARS CHANGE PLAN   JAN 2017- SEPT 2017   LCME visit 2018  

    CLINICAL YEARS CHANGE IMPLEMENTATION   MAR 2018?    

ORGANIZATION OF PROJECT

•  Curriculum Evaluation Working Group (CEWG) is the group that will present the proposals to the Curriculum Committee for final approval

•  SEVEN subcommittees each with two co-chairs •  Each subcommittee has specific tasks and deadlines

•  All documents available to all through a common share point •  Monthly reports to the CEWG from each subcommittee

•  Some assistance from the Deans Office as needed •  All subcommittees will have student involvement

SUBCOMMITTEE WORK

•  Review the literature and other pertinent resources •  Conduct a SWOT ( strengths, weaknesses, opportunities and threats) analysis

•  Develop a suggested action plan with specific realistic timelines and resource needs

•  Provide reports to the CEWG periodically •  Anticipate occasional faculty retreats/workshops etc.

•  Every member of the team has valuable input to provide •  Co chairs facilitate the discussion of all ideas to get to a strong outcome by the

deadline

•  Ask one of us for help if needed….

SEVEN SUBCOMMITTEES

•  Subgroup One: Resources for Learning •  Subgroup Two: Active Learning and Faculty Development

•  Subgroup Three: Student Learning and Peer Assessments •  Subgroup Four: Integrated Curriculum •  Subgroup Five: Clinical Experiences and Translation Pillars

•  Subgroup Six: Themes, Competencies and Intersession Topics •  Subgroup Seven: Grading and Assessment of Students

CALENDAR

•  March 2013: Subcommittees complete pertinent review of the literature related to their topic

•  April 2013: What do we have at SBU and what do we want to query other schools about?

•  June 2013: What resources are available externally and what are our resource needs?

•  September 2013: RETREAT for exchange

•  How do we move forward? •  December 2013: Hammering down details

LITERATURE REVIEW FORMAT

•  Each subcommittee will identify seminal papers for their topic •  Provide annotated summary to CEWG •  Collate Papers at the share point

SHARE POINT

•  All groups will post findings and material at the share point •  Groups will have edit capacity for own subgroup material

•  Edit privileges determined by each sub-group

•  Separate powerpoint with screen shots available

SUBGROUP ONE: RESOURCES FOR LEARNING

•  Co-chairs: Eisenberg, Hearing •  Focus on:

•  Multimedia learning tools

•  E lectures

•  Syllabi

•  Open sourceware

SUB GROUP ONE TASKS •  March 2013:

•  Literature review for Phase One of New Curriculum (Month 1-18) •  use of external resources such as content lectures •  Hybrid use of external and home- grown resources

•  April 2013: •  Inventory and collect in-house resources, talks, videos etc. •  Identify technical or legal or other barriers with using external (out of school) resources (including

cost barriers) •  Identify questions for outside schools on use of in-house and external resources

•  June 2013: •  Understand current student use of in house and external resources •  Inventory Med-Ed Portal and other on line repositories for potential useful resources- including

commercial resources; identify state of the art textbook and other gold standard resources •  September 2013:

•  Identify faculty development and resource needs for courses and teachers to use external resources

•  Identify student needs for home grown syllabi and learning style variations which may speak to use of external resources

•  Develop a road map and uniform format for each course •  December 2013:

•  Identify Best resources that meet new course curriculum after retreat

SUBGROUP TWO: ACTIVE LEARNING AND FACULTY DEVELOPMENT

•  Co-chairs: Fleit, Singh •  What formats of active learning would be most appropriate? •  How do we develop skills to learn and teach in these new formats among

students and faculty? •  What kinds of faculty retreats should we plan?

SUBGROUP 2 TASKS •  March 2013:

•  Literature review on teaching methods of active learning (team-based learning, PBL, CBL, CPC) and learning communities

•  Literature review on faculty development and resources for different active learning methods •  Review of AAMC resource

•  April 2013: •  Inventory of current methods used and effectiveness of strategy •  Develop query for other schools on methods used and how they trained faculty

•  June 2013: •  Develop content or find resources to develop faculty in these methods •  What are the resource needs at SBU for different methods

•  September 2013: •  What methods are the best for SBU after retreat findings •  How are we going to establish and monitor faculty competence in methods •  What are the barriers for faculty and Is there a need for more faculty learning specialists to

overcome barriers •  December 2013:

•  Develop curriculum for faculty development for chosen methods

SUBGROUP THREE: STUDENT LEARNING AND PEER ASSESSMENTS

•  Co-chairs: Iyer, Mogbelli, Wong •  How do students take primary responsibility for learning? •  What would some of their concerns be?

•  What are some solutions that they would offer?

•  How do we facilitate student peer assessments?

•  Will they count for grades? How much?

SUB GROUP 3 TASKS •  March 2013:

•  Literature search on peer assessment, grading use, new STEP one, professional identity formation in medical school, instilling values in students, pre-matriculation courses, and needs assessment before medical school

•  Liaise with division of teaching and technology •  April 2013:

•  Identify and inventory current use of peer assessment •  How do our medical students learn and what resources do they use in house and externally •  Identify needs of the whole spectrum of students including marginal students; identify resources for

learning specialist group •  Develop questions to query other schools

•  June 2013: •  Develop plan outline for pre-matriculation assessment, pre-matriculation requirements, summer

curriculum and course to bring up to minimum standards; list resources •  Develop professional identity curriculum plan and resource needs

•  September 2013: •  After retreat, identify needs for student use of in house and external resources for learning •  Identify specific needs to train students in new methods and professional identity curriculum

•  December 2013: •  Plan how to communicate and “advertise” Stony Brook SOM new curriculum and use it in recruitment

SUBGROUP FOUR: INTEGRATED CURRICULUM

•  Co-chairs: Fleit, Shelov •  What will the new curricular structure look like?

•  What are the components of the Foundational Course(s)? •  Where are the gaps, redundancies (wanted and unwanted)? •  How do we cover USMLE, LCME, and AAMC required topics?

•  What are the intended and unintended consequences of the change?

SUBGROUP 4 TASKS •  March 2013:

•  Identify, collate, summarize models of integrated curricula •  Identify and review success metrics and methods •  Understand new and innovative tracks (short track to residency being developed by AAMC

and AMA) •  Review existing literature on resource needs with integration reform

•  April 2013: •  Find gaps and redundancies in SBU SOM curriculum •  Identify some themes that would be aspirational, themes that would be worth pursuing •  Identify minimal required topics

•  June 2013: •  Propose feasible models and resource outlines •  Draw maps for overlap years (when 2 curricula overlap) •  Develop a ‘name’ for the new curriculum

•  September 2013: •  Articulate the changes and consequences of changes in course leadership and faculty

deployment with new plan •  Narrow down choices for new plan design after retreat

•  December 2013: •  Use changes in “Foundations” as a learning model for change at SBU SOM; •  Identify resource needs •  Identify changes in faculty recognition and time in team approach to teaching

•  Co-chairs: Lane, Wackett

•  How do we structure our clinical experiences in the second stage?

•  Are there opportunities for integration amongst clerkships?

•  What are the most appropriate Translation Pillars (TP)?

•  How would the TP’s be structured? Graded? In Stage III:

•  What are the challenges and opportunities to moving towards Longitudinal Integrated Clerkships?

•  * consider carving out clinical exposures early and phase 2 from translational pillars

•  And grouping translational pillars with themes, intersessions

SUBGROUP FIVE: CLINICAL EXPERIENCES AND TRANSLATION PILLARS

SUBGROUP 5 TASKS •  March 2013:

•  Literature search on models for translational pillars, early clinical exposure, interprofessional exposure early in medical school, review Hofstra curriculum

•  Literature search of different clinical clerkship models (phase 2) •  April 2013:

•  Inventory of current early clinical exposure •  Review family medicine clerkship change and results at SBU •  Review current integrated clerkship or fourth year curricula at SBU

•  June 2013: •  Discuss challenges and resource needs for structuring a 2.5 year clinical core experience •  Discuss new paradigms for clinical education: adopt a family; ambulatory, hospital, procedural rather than

traditional clerkships; graduated exposures from outpatient to inpatient •  Develop models for early clinical exposure and translational pillars

•  September 2013: •  Consider need for a committee B to develop actual content of translational pillars, look at models elsewhere,

work on themes throughout the curriculum •  December 2013:

•  Design phase one translational pillars and clinical experiences

SUBGROUP SIX: THEMES, COMPETENCIES AND INTERSESSION TOPICS

•  Co-chairs: Daroowalla, Granek

•  How will the new curriculum affect the competencies of the SOM?

•  How will we assess student achievement of the competencies?

•  Are there specific themes that run longitudinally across the whole curriculum?

•  What are the intersession topics that need to be included?

•  How will they be taught and assessed?

•  How can these topics and themes help integrate the curriculum better?

•  What are the challenges and opportunities to moving towards Longitudinal Integrated Clerkships?

SUBGROUP SIX TASKS: •  March 2013:

•  Literature search on curricular themes and intersession topics (review LCME ‘hot topics’), how to teach themes and intersession topics

•  April 2013:

•  Inventory of current competency assessment methods •  June 2013:

•  Propose new curricular themes and intersession topics •  Identify resource requirements for integrating new curricular themes and intersession topics

•  September 2013: •  Following retreat, begin to map curricular themes, competencies and intersession topics

•  December 2013: •  Propose map of curricular themes, competencies and intersession topics consistent with models

proposed by Subgroup Four (Integrated Curriculum)

SUBGROUP SEVEN: GRADING AND ASSESSMENT OF STUDENTS

•  Co-chairs: Lu, Richman

•  How will students be graded in the new curriculum?

•  How will competencies be meaningfully graded?

•  What is required to move assessments from MCQ’s to other forms?

•  What challenges and opportunities exist in this area?

SUBGROUP SEVEN TASKS: •  March 2013:

•  Update literature review on grading of non-MCQ assessment methods; literature review on grading of competencies.

•  April 2013: •  Inventory of currently used grading methods for all types of assessments in SBU SOM curriculum •  Review of AAMC assessment tools •  Identify resource needs for new assessment tools

•  June 2013: •  Develop model for grading and assessment of student achievements

•  September 2013: •  Following retreat, map grading and assessment to proposed maps of curriculum developed by

Subgroups Four and Six •  December 2013:

•  Present a map of assessment modalities associated with new teaching and learning strategies

THE TIME IS RIGHT •  Stony Brook is building a MART building in 2016 with a large auditorium and rooms

dedicated for team based learning and small group discussions

•  We are establishing an Academy of Clinical and Educational Scholars as part of the Strategic Plan in the SOM

•  We are creating Learning Communities within the SOM to allow for closer student and faculty interactions

•  Expansion of the Clinical Skills Center and Simulation Program under new leadership

•  We are moving towards interprofessional team-based training

•  Full LCME accreditation and no visit till 2018

•  New educational leadership in the SOM .. New Dean, Vice Dean, Chair of Curriculum Committee