Curriculum Change at Nebraska Emphasized Clinical Experience in Rural Settings
The University of Nebraska College of Medicine drafted and approved a new, integrated curriculum for medical students that the school implemented in the fall of 1992.
The project was part of the Robert Wood Johnson Foundation (RWJF) national program Preparing Physicians for the Future: A Program in Medical Education.
The college reported the following results to RWJF:
- The new curriculum emphasized early clinical experiences in rural, ambulatory settings.
- Faculty embraced innovative teaching methods and increased student contact with generalists and primary care physicians.
- The college recast traditional basic science courses into 12 interdepartmental, core concentration areas, and introduced a four-year course covering bio-psychosocial aspects of medicine.
- Project staff developed a clinical training experience for students in their junior and senior years within 86 small communities.
- In collaboration with the University of Nebraska at Omaha, the College of Medicine instituted a program to recruit minority students from Omaha-area secondary schools.
RWJF provided $143,651 in funding from September 1990 to February 1992 to support the project.
The University of Nebraska College of Medicine focuses on producing primary care physicians for underserved areas. Five years prior to receiving the grant, the school had embarked on a process of incremental change for its curriculum. Governance was already centralized in the Office of the Dean.
Governance was centralized in a Curriculum Committee, which was appointed by the dean. The dean also appointed several task forces, whose suggestions for curricular change were reviewed and discussed by faculty members. Principle objectives of the project were to:
- Improve recruitment of students from under-represented areas (i.e., minority and non-metropolitan students).
- Integrate clinical and basic science education and make the education of a physician a true continuum.
- Revise both student evaluation system and program evaluation.
- Increase ambulatory experience.
- Develop a curriculum for underserved areas, particularly rural.
- Develop programs that provide integration between the medical school curriculum and residencies.
- Project staff prepared a new, integrated curriculum to be instituted in Fall 1992. A core area entitled Integrated Clinical Experience combined longitudinal clinical experiences, correlations of basic and clinical science information, and Health, Medicine, and Society (a four-year exploration of the bio-psychosocial aspects of medicine). Three afternoons a week in the first two years were unscheduled, allowing students time for independent study. Clinical clerkships had an increased emphasis on ambulatory, primary care experiences. A one-month primary care clerkship between the first and second years provided students an opportunity to experience primary care in a rural community earlier than has occurred in the past. Students took eight weeks of basic science "selectives" during their senior year. Small-group, problem-based, and self-directed learning were promoted, along with increased student contact with generalists and primary care physicians.
- Project staff planned a major initiative the Rural Health Education Network to improve the experience in ambulatory primary care medicine. The plan utilized a hub-and-spoke concept, with clinical training occurring at 7 hubs and 86 small communities, covering medicine, nursing, pharmacy, allied health, and dentistry. During their junior or senior year, students in primary care rotations were to be assigned to a physician in one of the spokes for ambulatory patient care experiences. Once or twice a week, students would travel to the hub, which provided a primary care curriculum covering aspects of providing health care in rural communities.
- In collaboration with the University of Nebraska at Omaha, the College of Medicine instituted the Multicultural Vantage Program, which recruits underrepresented minority students from Omaha-area secondary schools.
The project director reported the following principal problems to RWJF:
- Changes in leadership contributed to a reanalysis of curricular change. The dean stepped down, an interim dean took over, and a new chancellor for the Medical Center was appointed.
- Lack of funding for the implementation grant resulted in a significant backslide in curricular reform. The lack of RWJF support was interpreted by the faculty as a repudiation of their effort and therefore resulted in some movement back to traditional presentations rather than problem-based learning, as originally planned. A considerable amount of effort was spent re-examining the reasons for change and degree of changes contemplated. The commitment to change was reaffirmed by the curriculum committee and the general faculty, and final approval for the new curriculum was given in March 1992.
No communication materials were produced under the grant.
AFTER THE GRANT
The new curriculum was to be implemented as originally planned, starting with the first year class in the fall of 1992. The financial support of the state and the College of Medicine, while limited ($540,220 for two years, with the school requesting more for the 199395 biennium), enabled the school to continue with the project. Several other sources of funding were being pursued.
A University of Nebraska College of Medicine Web site updated in August 2006 indicated that the hub and spoke network planned under the grant and funded by the Nebraska legislature after the RWJF grant ended endured. The network became the umbrella under which the school develops all rural outreach education activities. In 2001 the National Rural Health Association gave the Department of Family Medicine at the University of Nebraska Medical Center its Outstanding Rural Health Program Award. See the Rural Health Education Network Web site for more information.
GRANT DETAILS & CONTACT INFORMATION
Preparing Physicians for the Future, University of Nebraska College of Medicine
University of Nebraska College of Medicine (Omaha, NE)
Dates: September 1990 to February 1992
Robert H. Waldman, M.D.
Note: (Planning) ID# 017243
Report prepared by: Paul Mantell
Reviewed by: Susan Parker
Reviewed by: Robert Crum
Program Officer: Leighton Cluff
Program Officer: Lewis Sandy
Program Officer: Richard Reynolds
Program Officer: Annie Lea Shuster
Evaluation Officer: Beth Stevens