Reforms to Medical Curriculum Benefit Students at the University of New Mexico
From 1990 to 1999, the University of New Mexico School of Medicine, Albuquerque, combined elements of its alternative curriculum, which offered variations of clinical experience, with its traditional curriculum and offered the resulting integrated curriculum to all of its undergraduate medical students.
The program was part the Robert Wood Johnson Foundation's (RWJF) national program Preparing Physicians for the Future: A Program in Medical Education.
Though many elements of reform ran into unexpected difficulties e.g., dissent within the faculty and a changing economic environment that put increased pressure on faculty to focus on patient service rather than teaching the problems did not block the merging of the tracks.
- The school merged three different tracks Primary Care, Health of the Public, and the traditional courses into a new curriculum.
A key feature of the new curriculum was a clinical skills/clinical practicum course that brought student learning into a real-life context.
- The project altered the governance structure through the creation of a policy-setting Education Council and a curriculum Integrating Group, which met and formulated the plans necessary to implement curricular change and maintain coherence throughout the program.
- The school implemented a comprehensive performance assessment of students that takes place three times during their four years in medical school.
- The school's faculty took the lead in publishing in Academic Medicine the combined findings of the consortium of RWJF-granted schools (see Program Related Grants in the Projects List).
RWJF supported the project with two grants totaling $2,621,823 between September 1990 and February 1999.
The University of New Mexico School of Medicine adopted the Case Western Reserve School of Medicine's organ-based teaching when the school first opened in 1964. During the decade prior to the Preparing Physicians for the Future: (PPF), the school introduced and institutionalized major reforms in medical education in both the pre-clinical and clinical years.
Their most prominent innovations, the Primary Care Curriculum and the Health of the Public Program, used educational methodology that made students responsible for their own learning and assessment. The Primary Care Curriculum track for first- and second-year students, was a student-centered, problem-based, and community-oriented learning experience, and was typically opted for by approximately one-third of the student body.
This curriculum featured a four-month rural primary care clerkship. The Health of the Public curriculum track for third- and fourth-year students integrated social and preventive medicine into clerkship experiences, and fostered continuity of patient care in ambulatory and community settings. This track was chosen by approximately two-thirds of the student body.
With its planning grant (ID# 017244) the school combined the best of its three different tracks Primary Care, Health of the Public, and the traditional curriculum and created a plan for an integrated training program for all undergraduate students. The school involved more than 250 faculty and staff as members of task forces, multi-disciplinary planning groups, ambulatory-inpatient groups, and ad hoc committees.
With its implementation grant (ID# 019644) the school proposed to put the plan into practice. Specifically, the school:
- Instituted a new student assessment system that was competency-based, comprehensive, and cumulative, and that measured all aspects of learning.
- Ensured that the governance structure charged with implementing the new curriculum would encourage broad and interdepartmental ownership of the change process.
- The school merged the three different tracks Primary Care, Health of the Public, and the traditional courses into a new curriculum. This new, integrated curriculum was deployed in three phases. The first phase focused on basic science, with an introduction of clinical experience; the second on focused on varieties of clinical experience; the third increased the responsibility on students within their clinical experience. The school reports that the new system is working well, and has wide faculty and student support. Virtually all clerkships have successfully introduced tutorials, and students report satisfaction with their ambulatory and primary care experiences. A key feature of the new curriculum was the clinical skills/clinical practicum course that brought student learning into a real-life context. This was reinforced by a 12-week Practical Immersion Experience in which all students spent four weeks in a primary care practice around the state, then either stayed in those practices for another eight weeks or came back to campus for eight weeks of research.
- The project altered the governance structure through the creation of a policy-setting Education Council and a curriculum Integrating Group, which met and formulated the plans necessary to implement curricular change and maintain coherence throughout the program. Multi-disciplinary organ system committees now report to the Integrating Group.
- The school implemented a comprehensive performance assessment of students that takes place three times during their four years in medical school. This assessment, known as the Student Progress Assessment (SPA), occurs in the spring of the first year, fall of the second year, and summer of the fourth year. Competencies assessed include clinical skills, communication skills, critical integration of knowledge, professional attitudes, values and ethics, and self-assessment. The SPA takes the form of an Objective Structured Clinical Examination (OSCE), using standardized patients and checklists of expected performance to grade the students' competencies.
The project director reported the following problems to RWJF:
- The curriculum change provoked controversy within the School of Medicine. Since the change involved merging different curricular tracks, ownership on both sides was constantly being negotiated. Although leadership promoted the project as bringing together "the best of both," many in the traditional track felt devalued in the new approach because they perceived that their teaching block was the best, and that they were not consulted about the change.
- Due to economic factors affecting the nation's health care system, the medical center put increasing pressure on faculty and residents to focus on patient service, thus creating conflicts with the project's emphasis on education. In response to growing conflicts, the dean assembled an ad hoc committee of the faculty to resolve these and similar governance issues.
Project staff published more than 50 articles based on themes addressed in the project, and made more than 35 presentations. An article about the project also appeared in U.S. News & World Reports. See the site's Bibliography for details.
AFTER THE GRANT
Project staff continues to evaluate the curriculum and make changes as necessary. The School of Medicine has also worked collaboratively with the university's College of Nursing in the development of an off-site education program for nurse practitioners, nurse midwives, physician assistants, and medical students to learn together in communities outside of Albuquerque. In addition, the school has implemented a physician assistant training program on site that has these students also taking the same curriculum through the first phase of the curriculum as the medical students.
GRANT DETAILS & CONTACT INFORMATION
Preparing Physicians for the Future, University of New Mexico
University of New Mexico School of Medicine (Albuquerque, NM)
Dates: September 1990 to February 1992
Dates: March 1992 to February 1999
Leonard M. Napolitano, Ph.D. (retired)
Paul B. Roth, M.D.
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Bennahum DA. "Developing Professional Skills, Values, and Attitudes: Committing Medical Students to the Ethics of Medicine." Academic Medicine, 72(5): 425426, 1997.
Boelen C, McGrew M, Kaufman A, et al. "The Challenge of Changing Medical Education." World Health Forum, 14: 213352, 1993.
Coultas D, Klecan D, Whitten R, Obenshain SS, Rubin R, Wiese W, Wilson B, Woodall G and Stidley C. "A Randomized Trial of Training Medical Students in Smoking Cessation Counseling." Academic Medicine. In press.
Coultas D, Mines J, et al. "The Use of an Aggregate Scoring Method to Minimize Faculty Error in the Assessment of Clinical Reasoning." Teaching and Learning in Medicine. Submitted for Publication.
Eldredge JD. "A Problem-Based Learning Curriculum in Transition: The Emerging Role of the Library." Bulletin of the Medical Library Association, 81(4): 310315, 1993. Abstract available online.
Eldredge JD and Rhyne RL. "Building Foundations for Effective Library Skills in Medical Education: Library/Biometry Projects in the First Month of Medical School." In Rankin J (ed.). Handbook on Problem-Based Learning. Chicago, Ill.: Medical Library Association, 1998.
Eldredge JD, Teal JB, Ducharme JC, Harris RM, Croghan L and Perea JA. "The Roles of Library Liaisons in a Problem-Based Learning (PBL) Medical School Curriculum." Health Libraries Review, 15(3): 185194, 1998. Abstract available online.
Glew RH, Ripkey DR and Swanson DB. "Relationship Between Students' Performances on the NBME Comprehensive Basic Science Examination and the USMLE Step 1: A Longitudinal Investigation at One School." Academic Medicine, 72(12): 10971102, 1997. Abstract available online.
Glew RH. "Student-Centered Curriculum Teaches More Than Pathophysiology." Journal of the American Medical Association, 272(9): 743, 1993.
Glew RH and Glew RS. "Insights From a Medical Scientist Exchange Program Between the United States and Nigeria." Ethnicity and Disease, 3(Suppl.): S75S82, 1993.
Kaufman A. "Editorial." International Education Section, Academic Medicine, 67(5): 1992.
Kaufman A and Waterman R. "Health of the Public: A Challenge to Academic Health Centers." Albuquerque, NM: The PEW Charitable Trusts and the Rockefeller Foundation, 1993.
Kaufman A, Galbraith P, Alfero C, Urbina C, Derksen D, Wiese W, Contreras R and Kalishman N. "Fostering the Health of Communities: A Unifying Mission for the University of New Mexico Health Sciences Center." Academic Medicine, 71(5): 432440, 1996. Abstract available online.
Marcus E, Koinis C and Obenshain SS. "A Comprehensive, Integrated Performance Assessment of First-Year Medical Students." Academic Medicine, 70(5): 440441, 1995.
Marcus E, White R and Rubin RH. "Early Clinical Skills Training is Integral to a New Medical School Curriculum." Academic Medicine, 69(5): 415, 1994.
Mennin SP, Kalishman S, Mines J, et al. Longitudinal Evaluation Project. "Focus Groups on Curriculum and Program Evaluation." Academic Medicine, 71: 519, 1996.
Mennin SP and Kaufman A. "Increasing the Relevance of Education for Health Professionals." Geneva, Switzerland: WHO Technical Report Series, 1993.
Mennin SP, McConnell T and Anderson W. "Improving Written Narrative Assessments in Small-Group, Problem-Based Tutorials: Continuous Quality Assurance and Faculty Development Through Peer Review." Academic Medicine, 72(5): 460461, 1997.
Obenshain SS. "Curricula: Already Too Comprehensive." Transfusion, 35(6): 456468, 1995.
Pilon S and Tandberg D. "Neural Network and Linear Regression Models in Residency Selection." American Journal of Emergency Medicine, 15(4): 361364, 1997.
Platt M, Obenshain SS and Friedman M. "Integration of Computers into the Medical School Curriculum: An Example From a Microbiology Course." Medical Teacher, 16: 1, 1994.
Roberts LW and Subcommittee on Professional Attitudes and Values. "Sequential Assessment of Medical Student Competence with Respect to Professional Attitudes, Values, and Ethics." Academic Medicine, 72(5): 428429, 1997.
Roberts L, Franchini G and Fiedler K. "An Integrated Psychiatry-Neurology Clerkship Within a Problem-Based Learning Curriculum." Academic Medicine, 72(5): 423424, 1997
Umland B, Waterman R, Wiese W, Duban S, Mennin S and Kaufman A. "Learning from a Rural Physician Program in China." Academic Medicine, 67(5): 307309, 1992.
Urbina C, Hickey M, McHarney-Brown C, Duban S and Kaufman A. "Innovative Generalist Programs: Academic Health Care Centers Respond to the Shortage of Generalist Physicians." Journal of General Internal Medicine, 9(4 Suppl.): S81S89, 1994. Abstract available online.
Urbina C and Counsellor A. "University of New Mexico School of Medicine Rural and Urban Clinical Programs." CBT News Annual Session Edition (American College of Physicians), March 1997.
Urbina C, McGrew M and Kaufman A. "A New Curriculum." Journal of Minority Medical Students, 3235, Fall 1993.
"Hotbed of Innovation." US News & World Reports, 121(11): 924, 1996
Audio-Visuals and Computer Software
"Physical Exam of the Adult." Video Recording. Albuquerque, NM: University of New Mexico, 1995.
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