Craig Timm

Fitting it all in: integration of 12 cross-cutting themes into a School of Medicine curriculum

Changing demographic, social, economic and technological trends have impacted the expectations of the Academic Health Center in preparing physicians to serve the needs of the American society, resulting in revisions to current curricula. In addition to the traditional basic sciences and clinical disciplines, accredited medical schools are required to provide curriculum exposure in behavioral health, communication skills, diversity and cultural awareness, ethics, evidence-based medicine, geriatrics, integrative medicine, pain management, palliative care, public health, socio-economic dynamics, and domestic violence. These themes are considered ‘cross-cutting’ since it is recognized these important curricular components apply across all years of medical school. In this article, the authors describe a strategic model developed at the University of New Mexico School of Medicine (UNMSOM) to integrate horizontally and vertically 12 cross-cutting themes as an evolving interdisciplinary curriculum reform process. These areas were defined through a combination of internal self-study, external requirements, and student and faculty interest. In the early stage of use of this model at UNMSOM, the authors describe the new cross-cutting themes that have been integrated. Minimal disruption and a spirit of cooperation and acceptance have characterized the curricular change that has been required. Preliminary assessment indicates that the program has been successful. Practice points Cross-cutting themes have relevance and need emphasis throughout the medical curriculum. Cross-cutting themes are effectively taught through horizontal and vertical integration. Cross-cutting themes curricula should be designed by local experts with reference to the core competencies, to avoid duplication and facilitate acceptance. Modifications may be made to existing resources such as problem-based learning, lectures, panels, and student performance assessment. Ongoing institutional support is essential and is maintained by proving evidence through assessment of curricular content, student performance and satisfaction.

Cause or effect? The relationship between student perception of the medical school learning environment and academic performance on USMLE Step 1

Background: A schools learning environment is believed to influence academic performance yet few studies have evaluated this association controlling for prior academic ability, an important factor since students who do well in school tend to rate their schools environment more highly than students who are less academically strong. Aim: To evaluate the effect of student perception of the learning environment on their performance on a standardized licensing test while controlling for prior academic ability. Methods: We measured perception of the learning environment after the first year of medical school in 267 students from five consecutive classes and related that measure to performance on United States Medical Licensing Examination (USMLE) Step 1, taken approximately six months later. We controlled for prior academic performance by including Medical College Admission Test score and undergraduate grade point average in linear regression models. Results: Three of the five learning environment subscales were statistically associated with Step 1 performance (p < 0.05): meaningful learning environment, emotional climate, and student–student interaction. A one-point increase in the rating of the subscales (scale of 1–4) was associated with increases of 6.8, 6.6, and 4.8 points on the Step 1 exam. Conclusion: Our findings provide some evidence for the widely held assumption that a positively perceived learning environment contributes to better academic performance.

Evaluating educators using a novel toolbox: applying rigorous criteria flexibly across institutions

Valuing faculty as educators is essential for medical schools to fulfill their unique mission of educating physicians. The 2006 Consensus Conference on Educational Scholarship, sponsored by the Association of American Medical Colleges (AAMC) Group on Educational Affairs, provided educators seeking academic promotion with a portfolio-based format for documenting activities in five domains, using evidence of quantity, quality, a scholarly approach, and educational scholarship. Yet, the lack of a rigorous, widely accepted system to assess educator portfolio submissions during the promotion and tenure process continues to impede the ability to fully value educators and educational scholars. The AAMC Task Force on Educator Evaluation was formed in 2010 to establish consensus guidelines for use by those responsible for the rigorous evaluation of the educational contributions of faculty. The task force delineated the educational contributions currently valued by institutions and then fulfilled its charge by creating the Toolbox for Evaluating Educators, a resource which contains explicit evidence-based criteria to evaluate faculty in each of the five domains of educator activity. Adoption of such criteria is now the rate-limiting step in using a fair process to recognize educators through academic promotion. To inform institutional review and implementation of these criteria, this article describes the iterative, evidence- and stakeholder-based process to establish the criteria. The authors advocate institutional adoption of these criteria so that faculty seeking academic promotion as educators, like their researcher colleagues, can be judged and valued using established standards for the assessment of their work.

Early Predictors of Physicians' Practice in Medically Underserved Communities: A 12-year Follow-up Study of University of New Mexico School of Medicine Graduates

Background Substantial numbers of people are medically underserved because of rural residence and/or economic circumstances. The mission of many medical schools is service to this group, so the ability to identify applicants likely to serve this population is valuable. Method In 2009, the authors asked graduates from their medical school, class of 1997 and forward, if they practiced in a medically underserved community in the past year. Variables obtained from medical school applications and scores from a survey of attitudes toward the underserved measured at matriculation were analyzed using logistic regression. Results Of 244 practitioners, 35% reported working in an underserved community. Rural background, older age (25+) at matriculation, and being a member of an underrepresented minority were independent, statistically significant predictors of practice in an underserved community. Conclusions Schools wanting to increase the number of practitioners caring for the underserved could consider older as well as rural and minority applicants.

Narrative medicine and emerging clinical practice.

There in front of me lay a thin, almost translucent looking person. Her hands were warped with the ravages of rheumatoid arthritis and her hair was so thin I could see the age spots on her delicate little head. She was sleeping, soundly from the looks of it. Her oxygen tubing was wrapped around her head and the machine made a strange whirring sound reminiscent of a swamp cooler I once had in my apartment in college. I touched her hand, softly at first, then squeezed a little harder. “Mrs. G., Hi Mrs. G., are you awake?” Her eyes opened and she cracked a huge smile. Uh oh, I thought, she thinks this is funny already? “Mrs. G., I’m the medical student who was going to see you today, did your nurse tell you I was coming?” Her eyes closed again. “Oh sure! Betty told me this morning,” she said in a barely audible voice. “I even had them bring me an extra chair for you!” Wow, she is completely cognizant. Both a sigh of relief and a wave of terror struck me at once. Now I had to play the doctor.