University of South Florida College of Medicine

Curriculum Management and Governance Structure ♦ The educational program is overseen by the Committee on Curriculum (CC) and the Associate Dean for Undergraduate Medical Education (Figure 1).FIGURE 1:: Governance Structure♦ The CC is a standing committee that meets monthly. It approves curricular changes, reviews courses on a two-year schedule, and reviews horizontal/vertical integration. There are two student representatives from each of the four classes in the undergraduate educational program. ♦ In addition, there are monthly meetings of all instructors of required courses within years (1, 2, and 3–4) that discuss student assessment and proposed course changes and sequencing changes that affect all courses within that year. These committees hear feedback from elected student representatives on issues within each course every two months. Office of Education ♦ The Office of Educational Affairs (OEA) provides course support for required interdisciplinary courses, processes examinations, administers the standardized patient program, develops education technology, and assists the faculty committees in curricular oversight. ♦ The office is overseen by the Vice Dean for Educational Affairs and the Associate Dean for Undergraduate Medical Education (Figure 2).FIGURE 2:: Educational Affairs Structure♦ The OEA team includes one education PhD who develops assessment strategies for the curriculum and students, a second PhD who coordinates the Liaison Committee on Medical Education (LCME) and performs program analysis, a physician medical director of the standardized patient center, and seven administrative assistants who coordinate interdisciplinary courses. ♦ The OEA team coordinates all undergraduate curricular activities and acts as the liaison among the students, faculty, and administration on curricular issues. Financial Management of Educational Programs ♦ Specific funds support teaching development, staff development, standardized patients, and teaching incentives for faculty teaching innovation, in addition to the funds necessary to operate the OEA. ♦ The funding sources include a blend of state funding, practice plan funds, and other discretionary funds provided by the dean. Valuing Teaching ♦ Teaching is supported via explicit incorporation of evaluations into promotion and tenure committee decisions and variable salary support from departmental funds and the Office of Educational Affairs. ♦ A recent EVU (Education Value Unit) initiative is explicitly tracking the amount and type of teaching in all departments so that there can be improved alignment of resources with teaching effort. ♦ There are annual teaching awards for both faculty and students. Curriculum Renewal Process ♦ Curriculum renewal is a continuous process, with some changes to required curriculum made annually by the Curriculum Committee. ♦ The required year 1–2 courses have become thematically integrated around organ systems. Year 1 has now changed from discipline-based courses to thematic organ-system blocks. ♦ The required year 3–4 curriculum was extensively revised in 2004-05, with traditional departmental clerkships replaced with interdisciplinary clerkships (e.g., Maternal and Newborn Health, Inpatient Medicine/Pediatrics, Neuropsychiatry). ♦ An extensive review of the year 1–2 clinical curriculum and a reevaluation of the 2005 clerkship innovations is currently in progress. ♦ Objectives of the current review are enhanced integrating year 1–2 clinical courses, setting specific competency-based outcomes for students entering the year 3 clerkships, and creating additional elective/selective time in all years of the curriculum. Learning Outcomes/Competencies ♦ There are college terminal objectives, called “USFCARES” (Table 1).TABLE 1: Terminal Competencies and Objectives (USFCARES)♦ These general competencies are tied to course-specific competencies that are developed for each course/clerkship by those involved in teaching. New Topics in the Curriculum Since 2000 ♦ Elective Scholarly Concentrations were introduced in AY 2008-09. Completion requires participation in a 150-hour curriculum in years 1–4 and completion of a legacy project. Themes of the nine concentrations transcend typical disciplines (e.g., Public Health, Medical Education, Humanities, Biomedical Research). Of the year 1 class, 65% are enrolled in 2009-10. ♦ Newly organized required year 3–4 clerkships were initiated in 2005: Inpatient medicine and pediatrics Primary care and special populations: family practice, medicine, pediatrics, geriatrics, adolescent medicine with 12-week continuity of care emphasis Surgical care: general surgery and surgical gynecology Newborn and maternal health: obstetrics and newborn medicine Neuropsychiatry Interdisciplinary oncology: inpatient and outpatient treatment; radiation, chemotherapy, and surgical approaches to care; counseling and bad news Skin and bones: dermatology, rheumatology, orthopedics, sports medicine USMLE 2CX scores remained significantly above national norms after change to this novel clerkship format. ♦ Year 1 courses were changed from discipline based to 8- to 9-week organ-system blocks in 2010. ♦ Organ-system integration is in place for all year 1–2 basic science courses (emphasis on normal function in year 1 and diseases in year 2). ♦ Evidence-Based Clinical Practice is a required year-2 course merging concepts of statistics, evidence-based medicine, and introductory clinical medicine and coordinated with ongoing pathology, pharmacology, and microbiology topics. ♦ Doctoring 1–2, an integrated two-year sequence integrating physical diagnosis, communications, ethics, humanities, and cultural competence, was approved for 2010. It focuses on weekly small groups with uniform faculty/MS4 paired preceptors and weekly visits to community physicians. ♦ Colloquium is a 12-week year-2 course with 12–15 selective multidisciplinary options for students. ♦ Students are trained in introductory simulation of endoscopic surgery at the new USF Health Simulation Center at Tampa General Hospital during year-3 clerkships. Changes in Pedagogy ♦ Extensive use of new standardized patient (SP) center (36,000 hours of SP contacts overall): standardized patients for learning and assessment in year 1–2 Physical Diagnosis faculty-observed history and physical on a standardized patient at the start of year 2 observed complete SP history and physical in year 4, with faculty feedback ♦ Preclinical curriculum: continued integration and increased efficiencies have/will reduce contact hours in year 1–2 contact hours increase in interdisciplinary sessions in year 1–2 basic science courses increased use of Team-Based Learning and small-group discussion increase in clinical contact in preclinical years: Students now have weekly half-day longitudinal rotations with USF or community physicians each week in years 1–2 semimonthly standardized patient communications curriculum in small groups for 2010 Changes in Assessment ♦ Preclinical curriculum interdisciplinary block examinations in years 1–2, with a course director panel designing each examination together to enhance integration within the examination use of student “group examinations” after each year 1–2 examination, with five to six students required to reach group consensus on all examination questions and submit a uniform response; group score counts as 5–10% of total examination grade. ♦ Required clerkships miniclinical performance examination (CPX) in all required clerkships: one to two stations year-end 12-station CPX with standardized patients in year 3 NBME Shelf Examinations in most required clerkships ♦ Strategy has led to USMLE 2CX scores significantly above national norms. Clinical Experiences ♦ Main hospital sites are Tampa General Hospital, Haley VAMC (on USF campus), Moffitt Cancer Center (on USF campus), All Children's Hospital St. Petersburg, and Bay Pines VAMC St. Petersburg. ♦ Outpatient sites are a mix of on-campus clinics and multiple USF affiliated and community sites throughout the Tampa Bay region. ♦ Challenges are as follows: Some sites (i.e., St. Petersburg hospitals) are 45–60 minutes distant from USF campus for year-3 clerkship didactic sessions, causing travel difficulties. Novel integrated clerkships sometimes require students at very dispersed hospitals to gather for didactics. Extensive use of community preceptors in years 1–2 sometimes causes travel and timing issues in coordinating with on-campus preclinical classes. No discrete university hospital leads to financial and governance challenges. Regional Campus USF College of Medicine has recently affiliated with the Lehigh Valley Health Network (LVHN) in Allentown, Pennsylvania, to become a regional site for a distinctive medical student program beginning in 2011 with 24 admitted students, expanding to 54 by 2013. ♦ The four-year program will focus on leadership development with extensive incorporation of continuous quality improvement and patient safety methodologies and use of interprofessional health care teams. ♦ Students will take years 1–2 in Tampa, then years 3–4 at the LVHN site. ♦ Novel leadership-oriented program requirements must be met throughout years 1–4. ♦ Clinical and basic science curriculum and pedagogy for these students will otherwise be identical to the Tampa campus curriculum. Highlights ♦ Extensive early clinical exposure ♦ Novel integrated clerkship structure ♦ Well-developed Scholarly Concentration program ♦ Extensive use of standardized patient teaching and assessment (>36,000 encounters per year) ♦ Affiliation with Lehigh Valley Health Network to form a new regional site and unique medical student program

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