University of Iowa Roy J. and Lucille A. Carver College of Medicine

Medical Education Program Highlights The University of Iowa Carver College of Medicine (CCOM) recognizes the importance and contributions of the medical education curriculum and the learning environment in enhancing and maximizing students’ professional development. To maintain focus and achieve balance in these critical areas, the educational administration and staff are contained within a single Office of Student Affairs and Curriculum (OSAC). The mechanisms of health and disease (MOHD) curricular strand comprises 6 multisystem mechanisms that serve as the mechanistic framework for teaching foundational sciences. MOHD 1 and 3 cover the mechanisms of oxygenation, metabolism, and genetics/development. MOHD 2 and 4 cover the mechanisms of immunology/inflammation, locomotion/integument, and neuropsychiatry. Each MOHD course is codirected by a scientist and a clinician to facilitate integrating fundamental science with clinical relevance. A unique aspect of our curriculum is the combined curriculum that co-educates physician assistant (PA) and MD students simultaneously. The preclinical phase consists of 13 courses taught to PA and MD students that together use identical coursework, evaluation methods, and grading. This unique feature provides efficiency in training students while helping them learn to work in interprofessional teams throughout the first 18 months of the curriculum. Curriculum Curriculum changes since 2010 In April 2010, a curriculum renewal committee charged 4 separate design/modeling committees—each containing faculty, staff, and students—to develop a plan to innovate, renovate, and remodel the 4-year medical education program. These committees independently developed 4 new structural models that were presented to each CCOM department and to students. Broad feedback was obtained, and ultimately the most promising and innovative elements of each model were selected and synthesized into a single consensus curriculum. The preclinical semesters (Phase I) in the new curriculum were reduced from 4 to 3, and the length of individual courses in the MOHD strand was reduced from an entire semester to 8–10 weeks. Phase I of the curriculum also features longitudinal mentored clinical experiences beginning as early as the first week of medical school. During Phase II, students complete 9 core clerkships over a 12-month period. This core clerkship year now begins after 3 semesters of preclinical instruction rather than the 4 weeks in the previous curriculum. The core clerkships comprising Phase II are grouped into four 12-week blocks: Ambulatory practice module: community-based primary care, family medicine, and outpatient internal medicine Inpatient internal medicine and pediatrics Obstetrics–gynecology and surgery Neurology and psychiatry These linked clerkships have shared education days to cover specifically assigned components of the physical examination and mutually agreed upon exemplars, often as part of performance-based assessment activities (e.g., simulated patients, postencounter, computer-based assessments). The recommended timing of the USMLE Step 1 examination was moved to follow completion of core clerkships in Phase II. In Phase III, an increase from 2 to 3 semesters following completion of Phase II provided increased flexibility for students to individualize their medical education and explore multiple career options. Students engage in an individualized educational experience that is designed to ensure a broad base of medical knowledge and skill set at graduation to prepare for entry into their chosen residency. See Supplemental Digital Appendix 1—Curriculum Schematic—at https://links.lww.com/ACADMED/A936. Assessment The CCOM medical education program objectives are organized around the ACGME framework of 6 domains of competence. To assess program outcomes, the Medical Education Council (MEC) set benchmarks regarding achievement of the objective for each metric in the table. The council reviews outcomes relative to these metrics annually basis. In addition, CCOM developed its own clerkship tracking software, CLERX, that facilitates oversight of required clinical experiences at both clerkship and collegiate levels. This software replaced a commercial product that was more cumbersome for student recording and technically challenging for generating reports for central monitoring of Required Clinical Experience completion. A relatively recent enhancement in student assessment was the development of a cadre of physical exam teaching associates (PETAs) to facilitate teaching the physical examination. PETAs are rigorously trained by clinicians to teach the physical exam system according to a validated, clinician-developed checklist delineating the steps of the exam. See Supplemental Digital Appendix 2—Program Objectives and Assessment Methods—at https://links.lww.com/ACADMED/A936. Parallel curriculum or tracks Distinction track: CCOM’s distinction tracks offer students opportunity to pursue scholarship outside of the standard medical curriculum. These voluntary tracks represent ways for students to gain tangible knowledge and skills beyond the basic science and clinical knowledge domains. The pursuit of distinction tracks is documented within a student’s medical student performance evaluation and acknowledged during the graduation ceremony. There are 6 tracks: teaching, service, research, global health, humanities, and health care delivery science, management, and policy. Each track includes multiple requirements including didactic content, related educational activities, and a mentored capstone project. Each track includes a council that reviews student work and progress in meeting requirements. CCOM Rural Iowa Scholars Program (CRISP): This is a comprehensive parallel curricular program focusing on rural medicine throughout medical school by providing supplementing the standard curriculum. Students begin the program the summer before their first semester by shadowing a physician mentor in a rural community. Rural elements are embedded in their medical education through mentorships, seminars, research, and electives. The CRISP clinical experiences include completing continuity of care experiences at a rural site, with specific activities designed to introduce students to community life, health systems, and rural cultures. Additionally, CRISP students complete a rural capstone research project and attend a state or national rural medicine conference. Graduates must practice in an eligible community in Iowa for a minimum of 5 years after completing a qualifying residency to receive loan repayment. Pedagogy A “triple helix” model for the new curriculum was developed with the 3 strands extending throughout all 4 years. The 3 are MOHD, medicine and society, and clinical and professional skills (CAPS). The strands are interwoven in a helical spiral to enhance horizontal and vertical integration of content and to promote deliberate revisiting of material to encourage progressively deeper understanding and mastery. Pedagogical approaches in the new curriculum include case-based learning, problem-based learning, large- and small-group discussion, laboratory and lectures, ambulatory and inpatient clinical experiences, preceptorships, self-directed learning/tutorial, peer teaching, and video/podcasts, as well as an increase in team-based learning, simulation, standardized/simulated patients, and workshops. Clinical experiences Students have their first clinical experience during the first week of medical school. Clinical education occurs primarily at University of Iowa Hospitals & Clinics, the Veterans Administration Medical Center, the Des Moines Branch Campus, and Regional Medical Education Center (RMEC) sites (for the community-based primary care clerkship). This clerkship maintains an administrative structure in which the orientation of faculty to course objectives and grading is coordinated through 6 RMECs. During this clerkship, students spend 4 weeks with a family practitioner in community practice and 4 weeks at one of the RMECs located statewide. Curricular Governance The MEC is the designated executive body responsible for design, implementation, and evaluation of the CCOM curriculum. The 4 MEC subcommittees are the Medical Arts and Sciences Committee (MASC), the Clinical Experiences Committee (CEC), the Strand Director’s Subcommittee, and the Assessment Subcommittee. With the exception of the Strand Director’s Subcommittee, the MEC and the other subcommittees are chaired by a UME dean. See Figure 1—Curriculum committee structure.Figure 1: Curriculum committee structure.The MASC is charged with implementing, managing, and reviewing the preclinical curriculum (Phase I). It reviews and provides feedback on course objectives, sequence of instruction, and integration of material within and across the preclinical curriculum. The MASC reviews preclinical content areas and recommends and implements policies for ensuring quality in courses and fairness in assessments. The CEC is charged with the implementation, management, and review of the clinical curriculum (Phase II/III). It reviews and provides input to the MEC regarding clerkship objectives and sequence of instruction within and across the clinical curriculum. The CEC reviews the clinical curriculum to identify and address redundancies and gaps, facilitates integration of foundational science content, and conducts reviews of targeted areas of need specific to the clinical curriculum. The CEC also recommends and implements policies for ensuring quality in courses and fairness in assessments. The Strand Director Subcommittee is charged with implementing curricular goals, the 3 curricular strands, and the individual required course and clerkship objectives: developing and facilitating the integrated 3-strand curriculum, including coordination and communication across strands, semesters, courses, and clerkships; collaborating and participating in evaluating the overall outcome of the curriculum; and making recommendations for the appropriate utilization/distribution of limited education related resources. It maintains a current map of each strand’s goals, objectives, metrics, and integration across the required curriculum. This committee also reviews and provides feedback on course objectives, sequence of instruction, and integration of material within and across the 4 years. The Assessment Subcommittee is charged with developing and assisting in implementation of a data collection and analysis plan for evaluation of the UME curriculum, monitoring the UME program’s compliance with elements of the accreditation standards relevant to the evaluation of the curriculum, and making recommendations regarding policies related to student and program assessment as requested. It reviews and provides feedback on program objectives, sequence of instruction, and integration of material within and across the curriculum. This committee also conducts data gathering and analysis relevant to assessment of the curriculum, develops and implements policies for ensuring quality assessment of the curriculum, and reviews and provides feedback on relevant instruments and methods of data gathering and analysis. Educational Staff The OSAC is the group of 35 professionals who most directly facilitate medical student activities at CCOM. Additionally, each of the 4 learning communities have 2 faculty codirectors. The OSAC mission is to provide an environment of scholarship and humanism in which students can become the well-rounded physicians of tomorrow, fully prepared to enter their professional lives focused on the well-being of their patients and communities. OSAC consists of 10 units, and among its duties are selecting students who will thrive in this academic environment; facilitating the delivery of a medical curriculum providing the best didactic and practical learning experiences possible; providing opportunities for students to experience the world through research, service, travel, and the humanities; and supporting students throughout the learning process. The 5 educational deans for UME are also within OSAC. See Figure 2—Deans involved in UME.Figure 2: Deans involved in UME.Faculty Development in Education and Promotion The Office of Consultation and Research in Medical Education (OCRME) provides coordination of services and products that support curriculum development, faculty development, measurement, evaluation, and educational research. Departmental seminars and faculty workshops are conducted by OCRME. OCRME also leads the Clinical Teaching Scholars Program for faculty and a master’s in medical education program. The OCRME Community Clinical Teaching Scholars Program brings faculty from RMECs to Iowa City for all-day meetings 3–4 times per year to help develop local leaders who can partner with OCRME to conduct faculty development programs at each affiliate site. Each regional site also conducts faculty development programming on site at least twice yearly with guidance and assistance of OCRME staff. Promotion in the clinical track requires an acknowledged record of continued teaching success, including a record of successful direction of student, fellow, or resident work where applicable. Evaluation of teaching includes review of teaching materials and evaluations in terms of quantity and quality relative to peers. Educational activities including educational scholarship may also contribute to the record of professional productivity. Promotion on the tenure track also includes a similar evaluation of the applicant’s teaching record. Regional Medical Campus The assistant dean of the Des Moines branch campus monitors clinical sites, housing, and other facilities and resources. The clerkship directors at each campus work collaboratively to implement the curriculum, including determining identical learning objectives and requirements, formal educational sessions and resources, assessment methods, grading policies, and other conditions needed to ensure comparable education and assessment. Clerkships are reviewed regularly through the CEC, and annually the MEC evaluates comparability of education and assessment at the 2 campuses. The MEC determines the comparison measures and directs the medical education monitoring and evaluation team to analyze data and generate a comparability report including measures of student achievement and clerkship quality. See Table 1—Regional Medical Campus.Table 1: Regional Medical Campus

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