Rutgers Robert Wood Johnson Medical School

Medical Education Program Highlights Rutgers Robert Wood Johnson Medical School has a 4-year curriculum, and for AY 2020–2021, a 2 + 2 structure. There is an integrated systems-based preclerkship curriculum with normal structure and function, physiology/biochemical/molecular biology principles in year 1, and pathology/pathophysiology/pharmacology in year 2. The curriculum is anchored by the Patient Centered Medicine (PCM) course, teaching skills foundational to becoming a physician. This course also covers humanism, ethics, disparities in health and health care, patient safety, interdisciplinary teamwork, community/population health, and health systems science (HSS). The order of topics and flow of clinical encounters in PCM integrates with the foundational science curriculum, particularly in year 2. Two curricular threads, evidence-based medicine (EBM) and HSS, are integrated over 4 years. There are 8 traditional core clerkships, a critical care selective, 3 weeks of ambulatory experiences, a subinternship, and a 2-week specialty-specific transitions to residency course, focusing on transitions of care, high-fidelity simulation, advanced communication, procedures relevant to particular specialties, quality improvement/patient safety, and case-based learning as USMLE Step 3 examination preparation. Curriculum highlights Development and implementation of the Empathy and Clarity Rating Scale, an inductive developmental tool for formative and summative assessment of clinical skills: This scale with specific attention to empathetic communication was developed interinstitutionally, using the expertise of clinicians, improvisation actors, patients, and communication experts. After commenting on positive and negative observed behaviors, the rater considers the learner’s level of training and balance of positive to negative feedback needed, then rates the learner’s performance based upon behavioral anchors. The scale allows for rich formative feedback on communication and provides individual longitudinal data regarding approach to gold standard communication skills. Implementation of a student-led teamwork training program across the 4 years, anchoring HSS concepts: Our veteran students inspired a movement at the school. Recognizing how health care varies significantly from the synchronized and high-functioning team environment of the military, students proposed the integration of TeamSTEPPS (Team Strategies to Enhance Performance and Patient Safety) across the curriculum. The student body has embraced the core principles of TeamSTEPPS. Each year reinforces different skills; the movement has led to training in the clinical learning environment, and the skills are foundational to HSS experiential learning activities. Frame-of-reference training for clerkship evaluations: With the goal of decreasing the perceived gap between how students and their evaluators assess clinical performance, we built an interactive tool for faculty, residents, and students with the goal to train all stakeholders in using our clerkship evaluation form. Using case presentations developed by core clerkship directors to demonstrate different levels of clinical performance, we designed a web-based, frame-of-reference training tool allowing users to rate a set of case presentations, compare ratings to those determined by the clerkship directors, and receive feedback. We are assessing this program’s impact on rating habits and perception of fairness. An academic support program that focuses on the alignment of learning, teaching, and assessment: Academic support efforts are framed by the goal of aligning learning, instruction, and assessment. Our longstanding Cognitive Skills Program (CSP) supports student self-directed learning and preparation for future learning through group activities and widely used individual consultation. The CSP faculty support school-wide educational effectiveness through faculty development in designing and implementing instruction conducive to self-regulated learning and through guidance to faculty and staff. Educators are charged with designing, innovating, and evaluating programmatic assessments that focus on student learning in the near and long term. Curriculum Curriculum description See Supplemental Digital Appendix 1—Curriculum Schematic—at https://links.lww.com/ACADMED/A930. Curriculum changes since 2010 The ecology of medicine: interprofessional students caring for patients living at home with chronic conditions Enhanced patient safety/quality improvement curriculum: TeamSTEPPS annually Clinical Immersion experience with teams of students “belonging to” a hospital unit Safety Huddle experience with first-year students at primary teaching hospital Interprofessional simulations Prescription writing workshops with pharmacy students High-fidelity simulation throughout 4 years Specialty-specific transition to residency courses Workplace-based assessments and additional structure for subinternships New primary care track: Primary Ambulatory and Community Clerkship Experience (PACCE) 2 new regional medical campuses Narrative medicine in the clerkships EBM thread New topics: digital and connected health, physician wellness, patient- and family-centered care for veterans Formative Comprehensive Basic Science Examinations in year 2 Numerous student-driven and created electives and educational phenomena 7 opportunities for distinction: research, medical education, service to the community, bioethics, global health, biomedical innovation and entrepreneurship, and leadership in academic health care Expanded communication curriculum with improvisation-informed curriculum and student assessment using the Empathy and Clarity Rating Scale We are currently planning for an AY 2021–2022 new curriculum rollout. Tenets include enhancing clinical skills/clinical decision-making as well as entrustment of core professional activities by increasing the length of the clerkship curriculum and enhancing content in HSS and skills of practice. The curriculum will focus on the quadruple aim for medical education or the Four Cs: curiosity, critical thinking, competence, compassion. There have been multiple class size changes related to a former regional campus becoming a new medical school. Health systems integrations/consolidations have modified regional campus plans. We anticipate that no more than 30 students will complete clerkships at a regional campus; most students rotate through multiple sites. Assessment We use the ACGME framework as the basis for the medical education program objectives. The Core Entrustable Professional Activities framework is being considered for the new curriculum. We have implemented the Reporter–Interpreter–Manager–Educator–Professional paradigm since 2010. See Supplemental Digital Appendix 2—Program Objectives and Assessment Methods—at https://links.lww.com/ACADMED/A930. Parallel curriculum or tracks The focus for the PACCE track is to provide a clerkship experience that affords the opportunity for continuity of care. The longitudinal relationships between faculty mentors, other health professionals, patients, and peer students are paramount. School-wide and clerkship objectives are identical; however, the student experience in a longitudinal ambulatory setting with a panel of patients over time provides a richer learning environment to internalize many objectives related to primary and ambulatory care in the community. There is enhanced opportunity for transitions of care and interprofessional activities. Total inpatient clerkship time is abbreviated to allow 2 longitudinal blocks of outpatient care. The structure is the same as the traditional curriculum except for the third-year clerkship experience. In AY 2021–2022, we plan to offer a 3-year MD degree program to students pursuing primary care (family medicine). Pedagogy The preclerkship curriculum uses lecture with podcast capture, case-based learning, self-directed learning, laboratory (gross anatomy/neuroanatomy/histology/microbiology), simulation, and team-based learning. The preclerkship clinical curriculum includes lecture and small-group discussions, preceptorship, role play/dramatization, standardized patients, and procedure workshops. The clerkship curriculum includes ambulatory and inpatient clinical experiences, simulation, standardized patients, lecture and small-group discussions, and procedure workshops. The PACCE track has identical pedagogical approaches. Since 2010, simulation has been incorporated across the 4 years, procedure workshops have been enhanced via specialty-specific transitions to residency courses, self-directed learning activities and team-based learning have been added, and role play and dramatization have been added via improvisation informed curriculum. Clinical experiences Learners first encounter clinical experiences early in the first year. Clinical sites used for required educational experiences: Hospitals Outpatient offices Federally qualified health centers (FQHCs) Sites for care of individuals with disabilities Sites for care of individuals at end of life Home Required longitudinal experiences All students have required longitudinal experiences as selected experiences Continuity experiences with individual practitioners Promise clinic (student-run clinic) Home PACCE track Required and elective community-based rotations All students complete a required 15-hour service-learning experience in the family medicine clerkship. Sites include substance abuse rehabilitation centers, schools, food kitchens, and others. Outpatient sites for required preclerkship and clerkship activities include FQHCs and the student-run clinic. Students in the PACCE track may complete outpatient activities at VA clinics. Electives are offered through the student-run clinic. Challenges in designing and implementing clinical experiences Considerable oversight is needed to maintain comparability of clinical experiences, bedside/office-based teaching, and student performance assessments. The associate deans for clinical education, the regional medical campuses, and student affairs closely monitor student and faculty experiences. Curricular Governance The Office of Education supports the chair of the committee, administrative faculty and staff, all assessments, and academic support services. See Figure 1—Curriculum governance chart.Figure 1: Curriculum governance chart.Education Staff The Office of Education is led by the senior associate dean for education and academic affairs (SADEA), the CAO. It comprises faculty administrators (assistant dean for medical education; associate dean for clinical education; director for the Office for Advancing Learning, Teaching, and Assessment), core educational faculty (directors of all of the preclerkship integrated curriculum, director of simulation, and 3 doctorally trained cognitive skills specialists), a director for educational technology, an assessment and evaluation specialist, and support staff (program support specialists for the preclerkship integrated blocks, PCM 1 and 2, clinical courses, and Clinical Skills Center). All faculty administrators directly report to the SADEA. The SADEA collaborates with the Education IT Advisory Committee via the director for education information technology strategy. This collaboration is used to plan and prioritize strategic initiatives and ensure operability of the technological platform for implementing and evaluating the curriculum: course management platform, assessments and evaluations, independent project management, and Medical Student Performance Evaluation preparation. IT also supports distribution of and attestation to educational policies and learning objectives. The assessment and evaluation specialist performs planning/implementation/evaluation and monitoring of curriculum activities: facilitation of test construction and assessment, providing item-level data, analysis of student performance on exams, guidance for course directors and students on interpreting results, and preparation of curriculum searches. See Figure 2—Organizational chart.Figure 2: Organizational chart.The role of the medical education staff is to primarily support the UME program. The senior associate dean for education and academic affairs oversees all areas of the continuum, pre-UME, UME, GME, and CPD. Student Affairs, admissions, and registrar faculty and staff are fully integrated in the UME programming. The Office of Education and Academic Affairs is an equivalent of an academic department. It includes administrative faculty and core educators of the preclerkship curriculum and supports the administrative roles of directors of the PCM courses and third- and fourth-year curriculum. All faculty maintain a primary appointment within a basic or clinical discipline; however, the salary lines of the administrative faculty and the core educators are under the Office of Education. Faculty Development and Support in Education Professional development is offered through web-based applications and in-person teaching series. The SADEA is responsible for the faculty mentoring program and supporting faculty in developing individualized development plans, which are found to be most helpful for nontenure track faculty who want to develop educational portfolios. Teaching is mandatory for tenure and nontenure (clinical and research) tracks. Teaching evaluations are reviewed in all tenure decisions. Promotion in the professional practice track requires teaching activity, but not scholarship. Promotion in the clinician–educator and teaching tracks mandate peer-reviewed manuscripts. All faculty develop a teaching portfolio for the promotion process. The scope of the Institute for Excellence in Education includes faculty from other Rutgers schools beyond health professions, in addition to outside educational experts. The institution serves 3 groups—faculty, learners, and patients: “to engage learners to provide high-value health care, communicate respectively in a patient- and family-centered fashion, collaborate and partner with other health care professionals to devise treatment plans and strategies for adherence and self-care, integrate scientific underpinnings of clinical medicine and best evidence into daily practice, and prepare learners to distinguish themselves and prepare teachers for educational scholarship.” The institute supports the Medical Education Scholarship Learning Community and the Academy of Medical Educators. Regional Medical Campuses There is close communication between the CAO and principal academic officers at the regional sites. Functional integration of regional campus faculty via standing committees acculturates faculty from all campuses and leads to a shared mental model of the educational program. There is communication between clerkship and clerkship site directors at least every block, the associate dean for clinical education visit the sites at least quarterly, and the student affairs deans meet with all students on a clerkship at least every other block to obtain student feedback from students at all sites. An electronic clerkship evaluation system is monitored each block by the senior associate dean, associate dean for clinical education, and evaluation and assessment specialist. Shelf exam scores and clinical evaluations are reviewed annually for any discrepancies. See Table 1—Regional Medical Campuses.Table 1: Regional Medical Campuses

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