Virginia Commonwealth University School of Medicine

Medical Education Program Highlights Students enrolled at Virginia Commonwealth University School of Medicine (VCU-SOM) are engaged in diverse learning opportunities in the classroom, patient care areas, and the larger community. In 2013, a major curriculum redesign was completed. A traditional 2-year preclinical curriculum was replaced with an 18-month integrated systems-based curriculum that emphasizes active learning opportunities. The clinical phase was expanded in duration and now includes career-exploratory electives as well as formative assessment and coaching programs developed to support the Core Entrustable Professional Activities (Core EPAs) for Entering Residency. Students have opportunities to participate in experiential learning opportunities based in programs such as the VCU Acute Care and System Strengthening in Low Resource Settings and the International/Inner City/Rural Preceptorship. And, for those exceptional students seeking an early entry to residency, the competency-based continuum allows students to graduate when deemed competent for residency. Dynamic faculty development initiatives such as the Teaching in Medicine Education (TiME) certificate program and monthly lunchtime learning sessions provide faculty and staff members with opportunities to continue their education in learning and teaching topics and techniques. Curriculum Curriculum description The MD program curriculum is organized into a 3-semester basic science–oriented phase followed by a 24-month clinically oriented phase. See Supplemental Digital Appendix 1—Curriculum Schematic—at https://links.lww.com/ACADMED/A896. Curriculum changes since 2010 The VCU-SOM launched the C3 Curriculum (Competency Based, Centered on the needs of the learner, and Clinically Focused) in 2013. Additional modifications have been made on an annual basis following continuous evaluation of the program. Highlights curriculum include: Consolidated preclinical phase and extended clinical training Increased focus on active learning techniques Incorporation of curriculum in ultrasound, interprofessional education, quality, and safety Revision of core clerkships including reduction in the length of internal medicine, pediatrics, and psychiatry Creation of additional required clinical rotations in ambulatory medicine and a dedicated elective block in the third year Expansion of fourth-year requirements Development of interdepartmental acting internship experiences Adoption of Core EPAs and implementation across clinical rotations Development of required capstone course and specialty-specific “boot camps” prior to graduation Assessment The VCU-SOM objectives were developed to fit the framework outlined by the ACGME core competencies. Within each primary objective there are several subobjectives. See Table 1—Program Objectives and Assessment Methods.Table 1: Program Objectives and Assessment MethodsThe medical education objectives were based on the ACGME competency domains. In 2015, the subobjectives were modified to incorporate the Core EPAs. In the preclinical years, low-stakes summative assessments such as quizzes, team-based learning, and assignments were added to existing higher-stakes multiple-choice tests. Formative self-assessment questions were added to every course. In the clerkships, several additional modifications were made. Additional OSCEs were added to clerkships. A written clinical skills assessment was added to the pediatrics clerkship. Beginning in 2018, students were required to obtain formative workplace-based assessments for the Core EPAs. In 2018, the grading structure for the core clerkships and acting internships were revised to incorporate the RIME (reporter, interpreter, manager, educator) framework across clerkships. In the postclerkship phase, a formative clinical skills assessment was added to prepare students for the USMLE Step 2 Clinical Skills examination. The VCU-SOM has begun piloting a competency-based graduation program. While this program is not specifically a 3-year program (students graduate when deemed “competent”), the duration is, in effect, 3 years. Pedagogy In the preclinical phase and clinical phases, a variety of teaching strategies are used. Active learning strategies are encouraged whenever appropriate. The following is a list of approaches used throughout the program: Case-based learning Clinical experience: ambulatory Clinical experience: inpatient Discussion: large group Discussion: small group Lecture Peer teaching Preceptorship Role play Self-directed learning Simulation Standardized patients Team-based learning Virtual patient Workshop Other: process-oriented guided inquiry learning Since 2010, the VCU-SOM has established a goal of 50% of class time devoted to active learning, accomplished through utilization of team-based learning, flipped classroom, standardized patients, and workshops. In addition, increased time has been allotted for self-directed learning. In the clinical phase of the curriculum, clerkships have expanded in the use of simulation, standardized patients, and team-based learning. Examples are provided below: Internal medicine: revised didactic curriculum to include team-based learning activities Obstetrics–gynecology: developed pelvic examination simulation Neurology: created simulation for lumbar puncture Pediatrics: developed standardized patient exercise to teach family-centered rounds and simulations around respiratory distress, lumbar puncture, and otoscopy Surgery: developed workshops to teach students suturing skills and nasogastric tube placement Clinical experiences VCU-SOM uses a variety of clinical sites for required educational experiences. Ambulatory sites include primary care, subspecialty care, and surgical clinics at the VCU Health Medical Center, the Hunter Holmes McGuire VA Medical Center, and community-based settings throughout the state of Virginia. Inpatient sites are primarily based at the VCU Health and Hunter Holmes McGuire VA medical centers. In addition, a subset of medical students rotates through community hospital affiliates in the Richmond metropolitan area. The VCU health system (VCUHS) recently formed a partnership with Community Memorial Hospital in South Hill, Virginia. Plans are currently underdevelopment to initiate medical student rotations at this site. Practice of Clinical Medicine (PCM) course: This is an 18-month course that takes place throughout the preclinical phase of training. Students learn foundational skills of doctoring (e.g., history taking, physical examination) through a combination of didactics, small-group learning, and standardized patient exercises. Performance is assessed through multiple-choice-based examinations and OSCEs. Fourth-year students are provided an opportunity to function as coleaders in the small-group experience. Physician, Patient, and Society course: This course spans the entirety of the MD program. Its purpose is to provide students with humanistic, ethical, and legal skills required to practice medicine. A wide range of topics are presented and include career development, integrative/complementary medicine, palliative care, physician–patient relationship, spirituality, health disparities, physician bias, cultural competency, and application of ethics and law in medicine. Instruction includes didactics, patient panel activities, and experiential learning. Assessment is composed of multiple-choice tests, reflective writing assignments, and participation. Population Health and Evidence-Based Medicine course: This course spans the entirety of the MD program. In the preclinical component of the course, students learn foundational skills regarding social determinants of health, assessment of population-level health, methods for evaluating the health literature, and biostatistics. In the clinical phase, student apply evidence-based medicine skills to clinical situations encountered in their clerkships. Methods for instructions include didactics and small-group work. Assessment is conducted by participation and multiple-choice examinations. Patient Safety and Quality Improvement course: This interprofessional course spans the entirety of the MD program. Medical students work with learners from other health care professions to discuss principles of quality improvement and to apply those principles to the care of patients in the clinical environment. Instruction includes didactics, small-group learning, and simulation. Assessment is through participation, multiple-choice examinations, and standardized patient scenarios. Clinical experience first encounter Students are introduced to clinical medicine in the first week of the MD program in the context of the PCM course. In that setting, students participate in a simulation-based “boot camp” that includes standardized patient exercises. The first encounter with nonstandardized patients occurs in the third semester where students are paired with a preceptor for the PCM course. On a monthly basis, students spend at least 1 half day with the preceptor in his/her setting performing histories, physicals, and presenting patients. Required and elective community-based rotations The family medicine clerkship uses community-based physicians to deliver the clinical experience in the clerkship. Students are paired with a family medicine physician throughout the state of Virginia for the duration of their clerkship. A subset of medical students completes portions of their obstetrics–gynecology and pediatrics clerkships at community-based sites. The obstetrics–gynecology clerkship is offered at Riverside hospital, a community-based medical center in Hampton, Virginia. The inpatient component of pediatrics is offered at Chippenham hospital, a community-based facility within the Richmond metropolitan area. Challenges in designing and implementing clinical experiences for medical students VCUHS and the Hunter Holmes McGuire VA are outstanding major referral centers within the central Virginia region. While these sites are outstanding, there are several limitations. First, the high degree of specialization comes at some trade-off with respect to some lack of exposure to “bread and butter” clinical experiences. Second, while some specialties provide students with substantial patient volume, there are notable exceptions including pediatrics, obstetrics–gynecology, and to some degree psychiatry. The pediatrics volume will be improved with plans to complete the building of the first children’s hospital in the region in 2023. In addition, VCUHS has a limited number of affiliated ambulatory sites, which creates some strain on providing ambulatory experiences for students within the area, particularly in primary care fields. Curricular Governance Central oversight for the curriculum is provided by the Curriculum Council, which has the authority to monitor, review, and revise the curriculum of the medical school and acts on the authority of the dean. Membership consists of voting and nonvoting members. Voting members include those elected by the larger faculty body, those appointed by nature of their positions (the deans for preclinical and clinical medical education), and students elected by the student body. With the exception of members with positions in the dean’s office, all voting members serve a 4-year term. Voting members for the Curriculum Council are: 1 chair 2 vice chairs 4 basic science faculty 7 clinical faculty 2 assistant deans 4 student representatives (1 per class) Curricular governance allows for departments to propose curricula, assessment strategies, budget for various initiatives (e.g., simulation, OSCEs), and leadership (e.g., course and clerkship directors). Final approval is determined by the Curriculum Council. Education Staff Administration of the medical education program is coordinated through several offices that work in parallel with direct reporting responsibilities to the dean. The Office of Curriculum and Student Affairs serves 3 functions relevant to the medical education program: student affairs, oversight of preclinical and clinical educational programs, and financial aid. The Office of Assessment, Evaluation, and Scholarship provides comprehensive program evaluation. The Curriculum Council provides overall oversight and participates in monitoring the program. See Figure 1—Organizational chart.Figure 1: Organizational chart.The Office of Curriculum and Student Affairs is responsible for the undergraduate medical education program and student affairs only. Graduate medical education and continuing medical education are administered through separate offices with parallel reporting structures to the dean. Faculty Development and Support in Education Professional development for faculty as educators The Office of Faculty Development supports the development of teaching faculty within the VCU-SOM. Multiple opportunities for faculty are provided, which include: TiME postgraduate certificate: 12-credit certificate program coordinated through the VCU School of Education. Interested faculty are able to take coursework in adult learning, instructional design, educational scholarship, etc. iTeach website: a centralized resource for innovative teaching strategies. Includes best practice videos, featured faculty, audio/video podcasts, original research articles regarding innovations, and a public forum for engagement Lunchtime Learning: 90-minute sessions offered live and recorded on a variety of core teaching topics 1-on-1 teaching consultation: provided by faculty and staff within the Office of Faculty Development to assist in creation of new learning technology, instructional methods, and assessment Role of teaching in promotion and tenure Promotion and tenure are driven by 3 components: service, scholarship, and teaching. Eligibility for promotion is determined by designations of “unsatisfactory,” “satisfactory,” “very good,” or “excellent” ratings in each of the 3 categories. Faculty must demonstrate excellent performance in either scholarship or teaching for advancement unless the vast majority of their effort qualifies in the service domain. Teaching quality is measured holistically through a variety of categories including teaching activities, educational scholarship, educational leadership, and curriculum development. Regional Medical Campuses VCU-SOM maintained a partnership with INOVA Fairfax Hospital in Fairfax, Virginia, beginning in 2005. That partnership will be discontinued with the graduating class of 2021

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