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Medical Education at the Crossroads: A New Perspective

Mark Miller, PhD, associate professor in the Departments of Medical Education and Microbiology, Immunology and Biochemistry, helps a team work through a case study. Although the primary goal of team-based learning is for students to teach each other through team-based discussions, faculty instructors are available to answer questions and facilitate discussions.

Curriculum Change Sign2Continued from … Medical Education at the Crossroads

As the field of medicine constantly evolves, so must the training for those who practice it.

This is a fact that the leaders of the UTHSC College of Medicine wholeheartedly embrace. “It’s our greatest challenge and our greatest opportunity,” says Clint W. Snyder, PhD, MBA, senior associate dean and chair of the new Department of Medical Education for the UTHSC College of Medicine. Snyder, who joined the faculty in October 2014, is in charge of all undergraduate medical education, including curriculum planning, evaluation, and accreditation, along with educational faculty recruitment, development and research efforts.

To meet the challenge/opportunity, the College of Medicine has been updating its education model to equip medical students to practice in today’s health care system.

Dr. Clint Snyder

“Historically, the way that we’ve educated our learners has not been competency based. We’d stand at the front of the room and lecture while they’d sit passively and listen, and we’d give them exams to see if they remembered everything that we’d said,” Dr. Snyder explains. “Simply being a content expert is no longer the way that medicine is practiced, and as our graduates go into their fields, they need a very different set of competencies. They need to be able to work as a collaborative part of the health care team.”

Teaching for Today

Over the last several years at UTHSC, traditional lectures and exams have been giving way to “flipped classrooms” that involve more self-guided and online study by students with class time spent in scenario-based learning, evaluation and application of concepts. “We need to help our learners apply information, not just recall it,” Dr. Snyder says. “We need to help our learners know how to find information, not memorize massive amounts of it. That’s very different from the health care education environment that many of our faculty members went through themselves.”

Multidisciplinary, systems-based teaching has brought basic and clinical science faculty members at UTHSC together at the same time to teach around a concept or organ system. “Increasingly, we’ve seen our faculty come to this idea that there’s no one department that owns any part of the curriculum,” Dr. Snyder says. For example, instructors in biochemistry, physiology and anatomy are coming together with radiologists, internists and pathologists to teach around a core content area or organ system, rather than teaching in series.

“Learning is facilitated when it’s presented in a relevant way that’s similar to the way information is used,” says Stephen Nace, MD, FACP, associate professor of Medicine and assistant dean for Curriculum Integration at UTHSC. “Accrediting bodies have been encouraging transition to integrated curriculums.”

The old two-plus-two model gave students two years of basic science followed by two years of clinical science. “With integrated education, you learn the clinical relevance of a process or disease at the same time you learn the basic science,” Dr. Nace says. “It’s bringing clinical relevance into basic science instruction, so even M1 and M2 students learn clinical application.”

He credits former Associate Dean for Medical Education Robert Shreve, EdD, with being a leader in the move to integrate the medical curriculum at UTHSC. Dr. Shreve retired after the College of Medicine was reaccredited for a maximum eight-year term by the Liaison Committee on Medical Education (LCME). Accreditation by the LCME signifies that national standards for structure, function and performance are met by a medical school’s education program.

Team-based learning helps students learn necessary collaborative problem-solving within groups.

Team-based learning, started several years ago at UTHSC, also helps students to learn necessary collaborative problem solving within groups, Dr. Nace says.

Pat Ryan, PhD, assistant dean for the Basic Science Curriculum and associate professor in the Departments of Medical Education, and Microbiology, Immunology and Biochemistry, was the faculty accreditation lead for the College of Medicine.

Dr. Ryan says this continuing evolution in teaching contributed to the reaccreditation. “As for key changes, we made two significant ones,” he says. “First, we moved away from department-based courses that resulted in discipline ‘silos’ to a more integrated approach that uses organ systems as a basis for much of the instruction in the first two years. This is not a new idea, but we were using a very traditional model prior to the curriculum revision. The integrated approach facilitates contextual learning by the students and hastens clinical application of basic science tenets.”

Another key change is increasing the amount of engaged, active learning that students experience in the classroom. “One approach was the adoption of team-based learning as one delivery method,” Dr. Ryan says. “Active learning is a point of emphasis by the LCME because it pushes students to learn how to be lifelong learners, obviously a necessary skill for physicians.”

Students learn how to find information rather than memorize massive amounts of data. They apply the information to solve complex questions.

Students learn how to find information rather than memorize massive amounts of data. They apply the information to solve complex questions.

Dr. Snyder says, “We’ve been doing well here. But, I think that integration can be even stronger.”

Along with the changes in teaching come changes in testing, which is becoming less about recall and regurgitation of facts and more about testing students in ways similar to how they will be tested in practice. Emphasis in testing is placed on assessing skills, at synthesizing information and solving problems collaboratively.

The Robert J. Kaplan Clinical Skills Center on campus is key to this new approach to teaching and testing. Through simulation with standardized patients, students are taught interview skills, communication with patients and team members, and diagnostic skills. They get feedback from instructors based on their performance. Construction will begin soon on a $24.1 million Multi-Disciplinary Simulation building, which will provide more opportunities for collaborative, scenario-based training of students.

Student Select E
A student posts his team’s answer to one of the case problems at the conclusion of deliberations. All teams declare their answers simultaneously, revealing and defending them to the group at large.

Expanded use of virtual simulation and educational gamification are also providing educators with additional tools to engage students in meaningful ways. Dr. Nace, who will be leading the introduction of new educational technologies in the medical school curriculum, believes these tools hold the potential to greatly enhance the training of physicians.

Dr. Snyder also sees a teaching opportunity in the community. Training medical students first as patient navigators and later to help in some basic aspects of care would give them clinical education early on and advance UTHSC’s mission of service to the community. “Getting the students involved early and in meaningful ways with the community is something that greatly inspires me,” he says.

Planning for the Future

The new Department of Medical Education, formed in 2013, was a major step in the evolution of education in the UTHSC College of Medicine. “The creation of that department really shows the importance of education as one of our core missions,” says Dr. Nace, who served as the interim chair until Dr. Snyder was appointed.

The department reflects a dedication to developing educators and encouraging educational research and publishing. It also recognizes the accomplishments of faculty members as educators.

“Faculty development, the opportunity to improve our skills as faculty members, is vital. Whether it be around our teaching, our assessment, our research, our leadership, we as faculty spend so much of our time educating and training others that oftentimes our own developmental needs go by the wayside,” Dr. Snyder says. “I think development is frankly the least we can do for a group of faculty who have shown such commitment to educating our learners.”

The department is also moving to better map and manage its changing curriculum to ensure it is meeting content goals and objectives.

As the educational mission of the College of Medicine morphs, Dr. Snyder sees UTHSC alumni as “a huge and valuable resource” for the future. He encourages alumni support in providing clinical experiences, mentoring and advice to students.

“It’s an exciting time here at the College of Medicine, and we need them to help us move our education to the next level,” he says.

Next … Bridging the Gap