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Early Clinical Learning

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Several factors contribute to the trend toward earlier clinical learning in undergraduate medical …

Several factors contribute to the trend toward earlier clinical learning in undergraduate medical
education programs. This excerpt outlines factors driving significant change at a large Caribbean medical school which prepares students for practice in the United States-consistent with adult learning theory.

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  • 1. EARLY CLINICAL LEARNING:WHAT FOR, WHAT IF, AND HOW?Sharon Morang, MBA-Director of CurriculumJames Grogan, PhD-Assistant Dean of CurriculumMary Coleman, PhD, MD-Dean Association for Medical Education in Europe Glasgow, Scotland 2010
  • 2. The medical university is a propriety school held by a publicly traded companywith commitment toward developing healthcare education leadership.Enrollment is nearly 400 students per entering class, beginning three times peryear. 1. Large percentage (65%) enter primary care 2. Student body and faculty are diverse 3. Faculty work assigned is primarily teaching 4. The education program occurs in geographically distinct regions: a. Basic sciences in the Caribbean region b. Clinical clerkship training in the United States What is unique?
  • 3. BackgroundSeveral factors contribute to the trend toward earlier clinical learning in undergraduate medicaleducation programs. We outline factors driving significant change at a large Caribbean medical schoolpreparing students for practice in the United States that are consistent with adult learning theory.Summary of Work Planning for curriculum change has involved modification of the existing clinical education program andincreased emphasis on learning competencies related to professionalism, systems, improvement, andpatient centered care. Factors which were challenging in creating a strategy toward inclusion of greaterclinical learning were increased class sizes and faculty ambivalence towards change.Summary of ResultsWe summarize measures and parameters of these factors which have led to formulation of plans forcurricular change.ConclusionsThe resulting program implementation suggests that students’ earlier clinical learning experiences canbe improved by enhancing existing programs, such as community medicine projects and problem-based learning, while also implementing new early learning experiences through the use ofstandardized patients and simulations. Abstract
  • 4. Recommendations from Accrediting Institute of MedicineGreater emphasis oncompetencies, clinical Organizations recommendations education, and EBM Increase early clinical exposure Address patient Proposed safety, systems, changes to Drivers for cultural Licensure Exam Change competence, science 40% first time foundations pass rateInadequate writing and examination Feedback from skills Student performance on Clinical Faculty internal assessments regarding student (Comprehensive NBME) preparation Drivers of Curriculum Change These drivers were integral to underscoring the need for change while providing an opportunity to apply adult learning theory.
  • 5. Outcomes of Curriculum RevisionsGreater requirements for written case historiesCreation of a Department of Integrated MedicineDoubled semester 3 clinical exposureExpansion of hi-fi simulation and task-trainers into first 4 semestersHired more US trained clinicians and visiting facultyInitiated Standardized Patient ProgramUse of WebSP and Doc.com for feedback on clinical skillsAddition of service learning to allow more contact with real patientsAdoption of an organ systems-based curriculum
  • 6. What went well: Key changes implemented:  Engagement of faculty in module development teams across departments. .  Increased number and feedback on written case histories (H & Ps) for students. ..  Adoption of team approach to integrated interactive clinical cases that emphasize relevance of basic science concepts and applications to clinical medicine. Clarification of processes and ideas through workshops: .  Simulation .. .  Utilization of technology software to  Clinical Cases improve education Support of students by participation in  Incremental change process with respect development teams for requested implementation delays Reflections on Transition Process
  • 7. Barriers to Change A. Lack of engagement of all department chairs B. Increased enrollment simultaneous with curriculum change with closing of a second campus C. Unclear communications to students regarding registration caused delays in implementation D. Not all faculty provided new learning objective to support the implementationReflections continued…
  • 8. 1. Clinical learning experiences were increased demonstrating the application of adult learning theory.2. In an environment of sustained growth in student numbers, making curricular changes is challenging and evokes strain on mid-level administration.3. Despite efforts to communicate reasons for change and processes to achieve outcomes, morale was a continual challenge.4. Curricular change needs resources such as software technology to support database maintenance and extra administrative assistance.5. Changes not directly related to original goals can be implemented during periods of curriculum change.6. Incremental changes contribute to easing anxiety amongst faculty toward curriculum change. Findings
  • 9. ReferencesGrant, J. (2006). Principles of curriculum design. Understanding Medical Education monograph series. Oxford: Education, Blackwells Press.AAMC. (2008). Recommendations for Clinical Skills Curricula for Undergraduate Medical Education. Association of American Medical Colleges.Merriam, S., Caffarella, R. & Baumgartner, L. (2007). Learning in Adulthood: A comprehensive guide, 2nd edition. San Francisco: Jossey-Bass.