Perelman School of Medicine at the University of Pennsylvania

Abstract

Medical Education Program Highlights The University of Pennsylvania’s Perelman School of Medicine (PSOM), established in 1765, is the oldest medical school in the United States, with a long tradition of academic excellence and scientific discovery. Contemporary highlights include: A beautiful and purposefully designed new space, the Jordan Medical Education Center, opened in 2015. The Center for Student Life, a unique integration of the offices of student affairs, diversity and inclusion, curriculum, and the new position of associate dean for student success and professional development. A highly developed, team-facilitated learning environment with students assigned to a learning team of 6–7 students, linked to a House system with advisory deans; supported by a 2-day, business model–inspired team-building retreat informed by work from the Wharton School. An Academy of Master Clinicians, which is a distinction related to exemplary patient care: honorees provide mentorship and support to students through the House system. A world-class MD–PhD and MD+ program, with nearly 70% of students graduating with an additional degree or certification (12 master’s programs, 10 certificates). PennHealthX, a program to support exploration and innovation in health care. See List 1—MD+ Programs. Curriculum Penn’s curriculum has been rebranded as “Learning for Life.” Curriculum refresh has been iterative, building upon innovations from the last major curriculum revision, which included shortening the preclerkship curriculum (PCC) to 16 months, establishing a team-facilitated learning environment, and advancing individualized education. We are setting a galvanizing vision for UME and redefining competencies required for graduation while considering curricular advances that address the question of how we can best continue to train future-ready physicians to perform in a rapidly changing field. Class size has remained stable at approximately 150 students per class, with no plans to change class size. Our students represent a diverse and talented group of socially conscious learners, many with prior experiences that encourage maturity and promote leadership skills. PSOM has developed a culture of inclusion fostering our community as a whole, while directly supporting affinity groups. Assessment Almost all student assessment at PSOM fits into 1 of 4 categories: preclerkship formative, clinical formative, preclerkship summative, and clinical summative. For graduation, students are required to pass a 12-station summative OSCE as well as USMLE Step1, Step 2 CK, and Step 2 CS examinations. Students not pursuing a dual degree complete a required, 3-month Scholarly Pursuit capstone. See List 2—Description of Assessment Methods. Assessment methods have evolved continuously since 2010. We now use more secure exam software allowing for more robust and flexible testing. In preclerkship courses, team exams count toward the final course grade. We have transitioned to a Pass/Fail system in the PCC, while maintaining high performance standards. All clerkships except one have incorporated a multistation OSCE. Pedagogy The PCC at PSOM, spanning 3 semesters, is the first part of a modular, vertically and horizontally integrated curriculum, and it includes content from modules 1, 2, 3, and 6. The first semester covers core principles across module 1 (basic science), module 3 (technology and practice of medicine), and module 6 (professionalism and humanism). See Supplemental Digital 1—Modular Curriculum—at https://links.lww.com/ACADMED/A845. The second and third semesters cover integrative systems and disease across modules 2 (pathophysiology), 3, and 6. Small-group sessions, almost always conducted in learning teams, are the core of PCC learning. Near-peer support is provided in small-group facilitation, anatomy sessions, and tutoring opportunities. Didactic learning: Faculty provide lecture slides and notes with learning objectives, an organizational road map, and are asked to “chunk” content in 2–4 segments, answering questions after each segment. Attendance is optional, except for live-patient clinical encounters. Small-group team-facilitated learning: Small groups are student directed with faculty facilitation. Attendance is required. Learning teams work at their own pace and the House system provides additional academic and wellness support. Self-directed learning: In module 2, selected small-group sessions have a student-organized “teaching point,” a 5-minute presentation on a topic related to, but not covered in concurrent course materials. Each module 2 course also has self-directed learning topics, not formally covered in any lecture or small group, but featured on exams. Hands-on learning and simulation: The Introduction to Clinical Medicine (ICM) course provides direct, hands-on, interprofessional and experiential learning via standardized patients (SPs) and simulation. Bedside ultrasound is integrated across the curriculum. Longitudinal patient care: The Longitudinal Experience to Appreciate Patient Perspective (LEAPP) and the Elder Home Care Experience (EHCE) are both required. LEAPP is integrated with the Health Care Systems course in the PCC, and EHCE is integrated with the Doctoring course. Curriculum changes since 2010 Paperless course materials: students receive iPads for syllabi, slides, and notes (2011) Ultrasound Diagnostics course (2015) Cancer Biology 1-week foundations course, followed by oncology content throughout the curriculum (2016) “Inside Out”: fully integrated with ICM, anatomy, ultrasound, and radiology (2017) “Yoganatomy”: integration of anatomy and wellness curriculum (2017) Culinary medicine, art and medicine, narrative medicine preclerkship electives (2019) Preclerkship week to facilitate transition to clerkships (2019) The Measey Primary Care Pathway Program for students interested in pursuing careers in family medicine, outpatient general pediatrics, general internal medicine, and/or geriatrics (2019) Clinical experiences PSOM introduces clinical experiences early in the curriculum. During orientation, an accomplished Penn physician–scientist describes a clinical/scientific discovery and then introduces the students to a relevant patient. Students interact with patients during the Doctoring and ICM courses. We continue to introduce earlier patient contact and opportunities for interprofessional team-based learning. All clerkships have some didactic component in addition to immersion in the clinical environment, and many use self-directed learning and flipped classroom sessions. Since 2010, we have introduced a high-value care curriculum in the internal medicine clerkship, a simulation bootcamp session for senior students in pediatrics, and an expanded 2-week surgery bootcamp, focusing on simulation experiences and practical skills. All students rotate through a variety of inpatient and outpatient clinical sites within the University of Pennsylvania Health System, including The Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, and Pennsylvania Hospital; along with several affiliated hospitals, including Veteran’s Affairs Medical Center and Children’s Hospital of Philadelphia. Students are exposed to diverse patient populations with general and specialized diseases. There are opportunities to rotate at community hospitals and clinics in the tristate area. Outpatient experiences are integral within the clerkship year, including a 4-week clerkship in family medicine and a 3-week outpatient pediatrics clerkship, along with outpatient weeks in others. Students have multiple volunteer outpatient experiences. Close to 70% of students participate at community health clinics; and approximately 30% of students participate in 4- to 6-week-long global clinical experiences in locations such as Botswana, Peru, Tanzania, and Guatemala. Students can participate in service-learning opportunities or may complete an externship learning from Penn’s Community Health Worker program. In 2019, a group of students participated in a pilot emergency medical training program, with follow-up longitudinal outpatient experiences working alongside city emergency support services. Challenges in designing and implementing clinical experiences for medical students Multiple factors affect a student’s medical education experience. PSOM has worked to limit the impact of identified challenges: Our structure of student placement and faculty oversight at the clinical sites mitigate the challenges of high-turnover inpatient and rapid-paced outpatient clinical environments. Scheduling and selection of highly rated teaching sites help us address the challenges of limited outpatient clinic space. We have created simulation and SP satellites to accommodate just-in-time training needs. We have monitored and addressed inconsistencies in clinical education across sites. We collaborate with GME and faculty affairs to clarify student roles on teams. We prioritize Penn’s students’ education within our health system. Opportunities exist to make the expectations, assessment, and evaluation processes more cohesive. Curricular Governance PSOM’s curricular governance is evolving to ensure centralized oversight of operational groups. The Education Council is charged by the dean to maintain excellence and improve the efficiency of the many programs that make up the entirety of Penn Medicine, which includes the health system and PSOM. The Medical Faculty Senate (MFS) remains the formal instrument exercising authority with respect to admissions, educational affairs, and governance. MFS has delegated responsibility to the Undergraduate Medical Education Committee (UMEC) to review all matters related to UME including curriculum, assessments, and policy. Two subcommittees report to UMEC: the Program Evaluation Committee (PEC) and the Policy Committee (PC). PEC must annually review all curricular elements of modules, courses, and clerkships, with triennial in-depth review. The PC is tasked with ongoing evaluation and maintenance of educational policy. See Figure 1—Curricular governance overview.Figure 1: Curricular governance overview.Education Staff The Office of the Senior Vice Dean for Medical Education (SVDME) is the central administrative body responsible for UME and continuing medical education, with an integrated and collaborative relationship with GME. The SVDME and the chief operating officer oversee faculty administrators and staff responsible for admissions, curriculum, student affairs, student success and development, inclusion and diversity, assessment, community engagement, and wellness. See Figure 2—Education team organizational chart.Figure 2: Education team organizational chart.Each associate dean works with staff to perform relevant tasks such as those related to admissions, curriculum, assessment, and student affairs. In total, there are 30 staff working with 7 associate deans and 4 assistant deans. Cross-collaboration is expected and facilitated with weekly UME leadership team meetings. Collectively, the office is responsible for providing support for the course and clerkship directors in the planning, implementation, and oversight of the curriculum. Strategic direction for clinical education is under the supervision of the associate dean for UME clinical and health systems sciences curriculum and, along with scheduling clinical experiences, is managed centrally. Implementation and day-to-day management of the required clinical clerkships and electives rest with the clinical departments. Faculty Development and Support in Education Teaching is an essential PSOM mission. All faculty on the tenure, clinician–educator, and/or academic clinician tracks must submit teaching evaluations and a descriptive self-assessment during reappointment and promotion opportunities. We have developed an improvement plan for situations where faculty might benefit from enhancement of teaching skills. Our faculty have scored a nearly perfect 4.0 on a scale of 0–4 in over 10,000 documented student evaluations. The Faculty Life and Professional Development “Advance” Program is designed to orient faculty to institutional and learning expectations, support pedagogically sound best practices, develop core competencies in teaching, and provide resources and skill-coaching for faculty. All new faculty are required to complete the Onboarding for Teaching Program. The overriding objective of the university’s procedures for academic appointments and promotions is the recruitment and retention of a distinguished faculty. This objective stresses intellectual leadership as the chief criterion for academic advancement. Accordingly, a high degree of excellence is expected at PSOM in both research and teaching for members of standing faculty. Historically, teaching at Penn was judged by student evaluations of faculty teaching. Currently, we are looking to increase the presence of peer faculty evaluations as well as other assessment modalities including student focus groups. Notably, Penn created an academic clinician track in 2004 to recognize the excellent clinician–teachers at Penn. Advancement comes through excellence in clinical work and teaching, along with a recognized area of concentration. Initiatives in Progress Within the past 2 years, our restructured organization in UME has created a collaborative matrix of staff working with an effective faculty leadership team to support our students and curriculum. We are iteratively evaluating our curriculum as we explore additional innovations and will continue our reflective process to drive the future of our educational programs. Working groups of the newly convened Education Council will be charged with improving our curriculum and assessments, educational scholarship productivity, and use of technology, while leveraging partnerships with the Penn community, our interprofessional colleagues, and our regional clinical partners. PSOM continues to build upon our legacy of excellence in education with outcomes of distinction supported by student and faculty satisfaction, student performance on internal and board examinations, our Match results, and by surveys of residency program directors of our graduates’ performance. We are committed to training future-ready physicians who will serve as leading advocates for advancing science, discovery, and health care while furthering all relevant missions for our patients, communities, and society. List 1 MD+ Programs Dual degree (generally 5+ years) MD–PhD MD–JD OMFS MD–MTR MD–MBA MD–MBE MD–MPH MD–MS MD–ML MD–HPR MD–Non-Penn Masters Certificate (4 years) Research Year Medical Education Academic Surgery Healthcare Management, Entrepreneurship, and Technology Public Health Clinical Neuroscience Bridging the Gaps Global Spirituality List 2 Description of Assessment Methods Competencies Science of medicine: Bioscientific basis of disease Epidemiologic approach to medicine Decision-making/evidence-based medicine Information systems Health care systems Research principles and methodology Technology and practice of medicine Clinical practice of medicine including diagnosis management and treatment Prevention and nutrition Self-directed learning System-based practice Humanism and professionalism Professional skills and attitudes Intra- and interprofessional collaboration Assessments: Formative Preclerkship Small-group, case-based discussion Problem sets Journal club discussions in Module 1 Reflective writing assignments (in preparation for and during small-group discussions) Teaching point presentations during Doctoring course 1-on-1 meetings with Doctoring preceptors Clinical Small-group work Patient write-ups Simulation In some clerkships: Feedback cards History taking/physical exam Oral case presentation Written documentation General skill Evidence-based medicine Mid-clerkship feedback review Assessments: Summative Preclerkship Multiple choice question exam (some with matching and short-answer, tending to be team based) LEAPP self-reflection papers Elder home-visit reflection Doctoring capstone and disability assignments Two standardized patient exams: history/history and physical Self-directed learning activities Clinical End-of-clerkship exams (NBME, Aquifer, in-house) OSCEs Preceptor and residents’ ratings and narrative All clerkships > 4 weeks have other requirements, for example, an EKG quiz, presentation, ultrasound logs Other Penn Summative Clinical Skills Inventory (12 standardized patient exams) USMLE Step 1 USMLE Step 2 CK USMLE Step 2 CS Scholarly Pursuit project