Georgetown University School of Medicine.

Medical Education Program Highlights In 2017, Georgetown University School of Medicine (GUSOM) began implementation of the Journeys curriculum: a dynamic, adaptive curriculum incorporating elements of curiosity, choice, reflection, and, in keeping with our Jesuit mission of cura personalis, care for the whole person. There are 3 curricular phases: foundational, core clerkship, and advanced clinical. Interactive boot camp sessions precede the foundational and clerkship phases. Between each phase are Journeys periods; these 1–2 months are innovative, flexible, and centered on student choice. The curriculum includes early exposure to doctoring with instruction on the normal history and physical examination within the first 3 months. Students experience a 15-month preclinical curriculum organized by organ system modules and based on longitudinal basic science disciplines. The clerkship year is 48 weeks, including 6 weeks for students to select among non–core clerkship specialties. Within Journeys II, deep dive seminars reinforce academic curiosity within each students’ interests. The advanced clinical phase encourages individualized schedules. The focus of Journeys is to integrate scientific knowledge with clinical work throughout the 4 years and develop empathic, engaged, lifelong learners who care for the patient and for the community. Curriculum Curriculum description A highlight is the 1-week intersessions. These occur between regularly scheduled coursework in both the foundational and clerkship phases and include topics such as social determinants of health and the business of medicine. Intersessions are adaptive and topics may change with current health issues or the health climate. A diverse set of pedagogies are implemented as students are asked to discuss today’s tough health care issues. During Journeys workshops, students choose among several 2-hour seminars from 3 categories: physician wellness, cultural competency, and research. Topics include mindfulness and meditation and cross-cultural communication. Many students will have engaged in varying levels of research and our research workshops reflect this variation. Recognizing that an understanding of basic science and foundational concepts is enhanced with clinical experience, students return to these following the clerkship year as they participate in two 2-week deep dive seminars. These classroom activities elucidate topics of interest related to a student’s chosen field. Ranging from specialized neurosurgery tenets to fertility awareness, there are ample subjects that complement students’ medical education. To promote creativity and bring arts into practice, several deep dives focus on humanities, spirituality, and culinary medicine. Our curriculum offers students a forward-thinking journey as they apply knowledge, discernment, and humanity to the care of the whole person. See Supplemental Digital Appendix 1—Curriculum Framework—at https://links.lww.com/ACADMED/A943. Curriculum changes since 2010 Developing Journeys included a review of the attributes of our graduates; guiding factors included curiosity, individualization, and reflective practice. Examples of how these values are incorporated include longitudinal scholarly tracks, summer research opportunities, professional identity formation program, and Journeys workshops. The longitudinal scholarly tracks are extracurricular experiences in 6 areas from which students may choose: humanities, social justice, primary care, population health, health care leadership, and medical education research. The tracks generate significant interest and provide a mechanism to pursue specific interests. All students engage in an independent scholarly project; the curriculum provides time for activities and supports research with Journeys I workshops. Both the school and MedStar Health provide summer research opportunities and stipends for nearly 100 students. Reflective practice has been enhanced. Students are paired with a professional identity coach for regular meetings to share personal reflections meaningful in their growth as physicians. With curricular prompts, students journal and share thoughts with their coach, building a relationship that enriches their professional advancement. Embracing cura personalis, we emphasize care of the whole patient and care of the whole physician and have improved the clinical working environment to support programs centered on issues at the heart of stress and burnout. The school has an innovative elective mind–body medicine program for students, now a core part of graduate programs within MedStar. GUSOM offers physician wellness workshops; a nutrition intersession; and humanities-focused deep dive seminars on literature, dance, and music as they relate to medicine. Essential to our mission is service to the community. The school’s long tradition of providing care to the underserved in Washington, DC, continues with the student-run HOYA Clinic. The Health Justice Alliance is a new partnership with Georgetown University Law Center, and together students advocate for the patient in unprecedented ways. We continue to explore the Jesuit mission within our curriculum and anticipate an even stronger commitment to students, the patient, and the community. Medical education program objectives GUSOM competencies are centered around knowledge, skills, and attitudes necessary to become dedicated, compassionate physicians caring for patients and committed to the health needs of our society. Acquiring and applying knowledge is only part of our goal; developing a curious mind and integrating the psychosocial, spiritual, and cultural dimensions of health care are equally important. We value students as learners and also as teachers and strive to impart accountability, respect, and humility. While framed around KSAs, our objectives are tied to the ACGME core competencies and to AAMC Entrustable Professional Activities. See Supplemental Digital Appendix 2—Assurances of Learning—at https://links.lww.com/ACADMED/A943. Assessment Our dynamic assessment process provides appropriate, practical formative, and summative assessments in all phases of the curriculum. We broadened the scope of formative feedback in the foundational phase by allowing time each week for students to participate in a practice quiz. The exercise enhances understanding of the scope of students’ knowledge and ability to apply material. For skills-associated competencies, the curriculum offers quarterly CURA sessions (clinical unified reasoning activities) and OSCEs as part of the longitudinal cura personalis course, a hypothesis-driven, organ system–based doctoring course. Students practice skills and receive direct feedback from faculty. OSCEs continue throughout the clerkship year. Students take the USMLE Step 1 examination in the second year, before clerkships. A nontiered grading system has been implemented for the foundational phase; grading in the clinical years remains tiered. Pedagogy In the large-group didactics, case-based and problem-based workshops take place routinely. We also engage in interactive approaches that support adult-type learning. Small-group discussions and simulations are implemented across all years to teach individual and team-based skills. With the support of Dahlgren Memorial Library, we have space for an entire class to participate in team-based learning. In several courses, directors have used podcasts and e-prescribing assignments. Novel in the curriculum is our first virtual patient that students come to know, diagnose, and treat. With exercises in the longitudinal disciplines, students have the opportunity to work directly in our electronic health record system in a training environment created specifically for them. Enhancing clinical skills was an intentional commitment of Journeys. Our first-year medical students are brought into the hospital on day 2 to interview their first patients and work with physical examination teaching assistants to practice clinical skills. Students are assigned to ambulatory sites for the remainder of their first year, and then in the hospital setting in year 2, reinforcing these skills. Standardized patients reinforce practical skills throughout the curriculum with consistent formative feedback during regular OSCE exercises. We anticipate incorporating ultrasound and virtual reality technologies in the next year, continuing a modern approach to medical education. Clinical experiences As students enter medical school, we aim to impart a sense of excitement about medicine and have included basic life support training and first aid. The cura personalis: Foundations of Patient Care module includes a first patient interview as students meet their patient at the bedside and learn history-taking skills. Clinical exposure continues for the first 8 weeks of the curriculum and provides comprehensive communications instruction. Following block 1, students are competent in performing a normal history and physical examination and prepared for upcoming ambulatory experiences. The school uses various university-affiliated hospital, community hospitals, community health centers, and private physician offices/clinics to ensure students meet required educational experiences. Students participate in community-based rotations in family medicine (4 weeks), internal medicine (2 weeks), and pediatrics (3 weeks) during their clerkships and several elective opportunities exist in the advanced clinical phase at Virginia Hospital Center, Inova Fairfax, Walter Reed National Military Medical Center, and the D.C. Veterans Affairs Medical Center. Longitudinal experiences GUSOM began a longitudinal integrated clerkship (LIC) in 2016 at MedStar Franklin Square Medical Center. This clinical experience fulfills the requirements for family medicine, pediatrics, obstetrics–gynecology, and internal medicine. The LIC offers a unique clinical experience as students work with their own patient panel and provide care in all areas over the 6-month period. The LIC integrates clinical disciplines through both outpatient and inpatient care. With implementation of Journeys and early entry for students into the clerkship phase, we faced a 3-month overlap period. Challenges included identifying new clerkship sites, facilitating faculty development and appointments, and working transparently to engage faculty and staff. We faced the challenge of ensuring adequate inpatient volume and have creatively considered clinical experiences outside of the typical inpatient ward experience, including simulated and case-based scenarios. Ongoing discussion of required clinical experiences has enhanced a longitudinal, integrative approach to common medical problems across disciplines. We are cognizant of the challenges for faculty development, central monitoring of student instruction, and oversight of resident teaching. The clinical learning environment is critical to optimal learning, patient safety, and care. With MedStar Health, we have invested significant effort to improving the clinical learning environment and enhancing professional behaviors and respect. Curricular Governance The curriculum is overseen by the Committee on Medical Education (COME), composed of a diverse group of basic science and clinical faculty. Subcommittees pertain to each phase of the curriculum and membership is inclusive of all directors. The school’s Office of Medical Education (OME) is responsible for the curriculum; oversight occurs with the COME. With the support of educational coordinators, the OME assists directors in scheduling, gathering resources, preparing assessments, managing student schedules, and providing resources. Direct coordination of clinical rotations is the responsibility of clinical departments. The following tools are used for curriculum management: Canvas, Exam Soft, New Innovations, One45, and VSLO. The OME is overseen by the senior associate dean for curriculum. Reporting to senior associate dean are 6 academic deans, the medical director of the Integrated Learning Center (ILC), and a curricular project manager. The deans are responsible for implementation of the curriculum. The ILC administrative director plans the clinical skills and simulation programs. The assistant dean for curriculum management oversees the day-to-day operations and supervises support staff. The OME collaborates with other administrative offices and works in coordination with its clinical affiliates. See Figure 1—Committees and curricular governance.Figure 1: Committees and curricular governance.See Figure 2—Organizational chart.Figure 2: Organizational chart.Faculty Development and Support in Education The Office of Faculty and Academic Affairs supports faculty in important career development processes through courses and longitudinal mentoring programs. The mission of the Center for Innovation and Leadership in Education (CENTILE) is to support an interprofessional community of educators through a colloquium, grand rounds, workshops, and the Teaching Academy. CENTILE assists with professional development through a teaching certificate program, an educational scholarship consultation forum, and peer evaluations. The MedStar Teaching Scholars program is a longitudinal program leading to Medical Education Research Certification and Leadership Education and Development certification. The aim of the program is teaching educators how to apply research principles to medical education, to be effective collaborators in medical education, and to develop as a leader in academic medicine. For both university and MedStar employed faculty, a specific track devoted to medical education exists. There is a range of criteria for each rank in the areas of education, scholarship, and service. Faculty share teaching philosophies and educational goals in their teaching portfolio, which summarizes direct teaching hours, numbers of learners, overall course and individual faculty evaluations, and any teaching awards highlighted for the committee review. The Teaching Academy is open to faculty and residents cultivating a community dedicated to Georgetown University Medical Center’s mission. Membership spans 4 levels from protégé to distinguished educator. Applications are centered on educational philosophy and accomplishments in 1 of 5 areas: direct teaching, educational scholarship, mentorship, educational leadership, or instructional design. Distinguished educators must have achievements in 3 areas. Benefits include faculty development and review of teaching quality.