PurposeThe authors sought to determine common features, challenges, and benefits of departments of medical education (DMEs) at LCME accredited medical schools.MethodsThe authors utilized a multi-case case study approach to examine each department. Data were compiled in a constant comparative methodology, which included an iterative peer reviewing process by the researchers.ResultsFinancial resources were similar at the DMEs, relying on allocations from varied sources, including tuition. Two departments were the home for faculty teaching in the MD program-particularly the basic/foundational sciences. Two provided some teaching for MD students but had other primary roles. One included teaching in graduate programs and another being a home for MD degree faculty administrators in the undergraduate, graduate, and continuing medical education programs.ConclusionsThe results inform plans to develop a DME, which should be distinguished to align with an institution's mission and needs. DMEs serve as a home for faculty contributing to the educational mission and provide a route for medical educators to seek promotion/tenure outside of traditional departments. DMEs provide synergies to innovate, produce educational scholarship, and access resources for medical educator faculty development. Challenges include finding a physical home and fitting into traditional department frameworks. DMEs are often subjected to administrative resource allocation. Leaders may need to seek alternative funding. Future studies should consider a comprehensive analysis that would significantly provide greater details and a clearer picture into DMEs.

The Access in Medicine (AIM) Summit, held in April 2024, convened 60 delegates from across the United States to generate practicable solutions for dismantling accessibility barriers in medical education. These proceedings outline the Summit's objectives and present the resulting insights and actionable recommendations. The Summit featured an innovative design that engaged diverse delegates in collaborative, idea-generating activities that elevated the lived experiences of learners with disabilities. Inspired by guiding principles of social justice and accessibility, delegates recommended a bundle of action-oriented strategies for addressing social and structural barriers to disability equity and inclusion. The proposed action steps identified critical intervention points that span the continuum of undergraduate medical education, from improving support of disabled learners in recruitment and admissions processes through to their residency application and postgraduation transition stages. Though medical education was the AIM Summit focus, delegates emphasized the generalizability of themes to broad training contexts (e.g., residency and other health professions education training), both in the sociostructural challenges they confronted and in the solutions they proposed. These proceedings highlight the vital steps necessary to build more equitable and inclusive learning environments for learners with disabilities.

The Chicago Maternity Center provided obstetrical services for the medically underserved on Chicago's Near West Side for nearly eight decades (1895-1974). While its founder's vision, its outreach to underserved communities, the reasons for its decline, and the perceived abandonment of the community when it closed have been well documented, less attention has been paid to the role of trainees in providing obstetrical care. Medical students and residents routinely delivered babies in patients' homes, often without adequate supervision. This aspect of the center's history can help illustrate the evolution of experiential education in clinical medicine, along with emerging concepts of equitable access and quality of care. This work explores the center's role in medical education in light of contemporary perceptions of some participants-trainees, faculty, and institutional leadership-and through analysis of scholarly and popular publications, institutional archives, and communications with alumni and retired faculty. The popularity of the experience with trainees and its constituents, segregation of the center's activities from those of the sponsoring medical center, and its well-respected history led to the persistence of a model for clinical medical education that was an anachronistic remnant of earlier approaches to education and to care for the poor and disenfranchised.

PURPOSE:Medical students with disabilities (MSWD) from racial and ethnic populations that are underrepresented in medicine (URiM) may experience disparate educational paths compared to their peers, including disruption during training. This study examined whether MSWD who are also URiM experienced disproportionate rates of unintended leaves of absence (LOA) or extended time to graduation (TTG) compared to those who are only URiM, only MSWD, or neither. METHOD:The authors analyzed data from 372 MSWD and 689 matched nondisabled controls across 9 U.S. MD-granting programs. Students were matched by gender, graduation cohort, and Medical College Admission Test scores. MSWD were categorized into cognitive, physical/sensory, and chronic health disabilities, while race/ethnicity was classified as underrepresented in medicine (e.g., American Indian/Alaska Native, Black/African American, Hispanic/Latino, or Native Hawaiian/Pacific Islander), Asian, or White. Likelihood of LOA and extended TTG outcomes were assessed using mixed-effect logistic regression models. RESULTS:MSWD were 2.6 times more likely to take an LOA (25.0% vs 12.6%, P < .001) and 2.6 times more likely to have extended TTG than nondisabled peers (38.6% vs 21.9%, P < .001). URiM students were 1.7 times more likely to take an LOA (22.9% vs 15.3%, P = .01) and 2.1 times more likely to experience extended TTG than White students (36.2% vs 22.5%, P < .001). Adjusted analysis showed URiM MSWD were 5.9 times more likely to take an LOA (40.6% vs 13.4%, P < .001) and 4.9 times more likely to experience extended TTG than nondisabled White peers (56.4% vs 28.7%, P < .001). CONCLUSIONS:URiM MSWD faced disproportionately heightened risks for academic disruptions in the form of LOA and extended TTG, underscoring the need for interventions that are more supportive of students with overlapping identities.

PROBLEM:Formal medical student engagement in curricular evaluation provides significant value through identification of opportunities for curricular change. Students provide diverse perspectives and have a unique vantage point, which allows them to see aspects of the curriculum that educators and administrators might not recognize. Current descriptions of student engagement are focused largely on collection, analysis, and presentation of summative feedback in the pre-clerkship curriculum. However, medical students could potentially contribute to curricular improvement in ways extending beyond post hoc curricular evaluation. Student teams focused on identification of specific needs and project-based implementation of solutions represent one means of doing so but require a structured, organizing method in order to succeed.INTERVENTION:We describe a novel, project-based, student-driven medical education initiative, the Special Projects Team, which is focused on identifying opportunities for forward-looking curricular enhancements beyond single courses or rotations. We adapted and implemented the lean startup method, a model for project management, in order to address the need for organization and accountability in the Special Projects Team. Members of the Special Projects Team were recruited from the first- and second-year medical school classes in the 2018-2020 academic years and provided with training on the lean startup method. Team members selected and pursued projects according to the principles of lean startup method, reporting their progress to the chair of the Special Projects Team and other team members at monthly meetings with pre-defined structure.CONTEXT:The Special Projects Team is part of the local Student Curricular Board at the Chicago campus of the University of Illinois College of Medicine. The Student Curricular Board is responsible for conducting curricular evaluation and improvement, operating under the local medical student council with financial support from the Office of Curricular Affairs. Direct supervision of the Special Projects Team is provided by a student chair, the executive board of the Student Curricular Board, and the curricular dean.IMPACT:The projects initiated as part of the Special Projects Team covered a broad range of themes, including curricular evaluation, technology, and student experiences. Lean startup method contributed to sustained project success and frequent reassessment across the two years of our experience, with aggregate project success or continuation rate of 68.4% (13/19 projects). We further demonstrate how lean startup method increased productivity while providing structure and accountability for a student-led medical education team.LESSONS LEARNED:Lean startup method can be used to structure student-driven, project-based curricular enhancements. This approach is broadly applicable to other medical schools with implementation requiring only a motivated student team, faculty advisor, and basic knowledge of the lean startup method.

Problem Medical schools have implemented various ways to engage students in improving medical curricula. These systems, however, usually focus on the preclerkship curriculum, perhaps because medical students move through this phase of medical education synchronously, making it easier to collect student input. In contrast, clerkship and postclerkship curricula often lack similar levels of student engagement in program evaluation. Approach To increase communication among students, faculty, and administration during the clinical years of medical education, the Student Curricular Board (SCB) at the University of Illinois College of Medicine's Chicago campus (UICOM-Chicago) developed a student-driven feedback model in 2016 that aimed to parallel the system previously implemented in the preclerkship years. Interested fourth-year students were selected by their peers to represent individual core clerkships, and they communicated regularly with clerkship directors about concerns from current clerkship students. Third-year students applied and were selected to represent their cohort of peers moving through clerkship tracks. Proposed changes and improvements were tracked via novel, student-driven SOAP-Education (SOAP-Ed) progress notes written throughout the academic year. Outcomes In response to a program evaluation survey conducted after implementation of this pilot, third-year students said they felt that their feedback was taken seriously by faculty and administration. Furthermore, student feedback led to meaningful changes in core clerkship curricula and in the system used to gather clerkship feedback. Clerkship directors expressed appreciation for this partnership, and students said they gained valuable leadership experience and knowledge of curricular development. Next Steps Current SCB members and curricular leadership plan to assess student and faculty perceptions of this system and its efficacy and work toward expansion to all UICOM campuses. Lessons learned from this student-driven model of feedback in third-year core clerkships will likely add to the conversation on how to better engage medical students as active stakeholders in their own education.

Efforts to include people with disability as students and practitioners in the health professions have gained momentum in recent years. However, prevailing technical standards at U.S. medical schools have biases that can prevent or impede their admission, promotion, and graduation. These standards derive from an approach first promulgated in 1979 and have since remained largely unaltered. Current technical standards at most medical schools are now at odds with changes occurring since the 1990 enactment of broad civil rights protections for people with disability and current aspirations for diversity, equity, and inclusion in the medical profession. It is time to replace the technical standards construct with an approach more consistent with current medical practices, and with societal imperatives of equity and social justice. Such an approach should assess candidates’ demonstrable skills and merits, rather than relying on a preconceived construct identifying the presence or absence of defined levels of ability. The maturation of competency-based approaches to curricular design and assessment provides an opportunity to reconceptualize the abilities required to practice medicine, foster the appropriate inclusion of physicians with disability, and better align medical education and training with broader societal needs and goals.

Recognition of the need for equitable health care for people with disabilities and the need to appropriately educate the health-care workforce has emerged over the past few decades.1Silver JK Bean AC Slocum C et al.Physician workforce disparities and patient care: a narrative review.Health Equity. 2019; 3: 360-377Crossref PubMed Scopus (81) Google Scholar, 2Institute of Medicine Committee on Institutional and Policy-Level Strategies for Increasing the Diversity of the US Health Care Workforce Smedley BD Stith Butler A Bristow LR In the nation's compelling interest: ensuring diversity in the health-care workforce. National Academies Press, Washington, DC2004Google Scholar, 3McColl MA Jarzynowska A Shortt SE Unmet health care needs of people with disabilities: population level evidence.Disabil Soc. 2010; 25: 205-218Crossref Scopus (68) Google Scholar Although people with disabilities experience the same general health-care needs as other people, they are more likely to experience health-care inequities due to the inadequate skills and knowledge of health-care providers and inaccessible health-care facilities.4WHOWorld report on disability.http://www.who.int/disabilities/world_report/2011/en/index.htmlDate: 2011Date accessed: December 21, 2020Google Scholar In 2009, an art of medicine essay in The Lancet by Tom Shakespeare and colleagues5Shakespeare T Iezzoni LI Groce NE Disability and the training of health professionals.Lancet. 2009; 374: 1815-1816Summary Full Text Full Text PDF PubMed Scopus (138) Google Scholar posited that "perhaps the most dramatic learning can come when it is a peer who is disabled, rather than a patient". Medical schools are beginning to consider students with disabilities as a constituent part of their diversity, equity, and inclusion agenda, and several organisations and academic leaders from around the world are now offering formal guidance to medical schools, with the goal of fully realising the value that people with disabilities bring to medical education.6General Medical CouncilWelcomed and valued: Supporting disabled learners in medical education and training.https://www.gmc-uk.org/ablemedicsDate: 2019Date accessed: February 10, 2020Google Scholar, 7Meeks LM Jain NR Accessibility, inclusion, and action in medical education. lived experiences of learners and physicians with disabilities. Association of American Medical Colleges, 2018https://store.aamc.org/accessibility-inclusion-and-action-in-medical-education-lived-experiences-of-learners-and-physicians-with-disabilities.htmlDate accessed: February 10, 2020Google Scholar, 8Singh S Medical Council of India's new guidelines on admission of persons with specified disabilities: unfair, discriminatory and unlawful.Indian J Med Ethics. 2019; 4: 29-34Crossref PubMed Scopus (5) Google Scholar, 9Kezar LB Kirschner KL Clinchot DM Laird-Metke E Zazove P Curry RH Leading practices and future directions for technical standards in medical education.Acad Med. 2019; 94: 520-527Crossref PubMed Scopus (15) Google Scholar We share The Lancet's commitment to promoting diversity in medicine10The LancetThe Lancet Group's commitments to gender equity and diversity.Lancet. 2019; 394: 452Summary Full Text Full Text PDF PubMed Scopus (45) Google Scholar, 11Choo EK Introducing The Penumbra.Lancet. 2019; 394: 453-454Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar and concerns about the structural biases that negatively impact patient care. Health-care disparities for patients with disabilities are universal, and while efforts towards inclusion of more health-care providers with disabilities have been made, there is a global under-representation of clinicians with disabilities (appendix). The barriers to health care for people with disabilities are ingrained. The United Nations 2018 Flagship Report on Disability and Development maintains that "attitudinal barriers have compromised access to health services for persons with disabilities, as health professionals often have little experience interacting with or providing services to persons with severe and/or complex disabilities, or have negative, stigmatizing attitudes towards these patients".12United Nations General AssemblyUnited Nations 2018 flagship report on disability and development: realization of the Sustainable Development Goals by, for and with persons with disabilities, UN Doc. A/73/220.https://www.un.org/development/desa/disabilities/publication-disability-sdgs.htmlDate: 2018Date accessed: February 10, 2020Google Scholar This segregation of patient and provider, healthy and disabled, has adverse impacts on the wellbeing of people with disabilities and constitutes a barrier to health-care services and education. The inclusion of more health-care providers with disabilities offers one way to improve understanding about the needs of patients with disabilities.13Meeks LM Herzer K Jain NR Removing barriers and facilitating access: increasing the number of physicians with disabilities.Acad Med. 2018; 93: 540-543Crossref PubMed Scopus (53) Google Scholar Further progress will require attention to several different dimensions of disability inclusion. Health professions programmes could reassess the criteria by which they evaluate applicants for admission to focus on the core skills and perspectives that are vital for competent care.14McKee M Case B Fausone M Zazove P Ouellette A Fetters MD Medical schools' willingness to accommodate medical students with sensory and physical disabilities: ethical foundations of a functional challenge to "organic" technical standards.AMA J Ethics. 2016; 18: 993-1002Crossref PubMed Scopus (19) Google Scholar, 15Kezar LB Kirschner KL Clinchot DM Laird-Metke E Zazove P Curry RH Leading practices and future directions for technical standards in medical education.Acad Med. 2019; 94: 520-527Crossref PubMed Scopus (3) Google Scholar Medical schools and their affiliated clinical institutions must be able to determine and provide, with appropriate support, the optimal reasonable accommodations or adjustments for equal access to the curriculum, while ensuring competence for health professions practice. Changes to institutional culture are needed to ensure that all students and health-care providers are able to practise in inclusive environments.16Jain NR Political disclosure: resisting ableism in medical education.Disabil Soc. 2019; (published online Aug 9.)https://doi.org/10.1080/09687599.2019.1647149Crossref Scopus (15) Google Scholar, 17Stergiopoulos E Fernando O Martimianakis MA "Being on both sides": Canadian medical students' experiences with disability, the hidden curriculum, and professional identity construction.Acad Med. 2018; 93: 1550-1559Crossref PubMed Scopus (34) Google Scholar Some organisations have addressed the need to improve inclusion and have translated this into actionable guidance (table).6General Medical CouncilWelcomed and valued: Supporting disabled learners in medical education and training.https://www.gmc-uk.org/ablemedicsDate: 2019Date accessed: February 10, 2020Google Scholar, 18Medical Deans Australia and New Zealand IncInherent requirements for studying medicine in Australia and New Zealand.https://gamsat.acer.org/files/MedicalDeansInherentRequirements.pdfDate: July 2017Date accessed: February 10, 2020Google Scholar What is now needed is an international voice, combining guidance from individual countries, to create an international benchmark for disability inclusion that will provide a roadmap for countries seeking to create accessible health professions programmes and practice.TableInternational organisations' guidance on inclusion of learners with disabilitiesYearGuidanceAssociation of American Medical Colleges2018Accessibility, inclusion, and action in medical education: lived experiences of learners and physicians with disabilities7Meeks LM Jain NR Accessibility, inclusion, and action in medical education. lived experiences of learners and physicians with disabilities. Association of American Medical Colleges, 2018https://store.aamc.org/accessibility-inclusion-and-action-in-medical-education-lived-experiences-of-learners-and-physicians-with-disabilities.htmlDate accessed: February 10, 2020Google ScholarGeneral Medical Council of the UK2018Welcomed and valued: supporting disabled learners in medical education and training6General Medical CouncilWelcomed and valued: Supporting disabled learners in medical education and training.https://www.gmc-uk.org/ablemedicsDate: 2019Date accessed: February 10, 2020Google ScholarAustralian Medical Council; Medical Deans Australia and New Zealand Inc2017Inherent requirements for studying medicine in Australia and New Zealand18Medical Deans Australia and New Zealand IncInherent requirements for studying medicine in Australia and New Zealand.https://gamsat.acer.org/files/MedicalDeansInherentRequirements.pdfDate: July 2017Date accessed: February 10, 2020Google Scholar Open table in a new tab Several global developments are underway for 2020 to address the inequities in health science education and develop international benchmarks for inclusion, including the formation of an International Council on Disability Inclusion in Medical Education, which will hold its first meeting at the London offices of the General Medical Council in the UK, on Sept 11, 2020, and the Inaugural Meeting of the International Congress on Disability Health and Inclusion, which will be hosted by the Department of Family Medicine, University of Michigan Medical School, in Ann Arbor, MI, USA, on Oct 9–10, 2020. The International Council will aim to develop shared principles regarding the support of qualified individuals with disabilities in the medical profession that will serve as a benchmark for countries where guidelines on inclusion do not exist. The International Congress will bring together delegates from across the globe to envision and create a more inclusive environment for students, providers, and patients. Inequity and lack of diversity in educational programmes come at a high cost to patient outcomes and a loss of potential medical innovation. The health professions need to represent the population they serve. Under this wider principle, the inclusion of physicians, nurses, therapists, and other health-care providers with disabilities could help promote the care of patients with disabilities and their nuanced needs. It is our hope that the next decade will include further international cooperation and initiatives towards an accessible and inclusion environment for students, providers, and our patients. We declare no competing interests. Download .pdf (.12 MB) Help with pdf files Supplementary appendix

Medical Education Program Highlights The University of Illinois College of Medicine is among the largest and most diverse medical schools in the United States. One of 7 health sciences colleges of the University of Illinois at Chicago (which itself is 1 of 3 universities in the University of Illinois system), its 4 campuses (Chicago, Peoria, Rockford, Urbana) have contributed to training over 40% of physicians currently licensed to practice in Illinois, including 20% who are graduates of the MD degree program. The college is among the top 3 LCME-accredited schools in graduating both Latino/Latina and African American physicians over the last 4 decades. The university’s Urban Health Program (established 1978) and the college’s Hispanic Center of Excellence (established 1991) are mainstays of this commitment to diversity and inclusion. The college offers a broad range of career pathways. The Medical Scientist Training Program (Chicago) and the Medical Scholars Program (Urbana) provide MD–PhD training; other dual-degree programs and scholarly concentration programs (elective longitudinal opportunities focusing on global medicine, urban medicine, and several other areas) are also available. The Rural Medicine Program enrolls approximately half the Rockford-based students and has contributed significantly to alleviating physician shortages in rural Illinois, as has the Rural Student Preceptor Program, a longitudinal integrated clerkship option in Peoria. The MD program has been comprehensively redesigned, with the new curriculum debuting in 2017. This was in conjunction with a major restructuring of the college, expanding the programs in Peoria and Rockford to include all 4 years of the curriculum and phasing out the Urbana campus, which will close in 2022. Concomitant restructuring of the curriculum and the college structure have allowed better assurance of comparable educational experiences; streamlining administrative mechanisms for curricular management; and furtherance of our identity as a single, unified educational endeavor with statewide impact. Curriculum The Illinois Medicine Curriculum is a single, integrated curriculum for the Chicago, Peoria, and Rockford campuses, aligning all major aspects of course and clerkship structure, scheduling, and assessment and emphasizing interdisciplinary integration, active learning, and longitudinal assessment strategies. All content is organized around 5 themes: foundational knowledge; clinical practice; health, illness, and society; health care systems; and professional development. The curriculum is presented in 3 phases. Phase 1 consists of 7 consecutive organ-based block courses between 5 and 10 weeks in duration that integrate normal structure and function with disease processes and 3 concurrent longitudinal courses: Doctoring and Clinical Skills (DoCS), Synthesis, and Medical Colloquia. The DoCS course is the primary vehicle for the clinical practice theme. The Synthesis course comprises single weeks that follow each block course, with a capstone segment in the final Phase 1 term. The Synthesis week following a block course provides opportunities for reflection on learning progress and strategies, cumulative integration of prior learning, and engagement in professional development theme sessions with faculty; the capstone segment fosters overall integration and consolidation and a 2-week course, Transition To Clerkships, then completes Phase 1. Medical Colloquia are selective opportunities to explore a variety of presentations, seminars, and workshops extending beyond the scope of the core curriculum and incorporating perspectives from patients, community leaders, and other professions. See Supplemental Digital Appendix 1—Phase 1 Curriculum—at https://links.lww.com/ACADMED/A879. Phase 2 begins in May of the second year; 44 weeks of core clerkships (in medicine, surgery, family medicine, pediatrics, obstetrics–gynecology, psychiatry, and neurology) are completed within the first four 16-week clinical terms. Phase 3 requirements include a 4-week subinternship and 12 weeks of selectives in either a medical or surgical “pathway.” A third pathway is for students in the Rural Medicine Program. During Phases 2 and 3, 24 weeks of elective credits are also required, with flexibility regarding timing. A longitudinal Phase 2/3 course, Clinical Connections and Competencies, consists of a series of small-group sessions and asynchronous online activities that give context and meaning to students’ clinical experiences, opportunities to practice and receive feedback on clinical and procedural skills, and a 2-week transition to residency capstone. See Figure 1—Phase and term structure.Figure 1: Phase and term structure.The college of medicine is a multicampus college and curriculum. The college has encompassed 4 campuses since the early 1970s, when regional sites in Peoria, Rockford, and Urbana were created through an initiative in the state legislature. The Urbana campus ceased enrollment of new students in 2015 to accommodate the formation of the new Carle Illinois College of Medicine by our sister university in Urbana–Champaign. Our last Urbana-based MD–PhD students are expected to graduate in 2022. See Table 1—Student Enrollment by Campus.Table 1: Student Enrollment by CampusOur new curriculum’s management structure ensures a consistent educational experience across the campuses. The College Committee on Instruction and Appraisal (CCIA) is proportionally representative of all campuses, and oversees subcommittees that provide both campus-specific management of curricular implementation and central authority for policy approval and program evaluation. Each Phase 1 course is led by a team of basic science and clinical faculty from each campus, and clerkships are linked across campuses by Education Coordinating Committees (ECCs) that plan and review students’ educational experiences across all affiliates and all campuses. A Phase 1 ECC and Phase 2/3 ECC evaluate the coordination of courses within each phase on behalf of the CCIA. The Office of Educational Affairs, part of the central dean’s administration, evaluates comparability during each block course through weekly assessment performance review and interval evaluations by students. This office also produces course-level and phase-level program evaluation and performance data for review by subcommittees of the CCIA. Medical education program objectives The program objectives are based on the Physician Competency Reference Set competency domains. Our curriculum is competency based but not time variable; we do not plan to introduce curricular options spanning fewer than 4 academic years. In assessing student progress, we emphasize 3 approaches in particular: professional development, learning as a team, and assessment for learning. Our approach to professional development and its assessment has been informed by participation in the AAMC Core Entrustable Professional Activities Pilot Project. Early in the curriculum, we focus on professional identity formation and its role in the development of “entrustability” (discernment, conscientiousness, and truthfulness). In all 3 phases, evaluations of students are based on direct observation, with increasing expectations of professionalism in the clinical environment. Classroom activities in Phase 1 promote learning as a team. Students work in teams of 6 in team-based learning (TBL) sessions and other case-based learning formats. The block, DoCS, and Synthesis courses maintain stable teams throughout the academic year. Participation in peer evaluation is an element of the grade in block courses and in DoCS. Many assessment activities are low stakes, designed to instill habits of self-regulated learning and an appreciation of the skills of assessment for learning. These include students’ development of a focused learning plan before each block’s final exam, customized NBME examinations reflecting block course content, and access to a commercial adaptive learning platform that is integrated with curricular resource materials. Students receive individualized criterion-based and narrative feedback from standardized patients in a sequence of clinical simulations, beginning in Phase 1; they must also demonstrate competence in selected performance-based assessments before beginning the Phase 2 clerkships and again in Phases 2/3 as a graduation requirement. All Phase 1 courses are graded on a pass/fail basis; clerkship grades are reported with 3 passing tiers or as fail. See Table 2—Program Objectives and Assessment Methods.Table 2: Program Objectives and Assessment MethodsPedagogy Throughout the curriculum, we have a consistent pedagogical emphasis on active learning; assessment for learning; knowledge application; and approaches that develop teamwork, communication, and reflective practice skills. A series of core clinical cases forms the backbone of the Phase 1 block courses, providing clinical context for integrating foundational knowledge and the other curricular themes. Each week, 1 to 3 core case sessions focus on a specific disease or symptom; some sessions are in TBL format. Students work in groups of 6, with multiple teams led by a faculty facilitator and additional faculty with specific content expertise. Students prepare for sessions with assigned readings, videos, and other resources and work through the case with their team. TBL is also being incorporated into some Phase 2 and 3 clerkships. These small-group experiences are coupled with lectures and with laboratory work, including cadaver dissection. Several avenues for reflective practice are also incorporated throughout the curriculum. In Phase 1, these include pre- and postexamination learning plans and narrative writing about students’ medical school experiences to further their professional development. Clinical simulation is used in the DoCS course as well as in Phases 2 and 3 for both formative and summative assessment purposes. Clinical experiences The DoCS course introduces students to both ambulatory and hospitalized patients starting in the first term of the first year and integrates these experiences into the work of faculty-facilitated small groups throughout Phase 1. Each Peoria DoCS student is now embedded in a single community-based setting for the entirety of Phase 1; a pilot project in Chicago is providing a 4-year longitudinal team-based experience for selected students. There is no university hospital in Peoria or Rockford; however, each campus has built strong relationships with the teaching hospitals and physicians in its community over the last half-century. In Chicago, the University of Illinois Hospitals and Clinics and the Jesse Brown VA Medical Center are located on campus; a wide variety of other clinical affiliates also participate in student education. There is, however, considerable competition for clinical rotation opportunities from area medical schools, an osteopathic school, and schools from other states and countries. Curricular Governance Effective coordination of our multicampus curriculum requires a governance structure that creates a matrix of campus-level and institution-level authorities. The ECC infrastructure for each course, clerkship, and phase was described earlier. The ECCs serve as subcommittees of the CCIA, along with campus curriculum management committees that provide campus-specific oversight. The administrative leadership of the MD program is also best described by a matrix structure. The regional deans in Peoria, Rockford, and Urbana report to the executive dean, and each regional administration includes an associate dean for academic affairs who directly manages curricular and student affairs. The campus associate deans also work together and in conjunction with the college-wide Office of Educational Affairs, led by the senior associate dean for educational affairs and associate dean for educational planning and quality improvement, and with the senior associate dean of students. Education Staff The Office of Educational Affairs houses the college’s resources to support college-wide committees, including the CCIA, ECCs, and Accreditation Monitoring and Quality Improvement Committee. This office houses assessment and evaluation services and supports an enterprise-wide educational database, thus centralizing student assessment, program evaluation, and curriculum-related educational research. The senior associate dean of students oversees the admissions office and centralized student support services, including registration and records, financial aid and debt management, academic support, and an office attending to medical student learning environment. The majority of these areas are also represented on each regional campus by staff reporting primarily to campus leadership and secondarily to the college-wide leadership for that administrative function. The senior associate dean for educational affairs also oversees continuing medical education and has direct responsibility for graduate medical education at the Chicago campus. The Peoria and Rockford campuses are independent ACGME sponsoring institutions, with primary responsibility borne by the regional dean. Department of Medical Education The Department of Medical Education is the oldest (1959) continuously operating academic unit in the world dedicated to innovation and scholarship in health professions education. Faculty teach and conduct research in the context of master’s programs in health professions education and in patient safety leadership and a PhD program in curriculum studies. Department faculty are also active in the curriculum and, through international consultative services, have assisted in developing over 35 medical schools around the world. Faculty Development and Support in Education Faculty development has been essential to transformation from a primarily lecture-based curriculum to an emphasis on active learning methods. Faculty development at both the campus- and college-wide levels focuses on teaching methods, assessment, and use of educational technologies. Clinical departments receive financial support from central administration for faculty with significant roles in the preclerkship curriculum, particularly college-wide leadership roles. Both the individual and collaborative educational contributions of faculty are recognized for promotion.

The medical profession first addressed the need for technical standards (TS), defining the nonacademic requirements deemed essential for participation in an educational program, in guidelines published by the Association of American Medical Colleges in 1979. Despite many changes in the practice of medicine and legal, cultural, and technological advances that afford greater opportunities for people with disabilities, the profession's approach to TS largely has not changed over the ensuing four decades. Although physicians with disabilities bring unique perspectives to medicine and contribute to a diverse physician workforce of culturally competent practitioners, they remain underrepresented in the profession. As part of an initiative sponsored by the Association of Academic Physiatrists, the authors describe the need for an updated TS framework, outlining interval changes in the legal and regulatory climate, medical practice, and medical education since the initial TS guidelines were put forth. They conclude by offering eight recommendations and two functional approaches to TS that are consistent with now-prevalent competency-based medical education constructs. The profession's commitment to diversity and inclusion should extend explicitly to people with disabilities, and this stance should be clearly communicated through medical schools' TS and procedures for requesting accommodations. To this end, schools should consider the principles of universal design to create policies and assessments that work for all learners, to the greatest extent possible, without the need for after-the-fact accommodations. A thoughtful and concerted effort along these lines is long overdue in medical education.

BACKGROUND:Ethiopia has experienced tremendous growth in medical education beginning in the early 2000s. Research shows a need for emphasis on empathy and compassionate care in this setting. In the United States, the Communication Assessment Tool (CAT) is a widely used, validated survey measuring provider-patient interactions.OBJECTIVE:The goal of this study was to translate, culturally adapt, and pilot the CAT to allow it to be used with trainees and patients in Ethiopia.METHODS:Bilingual experts translated the CAT into Tigrigna, the primary language of the Tigray region in northern Ethiopia, followed by focus group discussions, back translation, and review by the original author of the CAT. The translated tool was administered to the patients of resident physicians in 6 specialties at Ayder Referral Hospital between December 2016 and February 2017.RESULTS:Our translation of the CAT into Tigrigna had semantic, idiomatic, and experiential equivalence. Of 1024 patients recruited, 1002 (98%) completed interviews using the CAT. Mean score was 3.09; 3% of all scores were excellent and 54% were good. Cronbach's alpha score for the full survey was 0.942, demonstrating high reliability.CONCLUSIONS:The translated CAT in Tigrigna can be used to assess communication skills in Ethiopian residents. Both mean score and percentage of excellent scores were considerably lower than scores in other countries, suggesting that there may be opportunities for improvement in residents' communication skills.

In 2012, the Northwestern University Feinberg School of Medicine launched a redesigned curriculum addressing the four primary recommendations in the 2010 Carnegie Foundation for the Advancement of Teaching report on reforming medical education. This new curriculum provides a more standardized evaluation of students' competency achievement through a robust portfolio review process coupled with standard evaluations of medical knowledge and clinical skills. It individualizes learning processes through curriculum flexibility, enabling students to take electives earlier and complete clerkships in their preferred order. The new curriculum is integrated both horizontally and vertically, combining disciplines within organ-based modules and deliberately linking elements (science in medicine, clinical medicine, health and society, professional development) and threads (medical decision making, quality and safety, teamwork and leadership, lifestyle medicine, advocacy and equity) across the three phases that replaced the traditional four-year timeline. It encourages students to conduct research in an area of interest and commit to lifelong learning and self-improvement. The curriculum formalizes the process of professional identity formation and requires students to reflect on their experiences with the informal and hidden curricula, which strongly shape their identities.The authors describe the new curriculum structure, explain their approach to each Carnegie report recommendation, describe early outcomes and challenges, and propose areas for further work. Early data from the first cohort to progress through the curriculum show unchanged United States Medical Licensing Examination Step 1 and 2 scores, enhanced student research engagement and career exploration, and improved student confidence in the patient care and professional development domains.

This article was migrated. The article was marked as recommended. Background: Medical schools seek admissions methods that identify applicants who hold promise to become physicians who will navigate and shape the future medical landscape. The focus on traditional cognitive measures for admission has prompted calls for holistic admissions review during the past five years. Yet, empirical evidence linking selection measures to holistic admissions practices has not been fully established, including their relationship with professional identity formation over time. A non-cognitive admissions situational judgment screening test (CASPer) measuring personal and professional characteristics was added to the University of Illinois College of Medicine admissions process two years ago, as we implemented a new curriculum that emphasizes professional identity development. Purpose: This study examined associations among admissions measures (Medical College Admission Test [MCAT], grade point average [GPA], interview, and CASPer), and their predictive relationships with curricular measures of professional identity formation (Professional Identity Essay [PIE]) and moral reasoning (Defining Issues Test [DIT2]). Methods: Data were taken from two entering cohorts (n = 596; entering class of 2017 and 2018 across 3 regional sites). Correlations and regression analyses were used to examine associations between admissions and professional identity measures. Results: CASPer and in-person admissions interview ratings had significant positive correlations, suggesting that CASPer can contribute to effective screening processes. In addition, CASPer demonstrated statistically significant positive relationships with professional identity (CASPer and PIE, r=.10, p<.05) and a measure of moral reasoning (CASPer and DIT2 type indicator, r=.09, p<.05). Association between CASPer and PIE remained consistent, even after controlling for MCAT, interview, and GPA. Conclusion: Our institutional focus on professional identity formation has provided new ways to conceptualize students' readiness for medical school – demonstrated academic rigor as well as signs of professionalism, ethics, and motivation. Non-academic factors measured in situational judgment tests may promote better alignment of admissions practices and desired educational outcomes.

New ways of thinking about medicine and health care demand new methods in medical education. Over the past two decades, as both the practice and the study of medicine have become increasingly concerned with demonstrable outcomes, medical schools have developed new curricula in health systems science and are increasingly emphasizing students’ development and demonstration of skills essential to a systems-based, outcomes-oriented practice environment. Polak and colleagues recently reported the development in Israel of one such curriculum, in lifestyle medicine, that includes opportunities for students to adopt the role of health coach. This commentary describes additional recent curricular developments elsewhere with similar goals, but utilizing more ambitious approaches that embed students in medical practices and provide meaningful, ongoing responsibility for assisting in the care of patients. These emerging new models for ambulatory care education, through a construct known as “value added education,” can simultaneously benefit both educational and patient care outcomes.

PURPOSE:Over one-third of U.S. medical schools offer combined baccalaureate/MD (BA/MD) degree programs. A subset of these truncate the premedical phase, reducing total time to the MD degree. Data comparing educational outcomes of these programs with those of conventional pathways are limited.METHOD:The authors reviewed demographic characteristics and medical school performance of all 2,583 students entering Northwestern University Feinberg School of Medicine from 1999 to 2013, comparing students in the Honors Program in Medical Education (HPME), an accelerated seven-year program, versus non-HPME medical students. They evaluated Alpha Omega Alpha (AOA) selection, quintile performance distribution from the Medical Student Performance Evaluation, United States Medical Licensing Examination (USMLE) scores, and Match outcomes.RESULTS:A total of 560 students (21.7%) entered through the HPME. HPME students were on average 2.2 years younger and less likely (15/537 [2.8%] versus 285/1,833 [15.5%]) to belong to a racial/ethnic group underrepresented in medicine. There were no significant differences in AOA selection, quintile performance distribution, or USMLE scores. More HPME students entered internal medicine (161/450 [35.8%] versus 261/1,265 [20.6%]), and fewer chose emergency medicine (25/450 [5.6%] versus 110/1,265 [8.7%]) and obstetrics-gynecology (9/450 [2.0%] versus 67/1,265 [5.3%]).CONCLUSIONS:The academic performances of medical students in the two programs studied were equivalent. Accelerated BA/MD programs might play a role in ameliorating the length and cost of a medical education. The academic success of these students absent the usual emphasis on undergraduate GPA and Medical College Admission Test scores supports efforts to redefine medical student selection criteria.

Background Longitudinal clerkships show promise in improving undergraduate primary care education. This study examines the Education-Centered Medical Home (ECMH), a longitudinal clerkship embedding teams of students across all four years into primary care clinics to provide patient care and serve as health coaches for high-risk patients. Method All students graduating in 2015 were surveyed to assess attitudes, experiences, and preferences regarding primary care education. ECMH students were compared with students receiving their primary care training in a traditional curriculum (TC) using paired measures of comparison. To assess the impact of the ECMH on patient care quality, authors performed a detailed chart review at one site. Results Seventy-six percent of eligible students participated in the study. ECMH students (n = 69) and TC students (n = 68) had similar baseline academic performance and career interests. ECMH students reported more continuity-of-care experiences, higher satisfaction with their primary care learning climate (86% versus 61% in the EMCH and TC cohorts, respectively), more confidence in their quality improvement skills, and scored higher on measures of perceived patient centeredness. Students from both groups recommended the ECMH (91% and 57%, respectively). Student involvement at one ECMH site was correlated with increased patient contacts and improved delivery of recommended preventive care. Conclusions Incorporating students longitudinally into primary care clinics is highly rated by students. The ECMH model led to improved continuity, improved perceptions of the learning climate, and higher patient centeredness. Preliminary data suggest that students add value and improve patient outcomes during longitudinal clinical experiences.