Medical Education Program Highlights The University of Utah School of Medicine (UUSOM) is the only medical school in Utah affiliated with an academic medical center (University of Utah Health) and is a state-funded, 4-year program. In addition to the MD degree, students can pursue 1 of multiple combined degree opportunities (MD–PhD, MD–MBA, MD–MSPH, MD–MPH, MD–MS of Biomedical Engineering). UUSOM’s clinical learning experiences are concentrated within 4 major affiliated teaching hospitals, affording a diversity of exposure to a variety of health systems within the intermountain west. Unique features of the program include: A longitudinal learning community model for teaching clinical skills and medical decision-making (CMC). This engages faculty as coaches and master clinician–observers and augments students’ growth and mastery of the Core Entrustable Professional Activities (Core EPAs). Focused effort to support the professional identity, leadership, and career development of students. The Real MD (Relationships Excellence Authenticity Leadership) program is a key extracurricular initiative emphasizing the student to physician transformation. The core educator model, created in 2017, has invigorated teaching faculty and enhances recognition and support for the growth and development of faculty as educators. The model focuses on the development and support of approximately 190 foundational science and clinical faculty who interface with students in the delivery of the core curriculum. Pathways of Excellence offer students additional training in areas of distinction for the University of Utah Health. Students can engage in longitudinal, 4-year elective programs of study to obtain expertise in precision medicine, population health, value-driven health care, students as teachers, wellness and health promotion, or global medicine. UUSOM is 1 of 4 schools implementing a competency-based, time-variable parallel track for a small cohort of students pursuing a career in pediatrics (Education in Pediatrics Across the Continuum [EPAC]). Curriculum Curriculum description See Supplemental Digital Appendix 1—Core Curriculum Map—at https://links.lww.com/ACADMED/A904. See Supplemental Digital Appendix 2—Core Curriculum With EPAC Parallel Track—at https://links.lww.com/ACADMED/A904. Curriculum changes since 2010 A number of modifications have been implemented since 2010: Implementation of a longitudinal learning community model to teach clinical skills and medical decision-making, integrating clinical coaches and master clinician–observers Major revision to the longitudinal curriculum addressing the medical humanities, ethics, and complexities of a changing health care system; and how culture, race, gender, economic factors, and access to care impact patient outcomes Implementation of a competency-based, time-variable parallel curricular offering for students pursuing pediatrics Required experiences in the final year of the curriculum to increase students’ preparedness for internship and mastery of Core EPAs (advanced internal medicine, critical care, and a required core subinternship). Pathways of Excellence offerings (4-year programs of study in precision medicine, population health, value-driven health care, students as teachers, wellness and health promotion, or global medicine) for students to achieve academic excellence beyond the core curriculum Core educator initiative, a major modification to funds flow supporting medical student, including significant resource allocation to support programming for faculty professional development, scholarship, and education research Strategic planning efforts beginning in 2018 to achieve the “Exceptional Learning Experience,” using a framework for organizational excellence and systems thinking to optimize the value, quality, and experience of faculty and students at UUSOM The UUSOM class size increased from 82 to 102 students in 2012. In 2015, the class size further expanded to 125 as the leadership of the school was able to successfully secure increases in state funding allocation to support the effort. Modest incremental changes to scheduling in the clinical learning environment and modifications to gross anatomy and clinical skills simulation spaces were planned for and implemented to accommodate the class size change. Assessment Medical education program objectives are based on a number of frameworks including the ACGME competencies, AAMC Core EPAs, and Physician Competency Reference Set. See Supplemental Digital Appendix 3—Program Objectives and Assessment Methods—at https://links.lww.com/ACADMED/A904. Significant changes to student assessment since 2010 include the following: Increased emphasis on noncognitive/attitudinal behaviors with narrative assessment through all 4 years of the program Implementation of peer feedback/ratings in the setting of team-based learning (TBL) and case-based learning (CBL) Clinical curriculum assessment alignment with Core EPAs Pilot of competency-based strategy for supporting the mastery of foundational science knowledge in the preclerkship foundational sciences courses (Knowledge for Practice Assessment of Competence Committee) Parallel curriculum or tracks The UUSOM implemented the EPAC pilot in 2013. As 1 of 4 medical schools collaborating with the AAMC, UUSOM’s program has been successful in accomplishing time-variable, competency-based advancement from medical school through residency to fellowship/professional practice. UUSOM’s students are assessed to a greater extent on the 13 Core EPAs than the traditional students. Once students complete the medical school graduation requirements and show competency in all EPAs, they transition to the pediatric residency program at the University of Utah. Pedagogy A mix of pedagogical approaches are used in the core curriculum, including significant use of active learning methods such as CBL, TBL, interactive labs, small-group discussion, clinical experiences (both ambulatory and inpatient), simulation (high and low fidelity), role play/dramatization, and standardized patient experiences. Learning communities are an important structural characteristic, serving as the foundation for the longitudinal clinical skills program. Self-directed tutorials are used in a number of courses across the 4-year program as is peer teaching. Pure large classroom didactic lectures are becoming much less prevalent in the program. The parallel track for EPAC requires all EPAC students to have the same experiences as their counterparts in the core curriculum; however, EPAC has an increased amount of clinical experiences, primarily ambulatory, in the form of a pediatric preceptorship as well as a number of workshops and an increased volume of assessment of the Core EPAs. Significant shifts in the implementation of active learning methods have been underway since 2010 with increased emphasis on consistent use of CBL across the preclerkship phase and the implementation of TBL in 2017. A small percentage of the program is delivered using traditional, didactic, lecture-based methods. The launch of Layers of Medicine and CMC have increased the use of small- and large-group discussion methods, peer teaching, role play/dramatization, and inpatient and ambulatory clinical experiences. Clinical experiences Clinical sites used in the required clinical curriculum include academic hospitals and clinics, community-based hospitals, and clinics including a number of rural sites (both inpatient and ambulatory) throughout Utah and Idaho. Across the 7 core clinical clerkships, there are 12 different inpatient sites and 9 types of ambulatory teaching sites that are used (including community health centers, rural clinics/Area Health Education Centers, and Veterans Affairs sites). The school does not use longitudinal integrated clerkships. Learners are introduced to the clinical method beginning the first week of the curriculum and encounter patients in the clinical environment midway through the first year of the program in ambulatory and inpatient settings. Students have a required 6-week family medicine clerkship (100% ambulatory), which is largely set in community-based clinics. Several sites are located in remote parts of Utah and Idaho. The surgery clerkship preceptorship (2 weeks) additionally places students in community-based clinics including rural sites in Utah. A small number of students complete a portion of their obstetrics–gynecology clerkship in rural Utah community clinics and hospitals. The VA system is an important training site for students during the internal medicine, surgery, and neurology clerkships for both inpatient and ambulatory experiences. Faculty training to ensure consistent and fair summative assessment proposes a notable challenge given the large number of faculty we engage in the core clinical curriculum. While our students provide us with data indicating that they receive high-quality clinical educational experiences, we continue to have reports of medical student mistreatment, which is counter to our values as an institution. We continue to work to identify opportunities and strategies to address the mistreatment of medical students in the learning environment. Curricular Governance There are no elements of the curricular governance that are decentralized or managed at the department level. See Figure 1—Curricular governance chart.Figure 1: Curricular governance chart.Education Staff The administrative and academic support for the planning, implementation, evaluation, and oversight of the curriculum is through the Office of Curriculum, which is overseen by the associate dean of curriculum. There are 3 assistant deans who direct the foundational sciences curriculum, clinical curriculum, and operations for curriculum evaluation and quality improvement, respectively. A staff director of curriculum and faculty support assists the Office of Curriculum leadership and teaching faculty in accomplishing the missions of the education program as well as supporting the Curriculum Committee (CC). The Office of Curriculum is responsible for identifying and maintaining the tools that support the delivery, monitoring, and managing the curriculum. The Education Technology Subcommittee of the CC also investigates and proposes solutions to curricular technology needs with membership including faculty and staff from information technology, library sciences, and University of Utah main campus education technology, as well as students. The medical education staff and administrative faculty ensure the implementation and continual improvement of the medical student program. The administrative leads in admissions, student affairs, health equity and inclusion, curriculum (includes the Office of Education Quality Improvement), continuing medical education, and finance work closely to ensure the delivery of a high-quality program. Faculty development explicit to the needs of the medical student program is directed by the offices of curriculum, student affairs, and admissions. The associate dean for GME closely collaborates with the Dean’s Office administrative faculty and staff. However, GME reports to the University of Utah Health Administration. The UUSOM does not have an academic department of medical education. See Figure 2—Dean’s office organizational chart.Figure 2: Dean’s office organizational chart.Faculty Development and Support in Education Professional development for education faculty is central to the mission of the Office of Curriculum. The core educators primarily deliver the curriculum and engage in regular professional development through retreats, skills-specific trainings, workshops, journal clubs, etc. These experiences help build a community of educators and prepare faculty for their roles in the program and to take a scholarly approach to education. The Offices of Student Affairs and Admissions conduct regular trainings for faculty who serve key roles in their operations, such as advisors, mentors, academic coaches, interviewers, and selection committee members, respectively. In promotion and tenure decisions, education excellence criteria have been developed and are used by the departments and committees responsible for the faculty appointment, review, and advancement procedures. The criteria for educational scholarship and education effectiveness and excellence were recently revised with broad input from key education administrators, faculty, and leadership at the school. In addition to the professional development programming that has heretofore been described, the UUSOM has an associate dean for faculty development/associate vice president for health sciences education. This individual directs faculty development efforts for the health sciences colleges’ faculty, which includes oversight of the Academy of Health Sciences Educators (AHSE). The AHSE includes faculty from all 5 health sciences colleges at the University of Utah (nursing, pharmacy, dentistry, health, medicine). Initiatives in Progress The UUSOM is reaching a final phase of planning a new medical education building. The development of a Pathway of Excellence and a graduate certificate in Rural and Underserved Health are being planned for the coming 1–2 years as part of the Rural and Underserved Utah Training Experience (RUUTE). With significant support from the Utah state legislature, the RUUTE program aims to enhance the training, health care access, and long-term socio-economic benefit for rural and underserved communities of Utah by expanding interest, awareness, and placement of students and physicians. Finally, strategic efforts to redesign the education program and achieve the “Exceptional Learning Experience” with a focus on relationships, community, diversity, professionalism, excellence, learning and continuous improvement, partnerships with students, and student centeredness are mapped out for the upcoming 3 years.

Concern about medical student attendance has been rising over the last decade. Thinking a required attendance policy would fix things, we instituted such a mandate in 2010 only to find that although students were present at lecture and other learning sessions they were disengaged. In addition, we experienced growing distrust between faculty and students and tensions between the Student Affairs and Curriculum offices. After five years, we dismantled the policy in favor of encouraged attendance. We discuss both positive and negative surprising consequences that followed this new approach to attendance which has reshaped our vision for the medical school learning experience. It has been transformative and has afforded us the opportunity to redefine our results in accord with the culture in which we aspire to live and work.

PURPOSE:To investigate current medical school admission processes and whether they differ from those in 1986 when they were last reviewed by the Association of American Medical Colleges (AAMC).METHOD:In spring 2008, admission deans from all MD-granting U.S. and Canadian medical schools using the Medical College Admission Test (MCAT) were invited to complete an online survey that asked participants to describe their institution's admission process and to report the use and rate the importance of applicant data in making decisions at each stage.RESULTS:The 120 responding admission officers reported using a variety of data to make decisions. Most indicated using interviews to assess applicants' personal characteristics. Compared with 1986, there was an increase in the emphasis placed on academic data during pre-interview screening. While GPA data were among the most important data in decision making at all stages in 1986, data use and importance varied by the stage of the process in 2008: MCAT scores and undergraduate GPAs were rated as the most important data for deciding whom to invite to submit secondary applications and interview, whereas interview recommendations and letters of recommendation were rated as the most important data in deciding whom to accept.CONCLUSIONS:This study underscores the complexity of the medical school admission process and suggests increased use of a holistic approach that considers the whole applicant when making admission decisions. Findings will inform AAMC initiatives focused on transforming admission processes.