Integrated Competency-Based Curriculum

First Year & Second Year Overview

On July 17, 2008 , the Curriculum Committee approved the plans for the new curriculum. The committee, under the direction of Russell Griesback, DO, and James White, PhDhas worked as a group to complete this project. The curriculum has been approved by the faculty, the Executive Council and the Commission for Osteopathic College Accreditation (COCA) for implementation in August 2009.

The new curriculum is based on the Seven Competencies of the American Osteopathic Association:

  1. Osteopathic Philosophy and Osteopathic Manipulative Medicine
  2. Medical Knowledge
  3. Patient Care
  4. Interpersonal and Communication Skills
  5. Professionalism
  6. Practice Based Learning and Improve me nt
  7. Systems Based Practice.

The curriculum utilizes many teaching and learning techniques including lecture/discussion, small group sessions, on-line learning, standardized patient encounters, simulators, the year one preceptor program, and community involved primary care projects. There is an increase in case-based learning, especially in year two. This learning technique, presently utilized to a lesser extent in the existing curriculum, is student directed learning in small groups based on cases written by and facilitated by faculty members.

A major goal of curriculum reform was to decrease the classroom time for first and second year students. A 21% decrease in student classroom time was accomplished by eliminating redundancy, utilizing on-line resources, and incorporating student-directed learning techniques.

Another important goal was to emphasize musculoskeletal medicine and to increase the content in pediatrics and geriatrics. The committee decided this was an important goal for an osteopathic medical school curriculum. The musculoskeletal medicine content has been increased from two weeks of rheumatology and orthopedics in the present curriculum to a five-week module that integrates not only rheumatology and orthopedics but also physical medicine and rehabilitation, sports medicine, and of course OMM. An increased emphasis on pediatrics and geriatrics was another important goal; both disciplines are now full three-week courses that conclude the curriculum; a significant increase from the existing curriculum.

Description of the New Curriculum

Year One: The first semester of year one is heavily involved in the basic sciences critical to success as a physician. Also integrated throughout year one are OMM (including functional anatomy), professionalism, the history of osteopathic medicine, the Family Medicine Preceptor Program, and community involved primary care. The semester begins with a block of the fundamentals of basic science which include cell physiology, membrane physiology, biochemistry, genetics, tissue types, and an introduction to microbiology and immunology. The next weeks are dedicated to cardiovascular science including physiology, histology, biochemistry, anatomy, microbiology and genetics.

The spring semester of year one begins with a renal/respiratory unit, then gastrointestinal science followed by endocrine/reproductive science. Each of these blocks includes physiology, histology, anatomy, microbiology, and genetics. The semester concludes with a large block of neuroscience and musculskeletal. This module integrates both the basic sciences and clinical medicine into one unit, and includes neuroscience, microbiology, genetics and pathology.

Year Two: The second year curriculum is organized in systems-based modules. These modules contain  integrated information in  clinical medicine, pharmacology, pathology, infectious disease, OMM, and physical diagnosis. The semester begins with the prevention module that not only reviews health and promotion prevention but also addresses nutrition and many of the learning objectives of the practice learning-based competency. Prevention is followed by neurology/musculoskeletal, endocrinology, cardiology, pulmonology, and nephrology/urology modules. Professionalism continues with biomedical ethics issues integrated through all case-based learning sessions and standardized patient encounters. The interpersonal communication competency begins in semester one and extends through the second semester. Psychiatry remains a course throughout both semesters of year two. The year two spring semester begins with a week of gastroenterology hematology/oncology, pain management, addiction medicine, and issues surrounding death and dying, women's health, geriatrics and pediatrics modules. The semester concludes with a formal preparatory time for COMLEX Level I examination.  Instruction in OMM continues weekly throughout every year of the medical school curriculum. The new learning formats allow for increased integration of OMM, especially in year two when instruction focuses on the patient's clinical presentations that are discussed that week. OMM is also integrated into case-based learning cases and many standardized patient encounters.

Year Three:

Years three and four mark the beginning of the clinical component of the medical education program. In the third and fourth years, students learn patient care and develop clinical technical skills and serve as members of a medical team. Students spend time with clinical faculty at the Kennedy University Hospital-located in Stratford, Cherry Hill, and Washington Township; Our Lady of Lourdes Medical Center in Camden; Christ Hospital in Jersey City, St. Joseph's Hospital in Paterson, New Jersey, Morristown Memorial Hospital and Overlook Hospital in Summit, and at other instructional sites in the area.

The following specialty areas offer clinical instruction in the third year: Family Medicine, General Internal Medicine, Obstetrics/ Gynecology, Pediatrics, Psychiatry, Geriatrics, Radiology, Surgery/ Anesthesiology and Medical Jurisprudence. Basic procedures are demonstrated and practiced by students in each of these areas. Students learn about the standard operating procedures of the hospital and office practice.

 

Year Four:

The Rowan University School of Osteopathic Medicine's fourth-year instructional format includes a series of clinical experiences. A primary purpose of instruction in this year is to help the fourth ­year student apply the didactic background and preliminary clinical training to more intensive clinical experiences. The student is given patient-care responsibilities on each service through which he / she rotates. Instruction takes place at the bedside and in clinical conferences. During the year, students develop skill and competency in history taking and physical examination, creating a differential diagnosis, ordering and using laboratory tests; learning procedures in making a diagnosis and providing treatment. They establish professional relationships with patients, participate in the management of patient care during the hospital stay and in subsequent follow-up visit and record data and present cases. The following specialty areas offer clinical instruction in the fourth year: family medicine, emergency medicine, surgical, and medicine specialties. Students have the opportunity for subspecialty experiences in cardiology, endocrinology, gastroenterology, general internal medicine, geriatrics, hematology/oncology, infectious diseases, nephrology, neurology, pulmonology and intensive care.

Through direct and extensive patient contact, the student has many opportunities to practice the concepts of osteopathic diagnosis and therapeutics and to learn through instruction by interns, residents, and faculty. The case specific learning experiences are a valuable aspect of the program.

 Innovative components have been placed throughout all four years of the curriculum. Ethics, clinical osteopathic manipulative medicine, and pain management are examples of curricular topics that are integrated within courses and clinical experiences spanning the four years of medical school. Traditional lecture formats are augmented and supported by an emphasis placed on self-directed study, online learning, videos, standardized patient lab, and a multitude of teaching strategies and technologies.

 

Integration of Basic Science, Clinical Medicine and OMM

The committee anticipates continued integration of basic science and clinical medicine. Much of this is occurring already in small group physiology sessions, clinical teaching in biochemistry and genetics, and case-based learning in the histology course. Anatomy instruction is fully organized around clinical issues and radiology. Neuroscience is a fully integrated module with neurology.

The year two curriculum integrates clinical medicine, pathology, pharmacology, physical diagnosis, and infectious diseases within the modules. The practice-based learning objectives and the practice-based learning competency, personal communication, and systems-based practice are integrated throughout the year.

Instruction in OMM continues weekly throughout the first two years of medical school curriculum. However, the new learning formats allow for increased integration of OMM, especially in year two when instruction can focus on the patient's clinical presentations that are discussed that week. OMM is also integrated into all case-based learning cases and many standardized patient encounters.

Student Evaluation

The new curriculum utilizes the same grading system as the traditional curriculum:

Honors 90-100
High Pass 80-89
Pass 70-79
Low Pass* 65-69
Fail 64 or less

* As of June 4, 2013, SOM will no longer have a grade of Low Pass.

The curriculum committee decided “to raise the bar” on student progress in many other ways. Definitions of failure are clearly written. Policies have been approved that set clear standards for student progress and academic failure. The new policy also raises the bar for student progress in their Year three and four clinical rotations.

Examinations will be integrated throughout the basic science and clinical modules. These interdisciplinary COMLEX style exams will not only evaluate student performance across disciplines but will also better prepare students for the board examinations.

Curriculum Evaluation

Three years ago the curriculum committee charged the assessment sub-committee, under the direction of Frank Filipetto, DO, to implement the school's learning assessment plan. The sub-committee, reporting to the curriculum committee, will therefore have the major role on institutional assessment of the new curriculum.

The Learning Assessment Plan at RowanSOM developed by focusing its efforts in four roles:

• Course/Unit/Clerkship (Curriculum) Assessment focusing on teaching, competency achievement, and evaluation of 7 AOA competencies.

• Academic Program Assessment identifying student and graduate outcomes measured against goal or intended outcomes.

• Institutional Assessment evaluating actual to intended outcomes related to admissions, matriculation, retention, and graduation.

• Quality Assessment/Quality Improvement process utilizing data collected in 1-3 above in efforts to improve learning at SOM and meet or exceed academic and institutional goals.

Faculty Effort

Although student time in the classroom is significantly decreased, faculty time in the classroom is slightly increased due to the facilitating requirements of case-based learning. Faculty will spend 2887 hours in each year of the new curriculum compared to 2778 hours in the existing curriculum, a variance of 109 hours increase, a small increase for 214 faculty members.

However, when standard metrics for faculty preparation time are utilized, the total faculty effort for the new curriculum is actually decreased since lecture has greater preparatory requirements then facilitating. The total faculty effort of 6357 hours for the new curriculum is slightly over 1000 hours less than the 7362 hours required for the lecture-based traditional curriculum.

Summary

To the best of our knowledge the new, competency-based curriculum is the first of any osteopathic medical school to fully incorporate all Seven Competencies of the American Osteopathic Association. This highly integrative curriculum utilizes many modern learning techniques including lecture discussion, small group sessions, on-line learning, standardized patient encounters, simulators and case-based learning. By utilizing teaching tools other than lecture and by eliminating redundancy, the committee has been able to decrease student classroom time by 21%. There is an increased emphasis on musculoskeletal medicine, pediatrics and geriatrics. Although faculty time in the classroom has been slightly increased, the overall faculty effort is significantly decreased. Importantly, carefully crafted policies on student progress will ensure that students will be responsible and accountable for their own learning.

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