[see LCME 7.x, 6.8]
The Curriculum of the University School of Medicine, has been established and administered by the Curriculum Coordinating Committee of the School. The 150 week curriculum is designed to be completed in 4 academic years, though many students may delay completion to participate in research, acquire additional academic degrees, or participate in programs to obtain specialty choices.
The overall aim of the curriculum is to prepare the student to be a successful resident within the framework of the Physician Competency Reference Set, which serve as the overall program goals. In addition, the curriculum is designed to prepare the student to be a life-long learner who will use their medical school education for the rest of their career. During the first two years of medical school, the curriculum is built around a series of interdisciplinary blocks to allow the student to connect and link relevant scientific material to clinical conditions. In addition, the first two years include a longitudinal course entitled Introduction to Clinical Medicine where students learn about the doctor-patient relationship and the psychosocial aspects of patients, organized medicine, and society to enable them to optimally treat the diverse group of patients that they will encounter. The third and fourth years of the curriculum provide the student a series of required and elective experiences to allow them participation in a broad range of medical specialties and settings, as well as the opportunity for focused areas of clinical activity as they prepare for their career choices.
[see LCME 6.1, 8.2]
Program and Learning Objectives
The medical education program objectives were developed by the Curriculum Coordinating Committee (CCC) with input from the Office of Medical Education and Office of Student Affairs, and were reviewed and approved by the CCC in 2015. All objectives are stated in terms of the AAMC Physician Competency Reference Set (PCRS).
Outcome measures are linked to program objectives by each course and clerkship director. The medical school ensures that the outcome measures selected are appropriate through review by the Year 1/Year 2 Committee for precelinical courses and by the Clinical Years Committee (CYC) for all clinical courses with ultimate approval by the Curriculum Coordinating Committee. The Year 1/Year 2 Committee formally conducts peer review of each required course on a rolling basis. This review provides the course director and Year 1/Year 2 Committee feedback on areas for improvement and integration between courses. The CYC formally conducts peer review of each required clerkship, allowing focused review of each clerkship's objectives and evaluation methods and providing feedback on areas for improvement through collaborative development of action plans.
The faculty, working through the CCC, Year 1/Year 2 Committee, and CYC, has framed all course and clerkship goals and objectives within the PCRS taxonomy. Both preclerkship and clinical years' goals and objectives; however, are ultimately driven and linked to the main University of Maryland School of Medicine educational program objectives. The individual course/clerkship directors formulate goals and objectives for each educational program unit with the input of departmental faculty and leadership. These goals and objectives are then reviewed and approved by the CCC and its subcommittees. In this review process, the faculty ensures that the learning objectives of individual courses/clerkships meet the overarching program objectives.
Faculty members within each course and clerkship receive the program and learning objectives from the course or clerkship director, who is tasked with ensuring that those objectives are disseminated in the most effective way for that particular group of instructors.
[see LCME 8.3]
Developing the objectives for individual courses and clerkships
Objectives are developed by course and clerkship directors and co-directors and are approved by the Curriculum Coordinating Committee (CCC) following review by the appropriate subcommittee (Year 1/Year 2 Committee for the preclerkship years, Clinical Years Committee (CYC) for the clinical years). Substantial changes in objectives are likewise reviewed by the subcommittees and CCC. The AssociateDean for Medical Education and the Chief Academic Officer (CAO) are non-voting members of the CCC and provide guidance to changes in objectives. The CAO, who reports directly to the Dean, has the overall responsibility for the medical education program of the school as a whole, but is not involved in individual course, clerkship, or objective development.
Identifying the appropriate teaching and assessment methods
Teaching and assessment methods are determined by the course and clerkship directors, with input from unit leaders, and are approved by the respective committees. Teaching and assessment methods are subject to change as a result of the student feedback (e.g., from focus groups), formal evaluations, feedback from individual teaching faculty, and suggestions developed in the process of peer evaluation of courses. Substantial changes in assessment methodologies are reviewed by the CCC and its
Identifying course and clerkship content and assessment methods that are appropriate for the course/clerkship learning objectives
The content for each course and clerkship is determined by the course/clerkship directors with input from the teaching faculty with review and approval by the CCC and its subcommittees. Content areas are evaluated compared to performance on NBME shelf exams and USMLE Step exams. Assessment methods are evaluated on a regular basis by the process of peer review, and in addition are reviewed at the CCC and its subcommittees. Any substantial changes are approved by these committees.
Evaluating the quality of individual faculty member teaching (e.g., through peer assessment of teaching or review of course content)
The course/clerkship director, co-director(s), and section leaders review individual faculty teaching effectiveness both on an ongoing basis and after the course/clerkship is completed. The review during the course occurs through personal observation, review of video capture of lectures, and after the completion of the course/clerkship. The course director, co-directors and unit/section leaders conduct a thorough review of formal student evaluations and provide feedback to the individual faculty regarding the quality of their teaching. Course/Clerkship directors work with the faculty to help them improve. If necessary, the teaching faculty are encouraged to take advantage of opportunities to improve their teaching effectiveness; for example, through numerous courses offered in the School and on campus, as well as through one-on-one coaching by the more experienced faculty.
Monitoring the quality of individual faculty member teaching (e.g., through the review of student evaluations of courses and clerkships)
The course/clerkship director, co-director(s), and section leaders monitor individual faculty teaching effectiveness through the review of student feedback and evaluations. This review occurs during and after the courses/clerkships. Monitoring during the course consists of peer review by course and section leadership, regular student focus groups, and realtime student feedback on individual sessions. Monitoring after the course consists of a required comprehensive end-of-course evaluation completed by all students. After the completion of the course/clerkship, the course director, co-directors and unit/section leaders conduct a thorough review of formal student evaluations and of the feedback provided during focus group meetings. Of note, there are several examples of when less than successful teaching performance by individual faculty members resulted in their replacement with a more apt educator, with the resultant improvement of student learning, performance on the exams, and student feedback.
Evaluating the overall quality and outcomes of the course/clerkship
Each year, the course/clerkship directors present the overall performance and quality of completed courses/clerkships at the respective subcommittee (Year 1/Year 2 Committee or CYC). The subcommittees also receive the results of ongoing peer evaluation of teaching effectiveness. Student representation on the CCC and its subcommittees provides overall student perspectives. The course leadership as well as CCC and its subcommittees regularly review such outcome data as student performance on internal examinations as well as NBME/USMLE examination results. In addition, both subcommittees regularly review the Graduation Questionnaire and NRMP data. The Associate Dean for Medical Education and the Medical Education Advisory Committee (MEAC) independently evaluate the courses to determine if leadership changes are needed within a course/clerkship.
[see LCME 8.3]
Curricular Review, Revision, Monitoring
MedScope, the online portal for curriculum management, is the current repository for the medical student curriculum. MedScope houses the curriculum database including such searchable items as topic/title, faculty instructor, objectives, keywords, teaching methods, learning materials and assessment methods. The faculty in each course and clerkship contribute to the database. Curricular content and instructional materials (i.e., presentations and notesets) from prior years are available on MedScope as well. All course and clerkship directors, section/unit leaders, and individual faculty instructors have access to the curriculum materials for the preclerkship years via MedScope. Leadership and staff of the Office of Medical Education (OME) and the Office of Student Affairs (OSA) also have access to all curricular content. Course and clerkship directors along with their respective administrative staff provide updated curricular information. This is monitored by OME. Primary responsibility for management of the content and function of the database rests with OME in collaboration with course and clerkship directors. The results of reviews of curricular content are provided to the Curriculum Coordinating Committee and its subcommittees.
Curricular content is monitored by course/clerkship directors in consultation with teaching faculty. The results of this monitoring are reviewed annually and presented to the respective subcommittee of the Curriculum Coordinating Committee. Recently, both the Year 1/Year 2 Committee and CYC have begun the task of mapping the four year curriculum. The findings in this process have already led to several enhancements of curriculum in the preclerkship and clinical years. For example, several redundant lectures in first and second year were consolidated and several under-represented areas enhanced (e.g. more formalized and detailed content on hematology and coagulation). The Office of Medical Education (OME) reviews the four year curriculum and, if any gaps are discovered, contacts the respective course/clerkship director for further information and/or action. OME is the hub for curricular mapping endeavors.
Required courses in the preclerkship phase of the curriculum
The Year 1/Year 2 Committee has a policy pertaining to formal review of required courses. In addition to reporting to the Year 1/Year 2 Committee and Curriclum Coordinating Committee (CCC) on outcome and performance measures for each course every year, all established courses are peer-reviewed at least once every five years; new courses are reviewed annually for the first two years, and biannually after thatfor another two cycles. Each formal peer review consists of a pre-observation meeting to discuss the targets and goals for the review, observation during the course, and post-course review of course evaluations. For content review, all course materials (including recordings of all lectures) are available on MedScope. To facilitate the review, the Office of Medical Education gathers and distributes data from internal and external sources. The formal review report includes the list of strengths and suggestions for improvement; it is shared with the course director and then reported to the Year 1/Year 2 Committee and the CCC. These reviews provide additional information to the continuing review of the entire curriculum by the CCC.
Required clerkships are formally reviewed within each respective department with reporting to the Clinical Years Committee (CYC) and CCC regularly, with the last occurring in 2014. Student evaluations of the clerkship/preceptor/site, faculty evaluations of the students, performance on all USMLE Steps, performace on NBME shelf exams, OSCE data, and NRMP match data are included in the review process. The CYC reviews and considers changes across the third and fourth years. Each clerkship director must report any significant changes in objectives, teaching methodology, and course format to the CYC and CCC annually. The Office of Medical Education gathers and distributes data from internal and external sources to support the curricular reviews. These reviews provide additional information to the continuing review of the entire curriculum by the CCC.
Individual years or phases of the curriculum
Both Year 1/Year 2 Committee and CYC conduct formal reviews of preclerkship and clinical years, respectively. This review occurs on an annual basis and includes review of formal student feedback (course evaluations and GQ) as well as outcome data; for example, review of student performance on internal examinations as well as the results from national examinations. These reviews are then discussed at the CCC, and changes to the curriculum are proposed to address identified deficiencies.
The curriculum as a whole
The CCC continuously monitors the effectiveness and cohesion of the entire curriculum; in addition, formal review of outcome measures and student feedback is undertaken annually. Outcome measures evaluated include the review of student performance on the National Board Examinations, shelf exams, Graduation Questionnaire, faculty evaluation of student competency through direct observation (e.g., mini-CEXs). Other outcome measures such as match results (frequency per specialty, perceived quality of matched programs, student ability to obtain residency of choice) are tracked. Residency program directors complete a survey at the end of the graduate’s internship to provide feedback to the School of Medicine on the graduate’s competency in achieving expected milestones. The results of this review are reported to the Medical Education Advisory Committee and the Dean; changes to the curriculum are proposed to address identified deficiencies.
[see LCME 8.1]
The Curriculum Coordinating Committee (CCC) is a standing committee of the School of Medicine mandated by its bylaws and serves as the faculty governance of the education program of the University of Maryland School of Medicine, representing the entire teaching faculty of the School. The CCC is comprised of all required course/clerkship directors and departmental elective directors, as well as elected faculty member, student class officers and curriculum representatives. The chair of the CCC is chosen by the Dean. Four faculty member representatives are elected by the School of Medicine faculty. The student representatives are elected by student vote at the beginning of each year. The CCC also includes as non-voting members the Senior Associate Dean for Academic Affairs, the Associate and Assistant Deans for Medical Education, Student Affairs, Admissions, as well as a community hospital liaison. The faculty members of the CCC do not have terms and serve as long as they hold the position of course/clerkship/elective directors. The elected faculty members of the committee serve a two year term. The elected student members of the committee serve until their graduation from the School. The CCC meets monthly.
The CCC has two standing subcommittees. The Year 1/Year 2 Committee is devoted to the preclerkship years and is comprised of all first- and second-year course directors as well as student representatives. The Clinical Years Committee (CYC) is comprised of all clerkship directors as well as student representatives. The charge of each subcommittee is to gather information from students, faculty, and department chairs; to review and evaluate the current curriculum; and to generate and evaluate proposals for changes in courses and clerkships. Each subcommittee meets monthly and reports directly to the CCC.
Developing and reviewing the educational program objectives
The CCC and its two subcommittees, working closely with the Chief Academic Officer (Senior Associate Dean for Academic Affairs) and the Medical Education Advisory Committee (MEAC), develop and periodically review and revise institutional objectives, ensure the use of appropriate teaching methods and evaluation, and monitor the effectiveness and quality of teaching. There is periodic review of goals and objectives, which undergo revision as the result of discussion and deliberations in both subcommittees and the CCC.
Ensuring that there is horizontal and vertical curriculum integration (i.e., that curriculum content is coordinated and integrated within and across academic years/phases)
Since the curricular reform of 1994, which created inter-disciplinary preclerkship blocks, the Year 1/Year 2 Committee has monitored the successful integration of those courses. The Year 1/Year 2 Committee and CYC include faculty representing continuous themes in the student education, such as ethics and professionalism, student research, radiology, genomics and epidemiology. Many themes run vertically through the curriculum: examples include clinical concepts and skills which are omnipresent in the first two years, both in the form of Introduction to Clinical Medicine I/II and in every preclerkship course in the form of lectures and small group sessions devoted to clinical significance of the concepts covered. To reinforce the vertical integration of continuing topics, a new course, Foundations of Disease, was created in the beginning of second year; this course consists of introduction to mechanisms of disease, pharmacology and epidemiology. Although these concepts are taught in first year, they are explored to a much greater depth in second year as the foundation and bridge to the primarily systems-based structure of second year. The course/clerkship directors, the Year 1/Year 2 Committee, the CYC, and the CCC constantly work on better integration of content taught throughout the curriculum.
Monitoring the overall quality and outcomes of individual courses and clerkships
Both the Year 1/Year 2 Committee and CYC conduct ongoing course and clerkship review; this review includes, for example, review of student performance on internal examinations as well as the results from national examinations. Each course engages in a peer review process where course directors from other courses sit in on aspects of the course under review, evaluate all student feedback, and generate their own evaluation of the course quality/effectiveness. The peer reviewers meet with the course director to discuss their observations and suggestions. The overall review is also brought to the Year 1/Year 2 Committee or CYC. The standard schedule for peer review is every five years for long standing courses. New courses are evaluated annually in the first two iterations of the course, then once more at the two year point before moving to the regular peer review cycle. In addition, both subcommittees regularly review the results of peer evaluation of teaching effectiveness, student evaluation data, as well as outcome measures.
Monitoring the outcomes of the curriculum as a whole
Outcome monitoring includes the review of student performance on the National Board Examinations, shelf exams, Graduation Questionnaire, as well as faculty evaluation of student competency through direct observation (e.g., mini-CEXs). A significant outcome measures is the result of the NRMP match (i.e., frequency per specialty, perceived quality of matched programs, student ability to obtain residency of choice). Residency program directors complete a survey at the end of the graduate’s internship to provide feedback to the School of Medicine on the graduate’s competency in achieving expected milestones.