Transcript Document

MPCC
October 12, 2012
Drivers: Local needs/challenges
• Physician shortage current – perhaps 1,800
• By 2020: 4,000-6,000
• Closing the gap and the ongoing loss of physicians to
their communities through retirement, etc.
• Distributional issue
• Recruiting to rural environment
• Retaining physicians in rural environment
• Who will come, who will stay?
• Pipelines-AHEC
• Inability to recruit and retain in central-north region
• Let’s start our own medical school!
Challenge: Criticality of retention
• Retain currently practicing physicians
• Retain our trainees
• Issue of access to care
• Physician supply: global, by specialty – general
surgery, psychiatry, family medicine, internal
medicine, pediatrics
• Physician distribution – geographic
• Distribution - specialties
Medicine’s Challenges/Drivers of change:
(Reports: Macy, HHMI, AAMC)
• Accelerating pace of scientific discovery
• Calls for more public accountability
• The economy
• Rising cost of health care
• Shortfalls in health care quality: IHI call for
care that is safe, effective, pt-ctrd., timely,
equitable (personal, evidence-based,
holistic)
• Racial/ethnic disparities
• Rising burden of chronic illness/disability
(boomers)
Challenges/needs – improving medical
education
• Re-define foundation sciences of medicine
• Psychology, social science, quality improvement,
decision science, epidemiology, EBM…
• Social determinants of health/wellness
• CQI and Evidence-based practice
• Facilitate problem solving and self-directed
learning skills
• Assure students experience continuity of care
• Emphasis on community-based education
rather than the hospital (reality, retention)
Improving medical education
• Prepare students to work as team members
(inter-professional teams)
• Increase knowledge of public health and nonbiological determinants of health and disease
• CQI in practice
• Reporting publicly, and for MOC
• Develop teaching and mentoring skills of faculty –
lecturing does not facilitate learning…
Improving medical education
• Proper learning environment
• Hidden curriculum and professionalism (Hafferty)
• Learning in simulated and actual clinical environment
• Simulation
• Patient presentation model (rich case model, digital presentation)
• Standardized, simulated patients
• Teaching OSCE – actual patients
• Computer simulations
• Integration of instruction
• Clinical relevancy of content
Carnegie 2010-Med Ed System Expectations
• Creates opportunities for integrative and collaborative
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learning
Inculcates habits of inquiry and improvement
Provides a supportive learning environment for
professional formation (students and residents)
Advances health of patients and populations
Standardizes learning outcomes
Integrate formal learning with clinical experience –
community engagement
Develops habits of inquiry and improvement into medical
education at all levels
Focuses on progressive formation of professional identity
The CMU plan
• Location of the college
• Holistic admissions process
• The curriculum
• The teachers and mentors
• The training sites
• Control debt
• AHEC
Mission
• Prepare exceptional physicians
• Improving access to individualized,
essential care (health care delivery)
• Focus in rural and medically
underserved regions of Michigan
• Rural/small community focus
• Differentiated skill set
• Generalist focus: (FM,IM, Peds, Gen Surg, Ob/Gyn, Psych, EM,
PM&R)
Vision
• Excellence in instruction/active learning
• Team-based learning experiences
• Early patient contact
• Student-centered environment/program
• Patient-Centered care
• Residencies (new, distributed)
• Community-based, 11 affiliations thus far
Future Practice of Medicine
• Patient-centered care
• Patients as individuals and member of population to
be cared for supporting health assessment, patient
outreach, illness prevention strategies
• Systematic assessment and improvement of quality
indicators for physicians, hospitals, systems, patient
populations
• Coordinates and delivers care through organized
systems
• Places value on cost-effective care
• Helps address constraints on health care resources
Helps to define physician skill set for future
Integrated Curriculum
Formal Knowledge/ Courses
embedded in:
Clinical Experience (real and
virtual), in an environment of:
Inquiry, Discovery, Innovation
Year I
Year II
Year III
Year IV
Course Structure
YEAR 1
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46
MED 630: FOUNDATIONAL SCIENCES OF MEDICINE
(21 wks)
MED 600: SOCIETY AND COMMUNITY MEDICINE
MED 610: ESSENTIALS OF CLINICAL SKILLS
MED 620: THE ART OF MEDICINE
MED 640: REPRODUCTIVE/
HUMAN DEVELOPMENT
(8 wks)
MED 600
MED 610
MED 650: CARDIO/PULMONARY:
WELLNESS & DISEASE
(10 wks)
SOCIETY AND COMMUNITY MEDICINE
BREAK
(2 wks)
4
SPRING BREAK
3
WINTER BREAK (3 wks)
2
ORIENTATION
1
ESSENTIALS OF CLINICAL SKILLS
MED 620
ART OF MEDICINE
YEAR 2
47 48 49 50 51 52 53 54 55 56 57
MED 740: NEUROSCIENCES/BEHAVIOR:
WELLNESS & DISEASE
(12 wks)
MED 610: ESSENTIALS OF CLINICAL SKILLS
MED 620: THE ART OF MEDICINE
MED 620: THE ART OF MEDICINE
MED750:
MUSCULOSKELETAL/
DERMAL
(4 wks)
MED 760:
GASTROINTESTINAL:
WELLNESS &
DISEASE (4 wks)
SOCIETY/COMMUNITY MEDICINE
ESSENTIALS OF CLINICAL SKILLS
SPRING BREAK
MED 610: ESSENTIALS OF CLINICAL SKILLS
MED 750:
MUSCULOSKELETAL/
DERMAL
(4 wks)
MED 600: SOCIETY/COMMUNITY MEDICINE
WINTER BREAK (3 wks)
MED 600: SOCIETY AND COMMUNITY MEDICINE
BREAK (2wks.)
MED 730: RENAL/ENDOCRINE:
WELLNESS & DISEASE
(10 wks)
58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94
MED 760:
GASTROINTESTINAL
(3 wks)
MED 770:
HEMATOLOGY/
ONCOLOGY
(5 wks)
SOCIETY/COMMUNITY MEDICINE
ESSENTIALS OF CLINICAL SKILLS
THE ART OF MEDICINE
THE ART OF MEDICINE
95 96 97 98 99 100 101 102 103
BOARD PREP
RESEARCH PROJECT
YEAR 3
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
HOLIDAY
BREAK
(2 wks)
1
LONGITUDINAL CLERKSHIPS
30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
LONGITUDINAL CLERKSHIPS
CC - A
(4 wks)
CC - B
(4 wks)
CC - C
(4 wks)
CC - D
(4 wks)
YEAR 4
CC/CE
(4 wks)
CC/CE
(4 wks)
CC/CE
(4 wks)
CC/CE
(4wks)
CC/CE
(4 wks)
CC/CE
(4 wks)
CC/CE
(2 wks)
2 wk.
Holiday
break
51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81
CC/CE
(2 wks)
82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100
CC/CE
(4 wks)
CC/CE
(4 wks)
CC/CE
(4 wks)
CC/CE
(4 wks)
CC/CE
(4 wks)
Curriculum
• College culture: respect, compassion, inclusiveness,
social responsibility, excellence, innovation, curiosity
• Integration of foundation and clinical science
• Anatomy, biochemistry, physiology, pharmacology…
• Psychology, decision science, continuous improvement…
• Early clinical experience
• Continuing foundation science education
• Schemata and Patient Presentation model, simulated
patients and families (relevancy)
• Team-based learning (learning communities, in practices,
in the hospital, friendly competition-game theory)
• Inter professional (PA, PT, et al.)
• Self directed learning/cognitive science
Curriculum years 1-2
• Longitudinal clinical skills curriculum – integrated with
anatomy, imaging, physical examination, interviewing
• Integrated content courses: Professionalism, Ethics
Population & Community Health, Research, CQI, EBM
• Clinical and health services/delivery research
• Lean, process and quality improvement – including as research, at
the practice and system levels
• Population health, epidemiology, community health
• Evidence-based medicine (proven practice)
• Health system, care delivery, business of medicine, financing…
• Assessments: to facilitate success for individual and team
(simulations, mannequins, simulated patients, actual
patients)
Curriculum – years 3-4
• Longitudinal, integrated clerkship – PCMH, a member of
the team
• Gradual transitions as skills/knowledge develop
• Focus on self assessment, lifelong learning, practicebased learning and improvement…
• Community engaged…learning in the community
• Clinical experience based there
• Community faculty as preceptors and facilitators
• GME community setting
• Patient Centered Medical Home (more later)
Affiliations
• Alpena
• Charlevoix
• Carson City
• Hancock Hospital
• McLaren (Central MI, Bay Regional, Northern MI)
• Mercy, Grayling
• MidMichigan (Midland, Gratiot, Clare, Gladwin)
• Saginaw (St. Mary’s, Covenant)
• West Branch
• West Shore
Predictors of specialty choice
• Indebtedness
• Lifestyle wants
• Married, female – Family Medicine
• Public medical school
• Primary care track
• Community training
Predictors of choosing rural practice
• Rural birth
• Interesting serving the underserved
• Interest in serving minorities
• Public medical school
• Males more likely than females
• Entering career plan: Family Medicine
• Training in the community
• Near final training location
Factors in retention
• Environment of training
• Location of training (100 mile radius)
• Institutional funding, culture and curriculum
• Context
• Experience (role models, happy generalists)
• Opportunities identified during residency…
• Linkage to home (grew up there)
• Scholarships to limit indebtedness
• Loan-repayment programs to address indebtedness
Environment/Institution
• Training in rural/small town communities
• Primary care more likely to choose rural
• Focus on primary care/generalism
• Public medical schools
• Based in primary care practices
• Role models who value primary care/generalism
Holistic admissions
• Application review – GPA, MCAT, home town, etc.
• Response to essay questions
• Personal statements, values
• Letters of recommendation
• Campus visit – MMI process
• Selection
CMU College of Medicine
Office of the Dean
208 Rowe Hall
Phone: (989) 774-7547
Web site: www.cmich.edu/med
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