Community Based Faculty Meeting Curriculum Update

May 10, 2014

History of Medical EducationPrior to 1920: Apprenticeship1920-1960: Standardization and scientific investigation Emphasis on the patient and their presentation Case studies and case series1960-2000: Genetic and molecular medicine Emphasis on laboratory and imaging Bench research and randomized controlled trials2000-present: Comprehensive physician Integration of scientific background and patient

presentation Clinical productivity Comparative effectiveness, patient safety, ethics

Randomized Controlled Trials in PubMed

1960

1963

1966

1969

1972

1975

1978

1981

1984

1987

1990

1993

1996

1999

2002

2005

2008

2011

0

5000

10000

15000

20000

25000

Meta-Analyses in PubMed

1960

1963

1966

1969

1972

1975

1978

1981

1984

1987

1990

1993

1996

1999

2002

2005

2008

2011

0

1000

2000

3000

4000

5000

6000

“He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.”

Sir William Osler

Our Approach Block schedule

One of the first medical schools to offer Intensive, concentrated exposure to each area

Emphasis on patient presentations and management

Flexible afternoon scheduling Basic science courses scheduled in the mornings

Curriculum Goals Integrate biomedical and clinical science Promote critical thinking Develop problem-solving skills Develop clinical reasoning skills Apply a biopsychosocial model to patient care

Pre-Clinical Years First two years of study Hybrid Curriculum

Begin with essential principles of core knowledge Integrated content based on organ systems

Focus on integrative thinking Necessary for the clinical years of medical school Successful modern physicians

First Year

Anatomy

Introduction to Clinical

Medicine 1

Biochemistry & Genetics

Foundations of Disease, Infection & Therapeutics

Neurosciences

Behavioral Basis of Medicine

Discipline Specific Anatomy

Core gross and microscopic anatomy Integrated with embryology Basics that will be further developed throughout the

curriculum Biochemistry & Genetics

Core biochemistry, genetics and cell biology Biochemical and genetic inheritance Actual patient clinical correlations of human disease

Foundations of Disease, Infection & Therapeutics

Basis of all human disease Integrated approach

Microbiology Immunology Pharmacology Pathology

True “foundation” on which remaining courses will build

Neurosciences Nervous system functions in health and disease Integrated approach

Neuroanatomy Neurochemistry Neurophysiology Neurology Neurosurgery Ophthalmology Otolaryngology

Behavioral Basis of Medicine Introduction to psychiatric conditions Integrated study

Psychiatry Behavioral science Pharmacology

Modes of treatment Pharmacologic Psychotherapeutic Psychosocial

Introduction to Clinical Medicine 1 Longitudinal clinical experiences Communication training and interviewing skills

Practice with “actor” patients, then with actual patients Small-group seminars

Medical Humanities Medical Ethics and Professionalism Developmental Pediatrics Geriatrics Cultural and Social Aspects of Health Care

Evidence-Based Medicine

Second YearMusculoskeletal & Integumentary Systems

Introduction to Clinical

Medicine 2

Hematologic & Lymphatic SystemsEndocrine & Reproductive SystemsRenal & Urinary SystemsCardiovascular SystemRespiratory SystemGastrointestinal System & NutritionMultisystem & Integrative Concepts

Organ System-Based Courses Diagnostic and therapeutic approaches to disease Integrative approach

Pathology Physiology Pharmacology Histology Radiology Microbiology/Immunology

Integrative Course Integrate knowledge among organ systems Analyze multisystem diseases Review material essential to licensing exam

Introduction to Clinical Medicine 2 Focus on physician skill set Small group sessions

History-taking Physical exam techniques Ultrasound as an adjunct to physical exam Clinical reasoning skills

Clinical Content Medical Humanities Medical Ethics and Professionalism Cultural and Social Aspects of Health Care Evidence-Based Medicine

Curriculum ComparisonM1 Year M2 Year

Anatomy

Histology

Biochemistry

Genetics

Neuroscience Physiology

Infection, Immunity &

Disease

Pathology(included Psychiatry)

PharmacologyIntroduction to Clinical Medicine 1 ICM 2 ICM 3

M1 Year M2 Year

Anatomy

Biochemistry

&Genetic

s

Foundations of Disease

, Infectio

n & Therape

utics

Neuroscience

Behavioral

Basis of Medicin

e

Musculoskeletal &

Integumentary

Hematologic & Lymphat

ic

Endocrine &

Reproductive

Renal & Urinary

Cardiovascular

Respiratory

Gastrointestinal

& Nutrition

Multisystem

/Integrative

Introduction to Clinical Medicine 1 Introduction to Clinical Medicine 2

Third Year Broad exposure to major disciplines Clinical exposure

Integrate pre-clinical learning into patient care “Art of doctoring”

Balanced experiences Involvement with patient care Study Assimilation of information

Third Year Curriculum Clinical Neurosciences – Neurology & Psychiatry

Two separate four-week rotations Family & Community Medicine

Four-week rotation Internal Medicine and Emergency Care

Integrated 16-week rotation in inpatient and outpatient settings Obstetrics & Gynecology

Four-week rotation Pediatrics

Eight-week rotation Surgery

Eight-week rotation

Fourth Year Further development of clinical skills Prepare for residency in their chosen specialty. Curriculum

Acting Internships Two four-week rotations, one primary and one secondary

Advanced Clinical Pharmacology and Anesthesiology Four-week course

Intern Prep Practical knowledge of the intern role

Elective rotations Four four-week rotations At the University of Kentucky or another approved site

23

Match 2014

24

29, 671 residency positions in the Match 17,374 US allopathic seniors in the Match 1,662 previous US allopathic grads in Match 2,738 US osteopathic students/grads in Match 5,133 US citizens students/IMGs in the Match 7,334 non-US citizens in the Match

Match 2014

25

40,394 registered for the Match in 2014. The Match offered 29,671 positions. Overall match rate was 75%. 94.4% of US seniors matched into a residency

position, with 79% getting one of their top three choices.

54% US seniors matched to 1st choice. ~1000 unmatched US allopathic medical students at

the end of the match

UK Match 2014

26

Of the graduating seniors, 37% are entering primary care specialties. Primary Care includes Family Practice, Internal Medicine, Pediatrics and Medicine-Pediatrics.

Of the graduating seniors, 31% elected to remain at UKMC, and another 4% are staying at programs in Kentucky.

Matched into 22 different specialties.

UK Match 2014

27

Top specialty choices for UK COM seniors were (listed in decreasing chronological order): Internal Medicine 20% Anesthesiology 12% Pediatrics 8% General Surgery 7% Emergency Medicine 6% Med/Peds, Neurology 5% Radiology, Family Medicine, Orthopedic surgery 4%

Charles H. “Chipper” Griffith, MDSenior Associate Dean for Medical

EducationUniversity of Kentucky College of

Medicinecgrif00@email.uky.edu