January 2007

Grant Results

National Program

Preparing Physicians for the Future: A Program in Medical Education

SUMMARY

From 1990 to 1997, the School of Medicine of the Oregon Health Sciences University (now the Oregon Health & Science University) revised its curriculum so that it more strongly emphasizes ethical and societal concerns, humanism in the patient-doctor relationship, the importance of preventive medicine, care of the underserved, and independent, self-directed learning by students.

The project was part of the Robert Wood Johnson Foundation (RWJF) Preparing Physicians for the Future: A Program in Medical Education national program.

Key Results

  • The school implemented a new curriculum, consisting of:
    • Clinical preceptorship experience early in the first year.
    • Interdisciplinary basic science courses.
    • Reduced lecture time.
    • Integration of basic and clinical sciences throughout the curriculum.
    • Increased experiences in primary and ambulatory care.
    • An expanded elective opportunity providing individual enrichment.
  • A reorganization of the Dean's Office resulted in increased personnel to support the educational program.
  • Central medical school administration emphasized the importance of teaching with bonuses and promotion incentives.

Funding
RWJF supported this project through three grants totaling $2,481,338 — two to the Oregon Health Sciences University School of Medicine ($349,101) and one to the Oregon Health Sciences Foundation ($2,132,237).

 See Grant Detail & Contact Information
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THE PROBLEM

As the only medical school in a large and predominantly rural state, Oregon must provide a breadth of experience in non-tertiary rural settings as well as in the more traditional academic environments. The school undertook a review of the curriculum two years prior to receiving the RWJF grant. The report that resulted from the review established the guidelines for the changes carried out under the Preparing Physicians for the Future (PPF).

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THE PROJECT

During the planning grant (ID# 017247), the school put into place a centralized responsibility for education and student affairs, established committees to involve the faculty in planning for the new curriculum, and put into place some initial courses for the curriculum.

For the implementation phase (ID#s 019645 and 020472), the school proposed to:

  • Develop a curriculum that integrated the basic and clinical sciences.
  • Enhance the process by which medical students acquire the knowledge, skills, attitudes, and values needed for physicians in the changing health care system.

Other sources of support for the school's efforts at reform included a 1993 Macy Foundation award for $30,000 annually to participate in a Northwest Regional Consortium for the enhancement and assessment of clinical performance through the use of standardized patients.

In October 1990, the Area Health Education Center Program (which helps arrange for educational opportunities for medical students throughout the state, particularly in rural areas) began funding a primary care clerkship and its preceptors in the third year curriculum. A benefactor of the School of Medicine established an endowment fund for the standardized patient examinations, which provides an annual award of approximately $15,000.

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RESULTS

  • A new curriculum was implemented, consisting of clinical preceptorship experience early in the first year, interdisciplinary basic science courses, reduced lecture time, integration of basic and clinical sciences throughout the curriculum, increased experiences in primary and ambulatory care, and an expanded elective opportunity providing individual enrichment. The new curriculum emphasizes ethical and societal concerns, humanism in the patient-doctor relationship, the importance of preventive medicine, care of the underserved, and independent self-directed learning. Transition courses were designed to bridge significant role changes encountered when students assume patient care responsibilities and as they become physicians. A Colloquium in Medical Sciences and Practice was instituted during the third year to emphasize the relationship between clinical and basic sciences.
  • A reorganization of the Dean's Office resulted in increased personnel to support the educational program. A new associate dean for Education and Student Affairs, recruited for this effort, engaged a broad group of faculty in the design and implementation of the revised curriculum. The Curriculum Committee was restructured to assure its authority and effectiveness during the reform process and to assure appropriate evolution of the curriculum.
  • Central medical school administration has emphasized the importance of teaching with bonuses and promotion incentives. Financial support for curricular management was increased to replace RWJF funding.

Principal Problems

The project director reported the following principal problems to RWJF:

  • Enhancing faculty commitment to teaching within a managed care environment, and recruiting and supporting community preceptors, proved to be formidable challenges.
  • It was difficult to evaluate faculty on their work with small groups of students. Gathering student feedback data from small group situations proved to be difficult and the evaluations gathered tended to be unreliable, because students had not spent enough time with the faculty they were evaluating. A minimum of five sessions was proposed for the reliability of future evaluations.
  • Overall curriculum evaluation continues to be of concern, due in part to logistical difficulties and the large amount of data. The school established a Curriculum Evaluation Committee to address this problem.
  • There were faculty conflicts around integrating new course content with the former course content. Faculty development workshops, regular meetings, and feedback opportunities resolved these issues in most cases. However, not all faculty members responded to invitations to attend faculty development activities.

(For lessons learned by the sites in PPF, see Lessons Learned.)

Communications

Project staff published six journal articles on the curriculum change process at Oregon and made 20 presentations. For a listing of publications, see the Bibliography.

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AFTER THE GRANT

Required clinical clerkships, the Colloquia in Medicine Series, and the Transition to Residency course have undergone curriculum review post-RWJF funding. A task force has also been created to focus on a graduate tracking database, as well as implementing an overall curriculum evaluation database.

In a November 2006 interview, Edward Keenan, M.D. Associate Dean for Medical Education at Oregon Health Sciences University, reported that the curricular reforms were still in place, and that the RWJF grants had helped put in place the support structure for "a culture of change."

He noted that since the RWJF grants ended, the medical school received two grants from the National Institutes for Health for further curriculum development. The first, to end in 2006, for $1.5 million, was to develop a curriculum in complimentary and alternate medicine and the second, which started in 2006, for $1.3 million, was to develop a behavioral and social sciences curriculum.

OSHU also received $38,500 from the National Board of Medical Examiners in 1999/2000 to continue work on the performance- based clinical skills assessment begun earlier with Macy funding. The AMA also gave OSHU a national award in 1997 for innovations to its curriculum. Laerdahl Corporation, which manufactures medical devices, also gave the school $60,00 to develop a simulation center where engineered mannequins serve as patients so that nursing and medical students can develop better skill working in teams.

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GRANT DETAILS & CONTACT INFORMATION

Project

Preparing Physicians for the Future, Oregon Health Sciences University

Grantee

Oregon Health Sciences University School of Medicine (Portland,  OR)

  • Amount: $ 97,116
    Dates: September 1990 to February 1992
    ID#:  017247

  • Amount: $ 251,985
    Dates: March 1992 to August 1992
    ID#:  019645

Grantee

Oregon Health Sciences Foundation

  • Amount: $ 2,132,237
    Dates: September 1992 to August 1997
    ID#:  020472

Contact

Joseph D. Bloom, M.D.
(503) 494-8220
bloomj@ohsu.edu

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Elliot D, Fields S, Keenen T, Jaffe A, and Toffler W. "Use of a GOSCE (Group Objective Structured Examination) With First-Year Medical Students." Academic Medicine, 69(12): 990–992, 1994. Abstract available online.

Fields S and Keenan, E. "Relationship Between Early Longitudinal Assessment of Clinical Skills and Performance in the Basic Sciences." Academic Medicine, 70(5): 441, 1995.

Fields S, Toffler W, Elliot D, Garland M, Atkinson R, Keenen T, and Jaffe A. "Principles of Clinical Medicine: An Interdisciplinary Integrated Two Year Longitudinal Curriculum." Medical Education, 29(1): 53–57, 1995. Abstract available online.

Fields S, Toffler W, and Bledsoe N. "Impact of the Presence of a Third-Year Medical Student on Gross Charges and Patient Volume in 22 Rural Community Practices." Academic Medicine, 69(10 Suppl.): S87–S89, 1994.

Fields S and Toffler W. "Principles of Clinical Medicine: A Multidisciplinary Integrated Two-Year Longitudinal Course." Academic Medicine, 69(5): 418, 1994.

Mahaffy J, Goldberg B, and Girard D. "The Oregon Health Sciences University Primary Care Clerkship: A Model, Rural, Multidisciplinary Experience." Academic Medicine, 69(5): 422–423, 1994.

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Report prepared by: Paul Mantell
Reviewed by: Susan Parker
Reviewed by: Robert Crum
Program Officer: Leighton Cluff
Program Officer: Lewis Sandy
Program Officer: Richard Reynolds
Program Officer: Annie Lea Shuster
Evaluation Officer: Beth Stevens

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