Departmental Assessment Update - Medicine Report

Department: Medicine
Program: M.D.
Level: Graduate

1. Has your program developed learning outcomes? If yes, please list.

University of Hawaii John A. Burns School of Medicine Objectives for Graduation Approved by the Executive Committee on June 20, 2008 Graduates of the University of Hawaii John A. Burns School of Medicine are life-long learners. They apply their knowledge of biological and medical sciences, demonstrate a deep appreciation for the community, and communicate effectively in the care of their patients, particularly the peoples of Hawaii and the Pacific Basin. They practice medicine with the highest professional standards while maintaining their personal health and well-being. All medical students at JABSOM must demonstrate achievement of these objectives prior to graduation. I. Life-Long Learning Skills Graduates will be life-long learners. Following PBL tutorial, patient care interactions, or in anticipation of future learning needs, students will be life-long learners by: A) Listing important learning issues in the biological, clinical, populational, and behavioral domains and meeting these learning needs through self-directed study. B) Searching for and retrieving (from electronic databases and other resources) biomedical information, critically appraising this information, and applying it appropriately to patients and populations. C) Evaluating the knowledge base supporting good patient care, recognizing gaps between prevailing and best practice, and incorporating the principles of quality improvement to enhance patient care outcomes including patient safety. D) Evaluating their fund of knowledge, clinical skills, communication skills, and professionalism and responding proactively to meet learning needs. As measured by the achievement of a satisfactory evaluation for all Preclinical PBL Tutorials, the Triple Jump Examination, and a grade of “credit” for all Preclinical courses, Third-Year Clerkships and required Fourth-Year courses. II. The Biological Sciences Graduates will understand the biological sciences underlying clinical medicine. Students will apply the biological sciences to the practice of medicine by: A. Stating the scientific basis for disease and the role of translational research. B. Explaining the principles of genetic transmission, the molecular biology of the human genome, the integration of genetics in clinical practice and the molecular, cellular, and biochemical mechanisms that maintain the body’s homeostasis. C. Describing the normal structure and function of each major organ system and the human body as an intact organism. D. Explaining the various causes (genetic, developmental, metabolic, toxic, microbiologic, autoimmune, neoplastic, degenerative, and traumatic) of illness and the way in which they operate on the body (pathogenesis). E. Explaining the altered structure and function (pathology and pathophysiology) of the body and its major organ systems that are seen in various diseases and conditions. F. Applying new findings in the biological sciences to diagnosis and therapy. As measured by achieving the grade of “credit” for all Preclinical Courses, Third-Year Clerkships, and required Fourth-Year courses, and achieving a passing score on the USMLE Step 1 Examination. III. The Care of Patients Graduates will be able to care for their patients with increasing responsibility, and seeking and responding to appropriate evaluation and supervision. When seeing a patient presenting with a concern or illness in the ambulatory or hospital setting, students will be able to care for that patient by: A) Approaching each patient with an awareness and sensitivity to the impact their age, gender, culture, spiritual beliefs, socioeconomic background, family support, sexuality, and healthcare beliefs may have on the development, diagnosis, and treatment of their illness. B) Applying clinical reasoning, critical thinking, and problem-solving skills. C) Performing a complete or organ-specific history and physical exam following an appropriate exam sequence and utilizing correct technique in a manner that reflects a clear understanding of the manifestations of common maladies. D) Respecting issues of modesty and personal space when interviewing a patient or performing a physical exam. E) Ordering appropriate diagnostic tests with careful consideration of the test properties, risks and complications, discomfort to patients, cost, and the patient’s overall therapeutic goals. F) Performing routine procedural skills under appropriate supervision, with minimal discomfort to patients. G) Developing and implementing an appropriate therapeutic plan that take into account efficacy, adverse effects, cost, and compliance issues, in the context of the patient’s overall goals, values, and cultural beliefs. H) Recognizing and initiating therapy for acute life-threatening conditions. I) Educating patients, families, and other healthcare providers about health, illness, and the prevention of disease. J) Providing end-of-life care including pain management and guidance to patients and their families on end-of-life care decision-making. As measured by achieving the grade of “credit” for all Preclinical Courses, Third-Year Clerkships, and required Fourth-Year courses, and achieving a passing score on the MDED 531 Observed Standardized Clinical Exam (OSCE), the USMLE Step 2 Clinical Knowledge Examination and the USMLE Step 2 Clinical Skills Examination. IV. Oral and Written Communication Skills Graduates will be able to communicate effectively with patients, families and other healthcare providers. When in a classroom, clinical, or other healthcare setting, students will communicate effectively with others by: A) Greeting patients warmly, eliciting relevant information, understanding the patient’s perspective, responding to their feelings, educating them about their condition, and explaining further management. B) Utilizing rapport-building techniques, including open-ended questions, empathic listening, checking for understanding, validation, and appropriate eye contact, body language, and voice quality to attend to patients. C) Communicating with patients and family in a manner that conveys compassion and sensitivity to their feelings and concerns. D) Incorporating patient-centered and shared decision-making principles into their practice. E) Motivating patients to adopt new or different behaviors to promote their health. F) Orally presenting cases clearly and concisely. G) Writing legible, comprehensive progress notes, history and physical exams, and prescriptions. H) Providing constructive, meaningful feedback to colleagues. As measured by achieving the grade of “credit” for all Preclinical Courses, Third-Year Clerkships, and required Fourth-Year courses, and achieving a passing score on the MDED 531 Observed Standardized Clinical Exam (OSCE), the USMLE Step 2 Clinical Knowledge Examination and the USMLE Step 2 Clinical Skills Examination. V. Populational and Community Health Graduates will appreciate the epidemiology of disease and the role of the physician in public health and global health issues, particularly those important to Hawaii and the Asia-Pacific region. When in the clinical or classroom setting, students will appreciate the epidemiology of disease and the role of physicians in populational and community health by: A) Stating the epidemiology of common illnesses within diverse populations and the systematic approaches useful in reducing the incidence and prevalence of such illnesses. B) Stating the important non-biological determinants of poor health and the economic, psychological, social, and cultural factors that contribute to the development and/or continuation of illness. C) Explaining the physician’s role in current Global Health Issues that include emerging infections and pandemics, bioterrorism, and natural disasters. D) Stating the important public health measures that support the health of communities. E) Stating important legal aspects of medicine. F) Caring for patients who are unable to pay and to advocate for access to health care for members of traditionally underserved populations. G) Applying common biostatistical tools such as the likelihood ratio, positive and negative predictive values, and the number needed to treat to patient care. As measured by achieving the grade of “credit” for all Preclinical Courses (including Community Health courses), Third-Year Clerkships, and required Fourth-Year courses, and achieving a passing score on the MDED 531 Observed Standardized Clinical Exam (OSCE), the USMLE Step 2 Clinical Knowledge Examination and the USMLE Step 2 Clinical Skills Examination. VI. Professionalism Graduates will be professional and ethical, demonstrate an enthusiasm for medicine, and value honor, integrity, altruism, respect, accountability, excellence, scholarship, and leadership while delivering compassionate care to their patients. When practicing medicine or representing JABSOM outside the classroom or clinical setting, students will exhibit the highest standards of professional and ethical behavior by: A) Stating the theories and principles that govern ethical decision-making including those related to the major dilemmas in medicine. B) Showing respect, honesty, integrity, and humility. C) Presenting a professional appearance and demeanor. D) Respecting patient confidentiality and preserving patient dignity. E) Recognizing potential conflicts of interest inherent in various financial and organizational arrangements in the practice of medicine. F) Dealing with professional mistakes openly and honestly in ways that promote patient trust and self-learning. G) Acknowledging personal limitations and the need for life-long learning. H) Completing school and professional requirements in a timely manner. I) Willingly teaching and supporting others. As measured by achieving the grade of “credit” for all Preclinical Courses, Third-Year Clerkships, and required Fourth-Year courses, and achieving a passing score on the MDED 531 Observed Standardized Clinical Exam (OSCE), the USMLE Step 2 Clinical Knowledge Examination and the USMLE Step 2 Clinical Skills Examination. VII. Personal Health and Well-Being Graduates will maintain personal health and well-being. Students will maintain their personal health and well-being by: A) Stating strategies to maintain personal physical and mental health. B) Stating healthy coping mechanisms to manage stress and exam anxiety. C) Stating strategies to maintain personal safety in both academic and clinical environments. D) Listing resources available for treating depression, substance abuse, and other forms of physician impairment. E) Recognizing the importance of balancing personal, family, and career goals. As measured by their creation of a personal health and well-being plan for the preclinical, clinical, and postgraduate periods of their medical training.

2. If your program has learning outcomes, where are they published (e.g., department web page)?

The Objectives for Graduation (program learning outcomes) are published in the general student handbook (General Guide to the MD Program), and in various individual course handbooks. They are posted on the JABSOM website and have been adapted in a series of seven 36" by 48" posters that are displayed prominently next to the medical student lecture halls.

3. Do your faculty list course learning outcomes on their syllabi?

Each required course in the medical student program has a formal curricular document with specific learning outcomes. These curricular documents are included in the course handbooks, and also posted online for student access.

4. Does your program have a curriculum map that links course outcomes to program outcomes? If so, please include.

The curriculum document for each required course in the medical student program is organized under the seven headings of the program learning outcomes. Course-specific learning objectives are listed under each of the seven major headings. All curricular outcomes are entered into a national database for medical school curricula (the Association of American Medical Colleges Curriculum Management Information Tool, or “CurrMIT”), and can be searched as needed. Links between course outcomes and program outcomes are described below. The JABSOM Graduation Objectives Student Achievement of the Graduation Objectives Student achievement of each of the JABSOM Graduation Objectives is determined by their performance on specific assessments throughout their four-year curriculum. The achievement criteria required are listed below each respective Graduation Objective and each must be met in order to earn the M.D. Degree from the University of Hawaii John A. Burns School of Medicine. Life-Long Learning Skills o A satisfactory evaluation for all Preclinical PBL Tutorials o A passing grade for the Triple Jump Examination o A grade of “credit” for all Preclinical Courses o A grade of “credit” for all Clerkships o A grade of “credit” for all required Fourth-Year courses. The Biological Sciences o A grade of “credit” for all Preclinical Courses – This requires a passing score on all written and laboratory exams assessing knowledge of the biological sciences. o A grade of “credit” for all Clerkships o A grade of “credit” for all required Fourth-Year courses o A passing score on the USMLE Step 1 Examination The Care of Patients o A grade of “credit” for all Preclinical Courses – This requires a passing score on all written exams assessing knowledge on patient care. o A grade of “credit” for all Clerkships o A grade of “credit” for all required Fourth-Year courses o A passing score on the MDED 531 Observed Standardized Clinical Examination o A passing score on the USMLE Step 2 Clinical Knowledge Examination o A passing score on the USMLE Step 2 Clinical Skills Examination. Oral and Written Communication Skills o A grade of “credit” for all Preclinical Courses o A grade of “credit” for all Clerkships o A grade of “credit” for all required Fourth-Year courses o A passing score on the MDED 531 Observed Standardized Clinical Examination o A passing score on the USMLE Step 2 Clinical Knowledge Examination o A passing score on the USMLE Step 2 Clinical Skills Examination. Populational and Community Health o A grade of “credit” for all Preclinical Courses – including all Community Health courses o A grade of “credit” for all Clerkships o A grade of “credit” for all required Fourth-Year courses o A passing score on the MDED 531 Observed Standardized Clinical Examination o A passing score on the USMLE Step 2 Clinical Knowledge Examination o A passing score on the USMLE Step 2 Clinical Skills Examination. Professionalism o A grade of “credit” for all Preclinical Courses o A grade of “credit” for all Clerkships o A grade of “credit” for all required Fourth-Year courses o A passing score on the MDED 531 Observed Standardized Clinical Examination o A passing score on the USMLE Step 2 Clinical Knowledge Examination o A passing score on the USMLE Step 2 Clinical Skills Examination. Personal Health and Well-Being o Creation of a Personal Health and Well-Being Plan for medical school.

5. Does your program benchmark or have goals for student performance? (e.g. 70% students will graduate within 5 years)

The medical student program has a number of requirements for graduation that go beyond achieving credit for all required courses. These include: a. Successful completion of the first two steps of the national licensing examination for physicians (USMLE Step 1, and USMLE Step 2 clinical knowledge component, and USMLE Step 2 clinical skills component). While no specific benchmarks have been set, JABSOM students consistently score at or above the national mean on these examinations. b. Successful completion of an internal comprehensive clinical skills competency examination.

6. Other than GPA, what data/evidence is used to determine that graduates have achieved stated outcomes for the degree? (i.e. capstone project, class assignment)

A critical part of the overall assessment of medical students are evaluations of their clinical performance in the hospitals, clinics, and other health care sites. Under appropriate supervision, students are required to demonstrate their ability to obtain medical histories, perform physical examinations, communicate effectively with patients, families and health care personnel, create rational management plans, and interpret results of diagnostic tests. Students are evaluated by their faculty, and in some cases patients and other health care professionals using a variety of assessment forms and feedback instruments. Oral examinations are performed twice during the first year of the curriculum. In the third and fourth years of the curriculum, oral (patient) case presentations are a major part of the assessment of medical students. These are included under the larger context of clinical performance described above. Standardized patients are volunteers from the community who are trained – in a very rigorous and scientific fashion – to portray patients with particular medical histories and diseases. Standardized patient examinations have been an integral part of the assessment system in our medical school since 1989. All medical students must complete a series of standardized patient examinations that are strategically placed throughout the four-year curriculum. These exams focus on medical interviewing, physical examination, and physician-patient communication skills. Of note, all medical students in the United States have been required to complete a three-step national medical licensing examination called the United States Medical Licensing Examination (USMLE). Step 1 is a written examination taken at the end of the 2nd year of medical school. Step 2 has two components; 1) a written examination taken during year 4 of the curriculum, and 2) a standardized patient examination offered at only a few national sites also taken during the 4th year of the curriculum. Step 3 is taken approximately 1-2 years after graduating from medical school.

7. Who interprets the evidence of student learning?

All educational outcome measurements are reviewed centrally by the JABSOM Curriculum Committee. Course-specific information is also provided to course directors, course faculty, educational subcommittees of the Curriculum Committee, and the JABSOM Office of Medical Education (OME). Faculty assigned to complete internal peer-reviews of each required course are provided access to student feedback about that course. JABSOM must also submit information to its accrediting body, the Liaison Committee on Medical Education (LCME). The JABSOM Curriculum Committee monitors the quality of the educational program by reviewing all educational outcome measures and determining what improvements, if any, should be undertaken. Two such activities deserve special mention. Student feedback on each required course and clerkship in the curriculum is collected via surveys generated by the JABSOM Office of Medical Education in conjunction with the Curriculum Committee and are completed by students at the end of each instructional unit. The results are tabulated and formulated into a report by faculty with knowledge of evaluations and assessment and reviewed by JABSOM Curriculum Committee. Based on the feedback, the committee finalizes recommendations that are sent to course directors. At a later date, course directors are asked to share in person, with the Curriculum Committee how they have responded to the recommendations and the results of that response. Ensuring that course directors respond to Committee recommendations appropriately is an important principle in JABSOM's quality improvement plan. This process, to use student feedback to evaluate student achievement and educational quality is referred to as the JABSOM Program Evaluation Plan and has been described in publication (Kasuya RT, Arakaki L, Lindberg M, Sakai DH. The Role of Program Evaluation in the Medical Education at the John A. Burns School of Medicine. Hawaii Medical Journal 2003;62(11):254-255.). As a part of its Curriculum Evaluation Process, the UH JABSOM Curriculum Committee performs peer-reviews of the curriculum for each required course. This process has been described in publication (Sakai DH, Kasuya RT, Naguwa, G. The Role of the Curriculum Review at the John A. Burns School of Medicine. Hawaii Medical Journal 2004;63(1):18-19.). Briefly, faculty review information provided by course directors and meet to evaluate the curricular objectives, student achievement of these objectives, instructional methods, student evaluations, and the course’s consistency with JABSOM's educational philosophy. Findings of each curriculum review are presented to the Curriculum Committee which presents recommendations to course directors based on the discussion. Course directors appear later to present their response to these recommendations. The JABSOM Curriculum Committee also reviews performance on licensing exams, selected internal exams, graduation rates, NRMP results, the AAMC Graduation Questionnaire, and surveys of graduates and Residency Program Directors, formulating recommendations for improvement in order to enhance student achievement of the SLOs. All medical schools are accredited by the Liaison Committee for Medical Education (LCME). The accreditation process includes annual reports and periodic institutional accreditation site visits. As one of many accreditation standards, the use of program outcomes and the process of using this information to assist in decision-making is reviewed and assessed.

8. How are the assessment data/results used to inform decisions concerning the curriculum and administration of the program?

The content of the curriculum and specific courses within it are subject to continuous improvement by faculty and content experts. Changes are made based on new advances in medical practice, biomedical science, behavioral sciences and populational health sciences. Assessment data collected from students, graduates and employers of graduates (residency training program directors) are all routinely and formally reviewed and discussed by the JABSOM Curriculum Committee and appropriate school administration. Input of faculty, course directors, discipline experts and educational administrators are also considered before any decisions for change are made.

9. What attempts are made to monitor students’ postgraduate professional activities?

JABSOM maintains an alumni database that monitors post-graduate professional activities. In order to obtain a license to practice medicine in the United States, all graduating medical students are required to complete at least one year of postgraduate training in an accredited residency training program. Specialty training requires 2-8 years of additional training beyond this one year minimum requirement. Over 90% of JABSOM graduates go on to pursue specialty training in one or more disciplines.