Oregon Health & Science University and competency-based curricula

Each individual month, the AMA highlights institutions that are element of the AMA Accelerating Improve in Medical Schooling Consortium to showcase their perform with the consortium and innovations in healthcare instruction.

Tracy Bumsted, MD, MPH

Affiliate dean, undergraduate health care schooling and professor, pediatrics

Oregon Health and fitness & Science College

Selection of decades in the consortium: Because the starting (~2014, 8 years)

1. Change to competency-based, integrated curriculum, termed YourMD

As of July 1, 2021, all of our classes in the full UME program improved to go/no go grading. Now, particular person competencies are connected to all courses in our plan, and students are delivered an evaluation for each linked competency by a skilled assessor (i.e., course director). We have markedly improved our use of the spiraling thread icons we created to spot in course components and for the duration of instructional periods for the Foundations of Medication (FoM) stage, so students have visual cues when integrated articles is taught.

This was an vital addition to our [Accelerating Change in Medical Education] challenge simply because we designed the new curriculum with a 3 science integrated design, incorporating basic, scientific and health units science material as threads jogging all through all FoM blocks rather of discrete programs. Whilst this approach is pedagogically seem as pupils understand foundational material in right context, with the use of our icons it is now more evidently obvious where by specific thread information is taught inside an built-in block as perfectly as spiraled afterwards in the curriculum with expanding complexity. A few examples of the thread icons [represent] introductory, reinforcing and mastery concentrations for the professionalism, microbiology and physiology threads, respectively.

The UME Entrustment Group (EG) also tracks proof of entrustment for the 13 Main Entrustable Professional Actions (EPAs), as section of our competency-based mostly evaluation framework. Immediately after three critiques for each pupil, the UME EG awarded the 2021 graduates a full of 1,080 EPA badges. This was the initial graduating cohort in which we displayed the students’ awarded EPA badges on their Professional medical University student Overall performance Evaluations (MSPEs) as very well as in their (OHSU-particular) MSPE Nutritional supplement we send out to all of their matched PGY-1 GME software directors, which serves as our “educational handoff.” Our 2022 graduates have earned even a lot more with a whole of 1,212 EPA badges pursuing the third and final review.

2. Competency milestones and EPAs tracked by a world wide web-centered electronic portfolio (REDEI)

Learners and the UME EG are in a position to review in actual time students’ development in competency attainment and badging for EPAs. The OHSU-precise e-portfolio, REDEI, properties all student evaluation and overall performance data (e.g., USMLE Move scores), and our REDEI Technique Programmer carries on to make ongoing advancements to displays and functionality. Element of the unique cash from our [Accelerating Change in Medical Education] grant have been instrumental in creating the REDEI electronic system and this has enabled our learners to see, in genuine-time, all of their assessments and progress toward competency and earning EPA badges.

3. Time-variable development

With a single of our unique [Accelerating Change in Medical Education] undertaking ambitions, we have been quite productive in minimizing time to degree for college students who have achieved all graduation necessities, before than the regular 4 several years. Given that implementing our competency-primarily based curriculum in 2014, learners have progressively been ready to graduate on an accelerated speed, lessening their instructional credit card debt by about $17,000 per university student. The benefits below now exhibit that the large the greater part of our college students are now graduating at the very least 1 term early:

• 2018 graduates: 25% graduated a phrase early
• 2019 graduates: ~60% graduated a expression early
• 2020 graduates: 66% graduated a expression early
• 2021 graduates: 77% graduated a term early
• 2022 graduates: 93% graduated at the very least a term early

Our reworked YourMD curriculum, designed and applied with the generous aid of the grant funding, included a new prerequisite for all pupils to comprehensive a scholarly undertaking. A scholar in the inaugural course of our new curriculum, (now) Dr. Skender Najibi, pursued his challenge plans by creating a proposal to develop numerous new faculty management positions in the MD system as diversity navigators. Dr. Najibi discovered a gap in how our software assisted pupils from underrepresented and numerous backgrounds navigate health care university and turn into physician graduates who thrive in the career of medication. From his venture proposal, we established new positions and have experienced two school UME diversity navigators considering that 2018.

This yr, we expanded the UME variety navigator program to four positions, just lately appointing school customers from a selection of numerous racial, gender and cultural backgrounds who will work independently with learners and also program and deliver big group programming activities and things to do to advertise fairness, range and belonging in our UME and College group.

In addition, in 2020, our UME Curriculum Committee approved the creation of the Fairness & Justice Sub-Committee, adhering to a collaborative proposal from health care pupils and faculty in the dean’s business. The Sub-Committee oversees the growth and continuous enhancement of curricular factors in YourMD linked to the elimination of overall health inequities and the advertising of an anti-racist and anti-oppressive medical training. The Equity & Justice Sub-Committee regularly evaluations every part of the YourMD curriculum, recommends curricular alterations that promote the identification and elimination of wellness inequities and systemic racism, and helps in the implementation of those variations.

The Sub-Committee has each a school and pupil Co-Chair, alongside with quite a few faculty, quite a few people, staff members associates, and healthcare pupils, and also involves 3 deans–two from UME and one particular from the much larger University of Medication.

The adoption of competency-centered curricula and evaluation with subsequent elimination of tiered grading in health care faculty courses throughout the place, alongside with the modifications to the scoring of USMLE Move 1 to pass/fail, will provide a strong impetus for UME educators, pupils, and GME software administrators to adapt how we conceptualize the UME to GME continuum. The Coalition for Medical doctor Accountability’s workgroup report and suggestions give a comprehensive framework for how we can make crucial modifications to boost the changeover from clinical university to residency instruction.

Healthier groups are not automated, nor magically made. We have intentionally tried using to sustain group comradery and persuade wellness in our college educators and workers users with transparent communication regardless of the tremendous uncertainty that nonetheless exists owing to the pandemic. Wellness activities–both for men and women and groups–are crucial features that ought to be constructed into the day-to-working day operate we do.

A great deal of notice is compensated to checking and establishing things to do that advertise student wellness, but considerably less has been specified for faculty and personnel wellness. We have discovered that (1) reliable discussions that name the realities, strain and ongoing issues we are encountering as educators, (2) a program that supports folks throughout especially hoping instances and (3) acknowledging that the challenging do the job we do every single working day will not produce universal joy for pupils, have all assisted set expectations and refocus our efforts on the outcomes we drive: graduating the most competent, experienced, compassionate, resilient and fulfilled medical professionals who are prepared and prepared to provide culture in the 21st century.