the right way to - usf health | education, research...

WHAT'S IN THIS ISSUE

University of South Florida | www.hsc.usf .edu

The right way to teach

USF soars into the national spotlight as the best way to teach physicians

March 2006

Third-year clerkships broaden student experience >>

USF part of new Flexner Report >>INSIDE: Learning objectives

defined for LCME visit >>Center for Advanced Clinical Learning opens >>

Since opening its doors in 1972, the College of Medicine has sought to provide the most current, applicable and meaningful medical education possible. That has meant continuous evaluation and improvement. The effort, especially the most recent work, has catapulted USF Health into the spotlight for providing students with unparalleled opportunities in education, research, and health care, said Paul Wallach, MD, vice dean of educational affairs at USF College of Medicine. “Our efforts have helped redefine what is taught to physicians, so much so that other medical schools are asking about our model,” Dr. Wallach said. Although changes began nearly a decade ago – following the LCME self study and a world of technological advances from hardware to software, from labs to clinics to classrooms – the most recent adjustments have really been more of a complete makeover. “We are building on the progress made by our energetic faculty and

taking it to the next level,” Dr. Wallach said. Even as steps are completed, changes will continue to keep the content fresh and pertinent, Dr. Wallach said. “We will never be finished because we are always looking to provide the best medical education possible,” he said. “If we think we’re finished, we’ll fall behind.”

Educational innovation is a hallmark of all components of USF Health.Most of this issue of Now focuses on medicine.

March 2006 USF Health | www.hsc.usf .edu USF Health | www.hsc.usf .edu March 2006

Starting in 1999, the College significantly changed the first- and second-year curricula, moving to a model that is more integrated, interdisciplinary and one that emphasizes applying essential basic science concepts to clinical medicine. And in 2004, the College began the Program to Advance Clinical Education (PACE) to keep up with the constant changes in health care and evaluate the sufficiency of the third- and fourth-year curricula. In addition to a fourth-year clerkship in critical care, plans are in place to add interdisciplinary oncology, dermatology, and orthopaedics.

Curriculum change highlights Throughout their four years, students are evaluated with a process within PACE known as USF CARES (see adjacent story). This allows faculty to continually assess students at all levels. In addition, considerable improvements have been made in the realm of instructional technology resources. The Clinical Skills Assessment Center, for example, is a groundbreaking training facility that simulates actual patient care and gives medical students hands-on clinical skills experience in a safe, controlled environment. “The overall goal is that, at the end of the fourth year, students are prepared to lead tomorrow’s pursuit to advance the quality of life across all populations,” Dr. Wallach said.

Year 1 and 2 Curricular Restructure• Longitudinal Clinical Experience• Increased integration in courses and between basic science and clinical faculty• More active learning• Greater emphasis on professionalism and humanism

Year 3 and 4 Curricular Restructure: • Interdisciplinary clerkship model • Clinical learning experience that exposes students to common disorders representative of those seen in the clinical practice• Integration of important contemporary issues in medicine• Enhanced use of technology

Center for Advanced Clinical Learning opened The USF College of Medicine recently opened a high-quality venue for teaching and testing clinical skills to medical students. Called the Clinical Skills Assessment Center, this groundbreaking training facility simulates actual patient care and gives medical, nursing

and physical therapy students hands-on clinical skills experience in a safe, controlled environment. For medical students, each formulates a care plan to address the needs of a standardized (mock) patient, who is trained to portray a set of symptoms and give a medical history. Once the care plan is devised, the standardized patient is trained to give feedback on the student’s performance. The Clinical Skills Assessment Center is central to a strong medical education, said Paul Wallach, MD, vice dean of educational affairs at the USF College of Medicine. Through the Center, the medical student will learn and be evaluated on:• Communication skills, interpersonal skills and history taking: Year 1 and 2• Physical examination skills: Year 1 and 2 • Examination techniques from faculty clinicians and the student will then perform the examination, breast, pelvic, male rectal and prostate examination: Year 2 and 3 • Interpersonal skills and their ability to obtain a history and perform a

Innovative curriculum puts USF at forefrontof medical education

We are making a huge difference The energy our faculty has shown as they make our medical curriculum outstanding is inspiring. Nothing happens overnight and that includes implementing innovative changes. But the effort is certainly worth it as I see our students embracing the new program and when I hear leaders of other medical schools talking about our model. We are making huge, positive, creative differences in how physicians are being taught medicine. That, in turn, makes huge differences in how we treat patients, conduct research and change our world for the better. I’m proud of the tremendous progress we have made and of the drive to keep pushing for excellence.

Dr. Klasko

physical examination that revolves around a specific medical complaint: Year 3• Ability to obtain a comprehensive history and physical examination, including their interpersonal and communication skills, examination technique and sequencing: Year 2 and 4 The Clinical Skills Assessment Center features state-of-the-art clinical exam rooms, all voice and video compatible and each room with an instructor’s one-way glass viewing station. The suite also includes a computer control room station, used to administer and monitor all exams given to medical students.

USF in the spotlight at AAMC The USF College of Medicine prompted much conversation at the national annual meeting of the Association of American Medical Colleges (AAMC) in Washington, DC, last fall. And the talking is continuing. As an invited keynote speaker, Paul Wallach, MD, shared the news of the transformation of medical education taking place at USF, including how our students are learning in teams, the new third-year clerkships, and expanded evaluation process for the entire curriculum. “We were really well received and wowed everyone with our program,” said Dr. Wallach, vice dean of educational affairs at USF. “The external reaction was phenomenal.”


Technology drives change.Change drives technology.

These general competency and education objectives serve as a guide for teaching medical students. Throughout the four years of the undergraduate curriculum, students are evaluated to measure if we are meeting these objectives. Such assessments are critical to the students’ success as future doctors and, at the end of the fourth year, each student is prepared to lead tomorrow’s pursuit to advance the quality of life across all populations.

General Competency andUSFCOM EducationalProgram Objectives

Understanding needs and uniqueness of patients. Utilization of empathy, hon-esty, and integrity in providing care.

Scientific approach to medical manage-ment and decision-making.

Formulation of effective diagnostic, therapeutic and preventive care plans.

Collaboration with others on the health care team and an understanding of system based practice.

Attitudes and values: exemplifying pro-fessionalism and patient advocacy.

Reflection and renewal: commitment to self analysis, lifelong learning and the teaching of others.

Ethics: utilization of principles govern-ing ethical medical practice.

Skills: competent performance of skills and tasks.

Recently, the USF College of Medicine students have seen a number of instructional technologies implemented or expanded throughout the curriculum. The move to use more technology in education has in large part been driven by the students, said Bryan Bognar, MD associate dean for Undergraduate Medical Education and a leader in coordinating the technological initiatives. “They have played an active role in the technology building process,” he said, “The use of technology in courses and clerkships is expected to grow and is embraced by students

throughout higher education, including here at USF.” Currently, the year 1 and 2 program offers an expanded array of on-line materials, including web-based course work through Blackboard and videostream archives of lectures and presentations. What started as a way to provide class notes has vastly expanded to include videoarchiving of lectures for student to review “on demand.” A new technology initiative (known as PACES) in the year 3 and 4 program is the electronic logbook for recording patient encounters that can be accessed through a PC or personal digital assistant (PDAs) interface. In addition, clerkship students have access to a robust digital library of “point of care” reference materials. Central to the technological advances in medical education at USF is the Center for Advanced Clinical Learning (CACL), a state-of-the-art facility with clinical exam rooms simulating actual patient care in a safe, controlled environment. Students and instructors can use recorded sessions of the student’s examination of standardized patients to enhance the learning and evaluation process. Also housed within the CACL are the patient simulators including Harvey (for cardiac auscultation) and Stan (a full-body critical care simulator). Planned technology initiatives include computer-based testing, podcasting and videocasting for ipods (vodcasting) as well as a greater use of computerized simulations. USF is committed to expanding the innovative use of technology in both basic and clinical science education and has set its sites on becoming a national leader in medical education technology, Dr. Bognar said.

New educational modelsThird-year clerkships expand student clinical experience

Six new clerkships for third-year medical students are among the many changes to the medical curriculum that are helping propel USF to the forefront of medical education. The USF Health clerkships are being studied as a model by other medical schools as an effective way to meet deficiencies in the current medical education offerings, said Paul Wallach, MD, vice dean for educational affairs at the USF College of Medicine. The third-year clerkship year is built upon an interdisciplinary, integrated model of medical education, grounded in the belief that the collective wisdom of the group is greater than that of any one discipline. These initial steps in modeling a team approach to education will nurture a

team approach to care, Dr. Wallach said. “This team-oriented approach to education emphasizes the art as well as the science of medicine,” he said. “Teaching doctors communication skills, collaboration with other health professional, enhanced use of technology and how to role model the best of the profession will ultimately benefit the patients they care for.” All clerkships require students to maintain a written log of patient encounters and procedures, and to document appropriate clinical experiences.

Maternal and Newborn Health: An educational experience that combines both obstetrics and newborn healthcare. The goal is to give students a clear understanding of the range of care needed by the mother and her yet unborn child, including prenatal care, counseling, labor, delivery, postpartum and newborn care. This is a four-week clerkship at the Tampa General Hospital labor and delivery unit and newborn nursery, and the Genesis ambulatory obstetrical clinic. Maria Baker, MD, (ob/gyn) is director. Laura Weathers, MD, (pediatrics) is associate director.

Emergency and Urgent Care: The goal is to give students the opportunity to evaluate patients prior to a diagnosis being made. (Prior interaction involved patients who were already diagnosed and, many times, already starting treatment). Experiences in the four-week clerkship include patients in eight broad categories of symptoms (abdominal pain, chest pain, extremity pain/trauma, dyspnea, common infection/fever, changes in neurologic status, headache, and major trauma) are provided mostly at Tampa General Hospital Emergency Department, but also in the cadaver laboratory, procedural laboratory, ER, a community urgent care center, and with Tampa Fire and Rescue EMS. Tracy Sanson, MD, (internal medicine, emergency medicine) is director.

Surgical Care: This eight-week clerkship gives students the core experiences in the surgical care of patients, including exposure to a variety of patient populations within general, gynecologic and subspecialty surgery experiences, including cardiothoracic, pediatric, plastics, ENT, orthopedics, transplant, urology, trauma and vascular areas. Experiences are provided at Tampa General Hospital, Haley VA Hospital, Bay Pines VA Hospital, and Moffitt Cancer Center. Stephen Goldin, MD, (surgery) is director. Shelly Holmstrom, MD (ob/gyn) is co-director.

Inpatient Internal Medicine and Pediatrics: The goal of this clerkship is for students to gain competence in the care of hospitalized patients across the life span, while learning about common disease processes in an organ system model. Students spend four weeks on an internal medicine ward team and four weeks on a pediatrics ward team. Each week includes experiences around nephrology, cardiology, hematology/oncology, endocrinology, gastroenterology, pulmonary, infectious disease, and rheumatology. Maria Cannarozzi, MD (internal medicine and pediatrics) is director.

Neuro-Psychiatry: The goal of this eight-week clerkship is to give students contact in two disciplines that study the brain and human behavior with core exposures to the continuum of behavioral cognitive and neurologic illness, including back pain, bipolar disorder, delirium, dementia, depression, headache, movement disorders, schizophrenia, seizures, stroke, and substance abuse. Experiences include four weeks in general psychiatry for adult inpatient care, two weeks for psychiatry in primary care/consultation, and two week in neurology, and are provided at the USF Health Medical Clinic, Tampa General Hospital, Haley VA Hospital, Bay Pines VA Hospital and several outpatient preceptor sites. Sandra Stock, MD, (psychiatry) is director. Rossitza Chichkova, MD, (neurology), is co-director.

Ambulatory Care and Special Populations: This 16-week clerkship provides students with the core experiences in primary care disciplines within a framework of a longitudinal, outpatient experience. Students are also exposed to other important ambulatory experiences like geriatrics, women’s and men’s health, and unique populations. Core experiences include family medicine, general internal medicine, and general pediatrics and students spend time at the USF Health Medical Clinic and several other outpatient settings. Kira Zwygart, MD, (family medicine) is director.

The USF clerkships are being used as a model as an effective way to meet deficiencies in the current medical education offerings


The USF College of Medicine students consistently outperform other medical students across the country in their mean scores and passing rates for the United States Medical Licensing Examinations (USMLE). The pass rate has averaged 98 percent on the Step II of the USMLE for the past seven years.

By the way...

CARNEGIE PROJECT:

The USF College of Medicine is one of 12 medical schools that will be part of the new Flexner Report, a study that will analyze the current state of medical education and innovative approaches to teaching medicine. Six are standard curriculums and six are innovative models: USF is in the innovative category. The study is the Second Flexner Report (the first was conducted in 1910 and set teaching guidelines that medical schools have followed ever since) and will look at key educational goals, basic practices of teaching and learning, and assessment of student learning. Like the first report, the Second Flexner Report is sponsored by the Carnegie Foundation. “We were asked to be involved because we’re doing something creative here,” said Paul

Wallach, MD, vice dean of educational affairs at USF. “It is wonderful to be a part of the process that will help update guidelines used for the last 100 years.” The first Flexner Report came about when, in 1908 the American Medical Association’s Council on Medical Education requested the Carnegie Foundation for the Advancement of Teaching to lead a survey of medical education in the United States. Abraham Flexner took the charge. Over 18 months, Flexner visited all 155 medical schools, looking at five areas: entrance requirements; number and training of faculty; size of endowment and tuition; quality of laboratories; and availability of a teaching hospital. Although most implied they had the five qualities, only a few had resources, facilities and teachers necessary to apply this demanding form of education.

Flexner noted, “We have indeed in America

medical practitioners not inferior to the best elsewhere; but there is probably no other country in the world in which there is so great a distance and so fatal a difference between the best, the average, and the worst.” While some promoted medical education reform as a way to increase professional status, Flexner’s take on it was more of a public health measure. It wasn’t until the 1930s that the combined efforts of state licensing boards, philanthropic foundations, and the AMA’s CME caused the closing of many of

America’s proprietary medical colleges and the standardization of the laboratory- and hospital-based research medical university model that Flexner advocated in his report.

The way they see it...

USF 1 of 12 schools chosen to help shape medical education with Second Flexner Report

Although changes in the USF medical curriculum seem fairly new, several classes of medical students have experienced them first hand. The following are comments offered by some of the students who have completed various components.

Students give feedback on how new programs affect their learning

The willingness of this school to change in a way that helps students learn better and the relationship of the students with the faculty is unparalleled. There has been student participation all the way through this process.

-- Aman Bhullar, 3rd year

The content emphasizes training for the entire professional, not just clinical. They help with grant writing, they are flexible with scheduling so we can participate in leadership development.

-- David Wilson, 4th year

One of the improvements in the new curriculum is the addition of the emergency medicine clerkship, which is a 4-week introduction to emergency medicine in the clinical, didactic and procedural setting. Prior to this clerkship, third-year students had no exposure to the ER. Students seemed to have enjoyed this rotation and I believe it has sparked an interest in the field that wasn’t discovered prior to the fourth year previously.

-- Janelle Fauci, 3rd year

I believe the new curriculum can add more breadth to our education. While we students are at Shriners, hospice, or amputee clinic we are witnessing pathology and clinical settings we may never get a chance to see again. For example, when I was on my pediatrics rotation last month, we had a young boy with possible osteogenesis imperfecta (OI). The pediatric residents had never seen a case of OI, but we had, thanks to our time at Shriners.

-- Elizabeth Sundean, 3rd year

I enjoyed how the inclusion of an emergency medicine rotation got students interested in a patient’s care, instead of picking up care half way through. Seeing an un-diagnosed patient was also a challenge, and refreshing too.

-- Rich Hopley, 3rd year


Health NOW is produced by the USF Health Office of Public Affairs, MDC 47, Room 1160 • Phone: 813-974-3300 • Fax: 813-974-5422.Published for faculty, students and staff of USF Health. Editor: Sarah A. Worth Art Director: Klaus Herdocia USF President Judy Genshaft Vice President for USF Health Stephen Klasko, MD, MBA

Vol. 17 No. 16

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By Anne DeLotto Baier The USF College of Nursing began the state’s first Doctorate of Nursing Practice program this January, giving nurses who want to practice, teach or manage at the profession’s highest level an alternative to the traditional research-oriented PhD degree. USF has offered the traditional PhD in nursing since 1997. In November, the USF Board of Trustees unanimously approved the College of Nursing’s proposal for a second doctorate program. The new DNP program started in January with 15 master’s-prepared nurses. Until the DNP’s creation, a master’s degree was typically the top degree for a nurse not interested primarily in research. Patricia Burns, PhD, dean of the College of Nursing, said USF continues to be a leader in transforming advanced nursing education. USF’s nursing school is the first in Florida and

among the first in the country to adopt the DNP, a program supported by the American Association of Colleges of Nursing (AACN) and endorsed by the National Academy of Sciences, Dr. Burns said. A $1.28 million SUCCEED Florida Career Education Grant, awarded to USF earlier this year, will support the first year of the DNP program. The grant from the state’s Department of Education will cover tuition and help subsidize salaries so students can take full-time course loads. The AACN has recommended that the level of preparation needed for advanced practice nursing roles move from the master’s degree to a clinical doctorate degree by 2015, similar to the PharmD for pharmacy or the DPT for physical therapy. The organization has pushed the DNP as a way to achieve a highly skilled nursing workforce capable of meeting practice demands associated with an increasingly complex health system. The DNP is also expected to help boost the pool of nurse educators and administrators, who are in even shorter supply than nurses who provide direct patient care. “Our nursing practice doctorate will serve several needs, but one of the most important will be to increase the number of doctorally-prepared faculty needed to teach nursing students,” said Mary Webb, PhD, associate professor

USF begins state’s first practice doctorate program in nursing

of nursing and director of the DNP program. “It also offers an opportunity to many very intelligent nurses out there who would like to obtain a doctoral degree, but don’t want to work as a nursing scientist who conducts research.” USF’s DNP program offers concentrations in advanced clinical practice and education. The College plans to eventually add a third concentration in health care management. Full-time students should be able to complete the doctorate program within two years, Dr. Webb said. “The DNP program will ultimately benefit our communities because, with advanced knowledge about health systems and evidence-based practice, its graduates will bring a higher level of care to individual patients, families and populations.”

Hospital emergency physician groups serving an increased volume of uninsured patients had disproportionately higher rates of free, or uncompensated, care – a consequence that may worsen overcrowding, adversely impact quality of care and lead more emergency rooms to close their doors, USF researchers found. USF researchers worked with the Florida College of Emergency Physicians (FCEP) on the study, which is published in the October-December 2005 issue of Health Care Management Review. The researchers surveyed 188 Florida

A sagging safety netFree care by Florida’s emergency physicians averages 47%, climbs faster as uninsured patient visits increase

Afriyie Johnson (left) is master’s prepared family nurse practitioner and an instructor at the USF College of Nursing who teaches health assessment at the Tampa campus. She is among the students admitted to the charter DNP class, which also includes several USF nursing instructors and nursing instructors from Polk Community College and Manatee Community College. Pictured with Johnson is Judith Karshmer, RN, PhD, associate dean of nursing, and Mary Webb, PhD, (right) director of the DNP Program.

hospital emergency physician groups about the uncompensated care they provided in 1998. The 83 physician groups responding provided substantial uncompensated, or free, emergency care, ranging from 26 to 79 percent with an average of nearly 47 percent. Uncompensated services are those for which no payment is received from either the patient or from a public or private insurer. Such services encompass charity care for patients who cannot afford to pay, bad debt from patients who choose not to pay their portion of the bill, and denial of payment by health plans. “This study is one of the first to quantify the uncompensated care provided by Florida emergency physicians,” said lead study author Barbara

Langland Orban, PhD, associate professor and chair of Health Policy and Management at the USF College of Public Health. “Emergency physicians say the large amount of uncompensated care they provide has become a substantial cost of practicing emergency medicine, but we did not expect such a high percentage of free care.” “Legislators and the public need to recognize that uncompensated care is not just a problem involving uninsured patients – it affects all patients,” said FCEP President Jorge Lopez, MD. USF’s Etienne Pracht, PhD, and Seena Salyani, MBA, MHA, were co-authors for the study.

the right way to - usf health | education, research...

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