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Office of Medical Education Overview  Curriculum Oversight and Management  a) Committee Priorities 2016‐2017  b) UC‐COM Educational Program Oversight Chart  c) Curriculum and Timeline Overview  d) Curricular Committee Structure Charter & Committee Membership List  e) Curricular Committee Structure   f) Committee Meeting Schedule  Performance and Advancement Committee (PAC)  LCME   a) Functions and Structure of a Medical School (published March 2016)  b) Data Collection Instrument for Full Accreditation Surveys (published  April 2016)  c) LCME Standards Placemat  Organization Charts  a) Medical Education  b) Learning Communities  c) 3rd Year Clerkships  d) 4th Year Electives  AAMC EPAs / PCRS  a) Goals  b) Guiding Principles  c) Faculty & Learners’ Guide  d) Physician Competencies Reference Set  Curricular Resources  a) Course Evaluation Templates:  M1/2, M3/4  b) Alignment Matrix   c) Course Syllabi:  M1/2, M3/4   d) Electives Proposal and Approval Form  Student Handbook 


Dear Colleagues,    The Office of Medical Education (OME) provides for central coordination of the curriculum and other educational  programs, and assures that all operational matters of the academic programs are compliant with accreditation standards  dictated by the LCME.     Some of the ways the OME provides management and oversight of the medical curriculum include:                

Providing support for the Curriculum Committees, the Educational Policy Committee, and the Performance and  Advancement committees (PACs).  Overseeing the design and analysis of student performance in our curriculum.  Producing an annual report on Medical Education.  Overseeing the development of a Dynamic Student Dashboard to analyze how well the curriculum is performing.   Coordinating and preparing reports and documentation for the LCME Self‐Study and site visit for  reaccreditation.  Providing consultation services to faculty on curriculum/course design, assessment, and analysis of course data.  Providing administrative support to course directors and co‐directors.  Overseeing student evaluations of our curriculum and faculty.  Facilitating student focus groups to identify further opportunities for improving our curriculum.  Overseeing the mapping of our curriculum for the annual LCME Curriculum Inventory Upload.  Supporting and administering LCMS+, the curriculum management software.  Administering computerized examinations, analyzing results, and communicating these to course directors and  students.  Maintaining a monthly faculty electronic newsletter to keep faculty up‐to‐date on current research in medical  education and the accomplishments of our faculty.  Presenting faculty development seminars and programs on teaching and learning.  Supporting faculty in the scholarship of teaching and learning. 

Serving the educational needs of 700 medical students, the OME achieves success through teamwork that is  characterized by mutual respect and adaptability.     Throughout the ongoing process of continuous improvement of our curriculum, we embrace new ideas and are  innovative in our thinking as we find the most effective and efficient ways to improve medical education based on the  evidence and scholarly literature.  The purpose of the Medical Education Resource Binder is to provide you with a guide to the University of Cincinnati   Medical School Curriculum and LCME Standards/Requirements.  Our hope is that you will take some time to familiarize  yourself with the documents included in this resource binder as well as to use it as a reference tool as you have  questions about our curriculum.  We consider this resource a work‐in‐progress and welcome feedback you may have for next year’s edition.  Note that  the resources included will need to be updated on an annual basis.  Each year committee membership changes, LCME  standards are updated, and the academic calendar changes, etc.  Sincerely, 

Pamela L. Baker Pamela L. Baker, PhD, Associate Dean    Medical Education       

Bruce Giffin  

 

Bruce Giffin, PhD, Associate Dean  Medical Education 


Overview of CincyMedEd Committee Structure and Responsibilities  Committee 

Charge

Priorities for 2016/2017  

Education Policy  Committee (EPC) 

Responsible for the overall  design and coordination of  the curriculum.    Reviews and approves all  major curricular changes  and new initiatives. 

   

Performance and  Advancement Committee  (PAC) 

Alignment & Assessment  Curriculum Team (AACT) 

M3/4

Regularly monitors the  progress of each student  and makes decisions on  promotion, retention,  dismissal, leave of absence,  and compliance with CoM  standards.  Oversees curricular  assessment across all four  years of the curriculum and  makes recommendations  to appropriate  committee(s)/EPC for  curricular change.  Coordinates curricular  design across the last two  years of CincyMedEd,  collects and analyzes data,  and makes  recommendations to the  appropriate  committee(s)/EPC for  curricular improvements  and innovations. 

 

   

   

Chair

OME Staff  Liaison 

Ensure alignment of the #CincyMedEd curricular structure to LCME  Competencies and the associated EPAs that have been identified by the  AAMC and adopted by the EPC.  Institutionalize a process for reviewing and implementing curricular  improvement to include achievement of our programmatic  objectives/mission, including calendar/timeline development for this process.  Create and capture curricular innovations and their impact on the learning  goals for our students.    Provide feedback to the Office of Medical Education on the Dynamic  Curriculum/Student Performance Dashboard.  Support an annual Medical Education Faculty Retreat. 

Phil Diller, MD/PhD 

Ned Donnelly,Ed.D 

Oversee the new Professionalism Framework in terms of faculty  communication and student follow‐up.  Each PAC chair shall attend the appropriate M1/2 or M3/4 curriculum  committee meeting at least twice a year to provide an overview of trends  observed in student performance.   Provide feedback to the Office of Medical Education on the Dynamic  Curriculum/Student Performance Dashboard. 

DJ Lowrie, PhD   (2017)  Sarah Ronan‐Bentle, MD  (2018)  Robert Ellis, MD   (2019)  Mike Lieberman, PhD   (2020) 

Ned Donnelly,Ed.D 

Contribute to the development of a master plan for the assessment of the  curriculum and student performance.  Provide feedback to the Office of Medical Education on the Dynamic  Curriculum/Student Performance Dashboard.   Provide feedback on the development and implementation of the Assessment  of Core Entrustable Professional Activities (ACEPA).  Provide feedback on the development of an interactive tool that can predict  student class rank in the 3rd year based on historical data.  Develop a calendar/timeline for recommending curricular improvements that  aligns with the EPC calendar of review.   Provide data and information related to the LCME Collection Instrument (due  April 1, 2017).  Review assessments in the Core Clerkships and strategize improvements  including the design of an OSCE (with a physical exam) across all Clerkships  and procedures for the completion of the Preceptor Evaluation.   Review data on the consistency of the learning experiences across clinical  sites.  

Pamela Baker, PhD, Chair  Catherine Smith  Steve Baxter, MD, Vice‐ Chair 

Rob Neel, MD 

Janet Rosing 


Committee

Charge

Priorities for 2016/2017   

 

(M3/M4)

 

   

       

Re‐examine data/studies on grade inflation in the Core Clerkships and  recommend how to achieve stronger consistency with National trends.  Review data on clinical learning environment quality and strategize  improvements.  Complete LCME required mapping for the Curriculum  Inventory Upload for all electives.  Provide input on the development of the ACEPA (an EPA‐based OSCE at the  end of M2).  Review and provide input on the M3/4 electives, including:  o A comprehensive review of all electives to address whether  our elective offerings and opportunities to take electives meet  our students need for career exploration and well‐ roundedness.  o Review length of M3 specialty electives giving consideration to  1‐week vs 2‐week lengths.  o The development of a standardized evaluation.  o The development of a standardized syllabus.  o The application to create an elective.  o The development of a process to review electives.  o The development of a process to “deactivate” electives.  Provide feedback to the Office of Medical Education on the Dynamic  Curriculum/Student Performance Dashboard.  Provide input on the redesign of the Intersessions including the review  current clerkship pathways to evaluate pros/cons to linkage of certain  clerkships.  Review the Core Clerkship Orientations to create stronger consistency across  all rotations and alignment with the Intersessions.  Provide input on the redesign of the MSPE and review clerkship and elective  narrative comments to develop a template.  Provide feedback on the development of an assessment tool that can predict  student class rank in the 3rd year based on historical data.  Provide feedback on the following Curricular Task Forces:  o Life Style and Wellness (Integrative Medicine)  o Radiology and Imaging  o Translational Research  Review all Core Clerkship yearly evaluations utilizing the new template. 

OME Staff  Liaison 

Chair


Committee

Charge

Priorities for 2016/2017    

M1/2

Coordinates curricular  design across the first two  years of CincyMedEd,  collects and analyzes data,  and makes  recommendations to  appropriate  committee(s)/EPC for  curricular improvements  and innovations. 

    

 

    

Clinical Core  Competencies Team  (CCCT) 

Coordinates curricular  design across all  experiential programs,  collects and analyzes data,  and makes  recommendations to either  M1/2 or M3/4 for  curricular improvements  and innovations. 

    

Develop a calendar/timeline for recommending curricular improvements that  aligns with the EPC calendar of review.   Map the basic science curricular structure to the 58 LCME competencies and  associated EPAs.  Provide data and information related to the LCME Collection Instrument (due  April 1, 2017).  Review and provide feedback on the efforts to incorporate more active and  self‐directed learning in the M1/2 Curriculum.  Review basic science assessments to devise strategies to overcome grade  inflation and better differentiate our learners.  Identify outcomes to create a more integrated curricular structure aligned  with appropriate activities and standardized assessments.  Provide feedback to the Office of Medical Education on the Dynamic  Curriculum/Student Performance Dashboard.  Provide feedback on the following Curricular Task Forces:  o Life Style and Wellness (Integrative Medicine)  o Radiology and Imaging  o Translational Research  Provide input on the development of the ACEPA (an EPA‐based OSCE at the  end of M2).  Continue course reviews using the new evaluation template to identify  opportunities for curricular improvement.  Develop a calendar/timeline for recommending curricular improvements that  aligns with the EPC calendar of review.   Provide data and information related to the LCME Collection Instrument (due  April 1, 2017).  Complete a comprehensive peer review of all course assessments including  samples of graded work.   Identify opportunities for collaboration with other Course Directors.  Review curricular threads that do not stand alone as a course (i.e. Nutrition,  Wellness and Lifestyle, Human Growth and Development, Career  Development) to identify gaps and areas of improvement.  Review and provide feedback on the syllabi of curricular threads (i.e.  Nutrition, Human Growth & Development, Professionalism, Career  Development, etc.)  Collaborate with the Office of Student Affairs to better address Wellness and  Career Development within our curricular structure.  Provide feedback to the Office of Medical Education on the Dynamic  Curriculum/Student Performance Dashboard.  Provide input on the development of the ACEPA (an EPA‐based OSCE at the  end of M2).  Provide feedback on the following Curricular Task Forces:  o Life Style and Wellness (Integrative Medicine)  o Radiology and Imaging  o Translational Research  Continue course reviews using the new evaluation template to identify  opportunities for curricular improvement. 

Chair

OME Staff  Liaison 

Steve Baxter, MD 

Becky Trippel 

Lisa Kelly, MD 

Gina Burg 


Committee

Charge

Priorities for 2016/2017  

MD/PhD Liaison 

Identifies opportunities for  MedEd research as well as  collaborations within CoM  and across institutions. 

   

 Research Steering  Committee (RSC) 

Identifies opportunities for  MedEd research as well as  collaborations within CoM  and across institutions. 

   

 

Conduct a meta‐analysis on CoM Faculty publications, presentations and/or  posters since 2009.  Provide data and information related to the LCME Collection Instrument (due  April 1, 2017).  Identify current research projects.  Recommend possible areas of research focus & collaborations.  Establish faculty research groups.  Conduct a meta‐analysis on CoM Faculty publications, presentations and/or  posters since 2009.  Provide data and information related to the LCME Collection Instrument (due  April 1, 2017).  Identify current research projects.  Recommend possible areas of research focus & collaborations.  Establish faculty research groups. 

Chair

OME Staff  Liaison 

George Deepe, MD/PhD 

N/A

Andrew Thompson, PhD, 

Lo’Rain Drais 


UC‐COM Educational Program Oversight

College of Medicine Council (1st Mon 7‐8am)

Dean William Ball, MD, Chair Arthur Pancioli, MD Shuk‐mei Ho, PhD William Barrett, MD Arthur Evans, MD Gregory Rouan, MD Michael Edwards, MD Andrew Filak, MD Myles Pensak, MD Fred Lucas, MD Mario Zuccarello, MD Brian Adams, MD, MPH Phil Diller, MD, PhD Michael Archdeacon, MD, MSE

Brett Kissela, MD, MS Mary Mahoney, MD Jerry Lingrel, PhD Margaret Hostetter, MD Jun‐Lin Guan, PhD William Hurford, MD Peter White, PhD Gregg Warshaw, MD Karl Golnik, MD John Lorenz, PhD Robert Highsmith, PhD Bruce Yacyshyn, MD Melissa DelBello, MD Student Reps

Sr Associate Dean of Education Andrew Filak, MD

Medical Scientist Training Program (MSTP)

Phil Diller, MD, PhD, Chair Brad Davis, MD Pamela Baker, PhD George Deepe, MD Steve Baxter, MD Brian Evans, DO Aurora Bennett, MD Andy Filak, MD

Bruce Giffin, PhD Lisa Kelly, MD Mike Lieberman, PhD DJ Lowrie, PhD

Laurah Lukin, PhD Mia Mallory, MD Laura Malosh, PhD Chip Montrose, PhD

Rob Neel, MD Robbie Paulsen, MD Sarah Ronan‐Bentle, MD Dana Sall, MD

Leslie Schick, MSLS Tina Whalen, DPT James Whiteside, MD Students M1, M2 M3, M4, MSTP

Alignment, Assessment & Curriculum Team (AACT) (2nd Th 3:30‐5:00PM)

Pamela Baker, PhD, Chair Steve Baxter, MD, Vice‐Chair Amy Bunger, PhD

Bruce Giffin, PhD Lisa Kelly, MD Laurah Lukin, PhD

Anil Menon, PhD Rob Neel, MD John Quinlan, MD

Healthcare Emergency Part I First Responder Clinical Skills 101, 102 Physician & Society 101, 102 Fundamentals of Molecular Medicine Fundamentals of Cellular Medicine Gastrointestinal/Endocrine/ Reproduction Longitudinal Primary Care Clerkship Interprofessional Experiences 101 Musculoskeletal – Integumentary

Kay Vonderschmidt, MPA Mike Sostok, MD Aaron Marshall, PhD Joe Kiesler, MD Lisa Kelly, MD Keith Stringer, MD John Monaco, PhD Keith Stringer, MD Edmund Choi, PhD Aaron Marshall, PhD Mercedes Falciglia, MD Kathi Makoroff, MD Roohi Kharofa, PhD Sarah Pickle, MD Tiffany Diers, MD Mark Goddard, MD Andy Thompson, PhD Steve Baxter, MD

Renal Pulmonary

Clinical Skills 201‐202 Physician & Society 201‐202 Longitudinal Primary Care Clerkship 201‐202 Interprofessional Experiences 201‐202 Multi‐Systems

M1 PAC (Class 2020)

M2‐PAC (Class 2019)

Lisa Kelly, MD, Chair Pamela Baker, PhD Steve Baxter, MD Alice Mills, MD

Blood and Cardiovascular System

Michael Lieberman, PhD, Chair Robert Brackenbury, PhD Amy Guiot, MD John Lorenz, PhD Robert Ellis, MD Rick Ricer, MD

Clinical Core Competency Team (CCCT) (3rd Th 1‐3PM)

Brain, Mind & Behavior

HealthCare Emergency Management Part II: Mass Casualty Incidents Triage and Natural Disasters Learning Communities

Learning Communities

Pamela Baker, PhD

Andy Thompson, PhD, Chair Amy Thompson, MD Aaron Marshall, PhD Lo’Rain Drais

Pamela Baker, PhD Laurah Lukin, PhD Abby Tissot, PhD

M3‐M4 Curriculum Committee (3rd Th 3‐5PM)

Tiffany Diers, MD Joe Kiesler, MD Laurah Lukin, PhD Mia Mallory, MD

Rob Neel, MD Sarah Pickle, MD Megan Rich, MD Mike Sostok, MD

Kay Vonderschmidt, MPA Laura Malosh, PhD Students: M1, M2, MSTP

Bruce Giffin, PhD John Quinlan, MD DJ Lowrie, PhD Laura Wexler, MD DJ Lowrie, PhD Max Reif, MD & Kathryn Wikenheiser‐Brokamp, MD, PhD Heather Christensen, PhD Mike Sostok, MD Joe Kiesler, MD Lisa Kelly, MD Roohi Kharofa, PhD Sarah Pickle, MD Tiffany Diers, MD George Deepe, MD DJ Lowrie, PhD Kay Vonderschmidt, MPA Steve Baxter MD

Rocky Ellis MD, Chair Michael Lieberman, PhD John Monaco, PhD Tim Pritts, MD John Quinlan, MD Amy Thompson, MD David Wieczorek, PhD

Robert Neel, MD, Chair George Deepe, MD Brian Adams, MD Reena Dhanda Patil, MD Krishna Athota, MD Robert Ellis, MD Pamela Baker, PhD Brian Evans, DO Steve Baxter, MD Andy Filak, MD Aurora Bennett, MD Barb Gadzinski, BA John Campbell, MD Bruce Giffin, PhD Steve Carleton, MD, PhD Brian Grawe, MD LeAnn Coberly, MD Amy Guiot, MD

Thomas James, MD Peirce Johnston, MD Jordan Kharofa, MD Jeffrey Keller, MD Lisa Kelly, MD Greg Kennebeck, MD Shagufta Khan, MD Jordan Kharofa, MD Corinne Lehmann, MD

M3‐ Year Three Intercession (1wk x 3/year) Family Medicine Core Clerkship (4wks x 12/yr) Internal Medicine Core Clerkship (8wks x 6/yr) Neuroscience Core Clerkship (4wks x 12/yr) Obstetrics & Gynecology Core (6wks x 6/yr) Pediatrics Core (8wks x 6/yr) Psychiatry Core Clerkship (6wks x 6/yr) Surgery Core Clerkship (8wks x 6/yr) Elective Clerkship (2wks x 12/yr)

Course Director Amy Guiot, MD Robert Ellis, MD LeAnn Coberly, MD John Quinlan, MD Amy Thompson, MD Corinne Lehman, MD Peirce Johnston, MD Krishna Athota, MD *below

M3‐ Year 3 Electives (Course Director)

Anesthesia (Thomas James MD) Cardiovascular ICU (LeAnn Coberly MD) Dermatology (Brian Adams MD) Clinical Oncology (Jordan Kharofa MD) Emergency Medicine (John Campbell MD) Geriatric Medicine (Jeffrey Schlaudecker MD) Medical ICU (LeAnn Coberly MD) Otolaryngology (Reena Dhanda‐Patil MD) Ophthalmology (Lisa Kelly MD) Pathology & Lab Medicine (Shagufta Khan MD) Orth Surgery (Brian Grawe MD) Radiology (Lilly Wang MBBS) Urology (Nilesh Patil MD) Health Care Emergency Management Part III: Chemical, Biologic, Radiologic, and Nuclear Disasters (Dustin Calhoun MD)

Jeffrey Schlaudecker, MD Michael Sostok, MD Amy Thompson, MD Kay Vonderschmidt, MPA Lily Wang, MBBS Students: M3, M4, MSTP

David Wieczorek, PhD Pierce Johnston, MD Michael Lieberman, PhD

M4‐Year 4 Experiences Acting Internship #1 (IM ‐ 1 month) Acting Internship #2 (1 month)* Elective Internal Medicine (4wks) Intensive Clinical Elective (12wks ‐ICE] Undesignated Elective (8wks) (UC COM or as away) Healthcare Emergency Part IV Disaster Med

Course Director LeAnn Coberly, MD Various* LeAnn Coberly, MD Various (1) (2) Various Kay Vonderschmidt, MPA

*Acting Internship #2: Adult Psychiatry (Brian Evans DO) Anesthesia (Thomas James MD) Emergency Medicine (Robbie Paulsen MD) Family Medicine (Rocky Ellis MD) Gynecology (Amy Thompson MD) Neurology (John Quinlan MD) Obstetrics (Amy Thompson MD) Pediatrics (Amy Guiot MD) Surgery (Krishna Athota MD) (1) (2) For a detailed list of M4 electives refer to MOS.

M4‐PAC (Class 2017)

M3‐PAC (Class 2018) Sarah Ronan‐Bentle, MD, Chair Michael Farrell, MD Aaron Marshall, PhD

Jaime Lewis, MD Laurah Lukin, PhD Laura Malosh, PhD Mia Mallory, MD John Quinlan, MD Nilesh Patil, MD Robbie Paulsen, MD Anjali Pearce, MD Jenn Scheler, MD

M4 (Year 4)

M3 (Year 3)

M2 (Year 2)

M1 (Year1)

Student Affairs

Aurora Bennett, MD

Research in Medical Education

Sarah Ronan‐Bentle, MD Amy Thompson, MD Eric Warm, MD Paul Wojciechowski, PhD

M1‐M2 Curriculum Committee (2nd Th Noon‐1:30)

Steve Baxter, MD, Chair Phil Diller, MD, PhD Terry Kirley, PhD John Monaco, PhD Andy Thompson, PhD Pamela Baker, PhD Mercedes Falciglia, MD John Lorenz, PhD Rob Neel, MD Becky Trippel Aurora Bennett, MD Bruce Giffin, PhD DJ Lowrie, PhD Sarah Pickle, MD Kay Vonderschmidt, MPA Edmund Choi, PhD Mark Goddard, MD Laurah Lukin, PhD John Quinlan, MD Laura Wexler, MD Heather Christensen, PhD Lisa Kelly, MD Kathi Makoroff, MD Max Rief, MD Kathryn Wikenheiser‐ George Deepe, MD Roohi Kharofa, PhD Laura Malosh, PhD Mike Sostok, MD Brokamp, MD, PhD Tiffiny Diers, MD Joe Kiesler, MD Aaron Marshall, PhD Keith Stringer, MD Students: M1, M2, MSTP

Bruce Giffin, PhD

Andrew Filak, MD, Chair  Pamela Baker, PhD, Co‐Chair (Med‐Ed)  Phil Diller, MD, PhD (EPC)  Aurora Bennett, MD (Student Affairs)   Mia Mallory, MD (Diversity)  Bruce Giffin, PhD (Med Ed) 

Leadership George Deepe, MD  Gurjit Khurana Hershey, MD, PhD  Tim LeCras, PhD  Louis Muglia, MD, PhD  Arnold Strauss, MD  Kathryn Wikenheiser‐Brokamp, MD, PhD 

Office of Medical Education

LCME Oversight WorkGroup

Educational Program Committee (EPC) (1st Th 3‐4:30pm)

Yash Patil, MD

DJ Lowrie, PhD, Chair John Kues, PhD John Lawrence, MD John Campbell, MD Elizabeth Kelly MD Keith Stringer MD Zelia Correa, MD, PhD Michael Lieberman PhD (PAC Coordinator)


M1 M2

12 10/24

Fundamentals of Molecular  Medicine

Learning Community 101

Physician & Society 101

Clinical Skills 101

August 2 3 8/15 8/22

4 8/29

5 9/5

September 6 7 9/12 9/19

8 9/26

9 10/3

October 10 11 10/10 10/17

Brain, Mind, & Behavior

M2

Learning Community 201 Physician & Society 201 Logitudinal Primary Care Clerkship 201 Clinical Skills 201 Interprofessional Experiences 201

December Break 18 19 12/5 12/12 12/19 12/26

Fundamentals of Cellular  Medicine I n t e g r a t e d   E x a m

Surface Anatomy/  Radiology/Utrasound

1 8/8

November 13 14 15 16 17 10/31 11/7 11/14 11/21 11/28

P&S 101

CS 101

January 21 22 23 1/9 1/16 1/23

13 10/31

I n t e g r a t e d E x a m  

November 14 15 16 17 11/3 11/7 11/14 11/21 11/28

Physician & Society 102 Longitudinal Primary Care  Clerkship 101 Clinical Skills 102

P&S 201 LPCC 201

28 2/27

18 12/5

March 29 30 3/6 3/13

31 3/20

April 33 34 4/3 4/10

32 3/27

LC 102

P&S 102

May June 38 39 40 40 5/8 5/15 5/22 5/29 6/5 6/12 6/19

Brain, Mind & Behavior

Brain, Mind & Behavior I n t e g r a t e d   E x a m

35 36 37 4/17 4/24 5/1

LPCC 101

I n t e g r a t e d E x a m

LC 102

P&S 102

LPCC 101

CS 102

CS 102

IPEX 101

IPEX 101

Surface Anatomy/  Radiology/Utrasound

Surface Anatomy/  Radiology/Utrasound

Surface Anatomy/  Radiology/Utrasound

December 19 Break 12/12 12/19 12/26

20 1/2

January 21 22 1/9 1/16

Blood &  Cardio  System

LC 202 P&S 202 LPCC 202

CS 201 CS 202 IPEX 201

27 2/20

Interprofessional Experiences  101

Blood & Cardiovascular System

LC 201

February 25 26 2/6 2/13

Learning Community 102

Surface Anatomy/  Radiology/Utrasound

12 10/24

24 1/30

Musculoskeletal‐Integumentary

I n t e g r a t e d E x a m

LC 101

20 1/2

23 1/23

I n t e g r a t e d E x a m

24 1/30

February 25 26 2/6 2/13

27 2/20

28 2/27

Renal &  Pulmonary

LC 202 P&S 202

29 3/6

March 30 31 3/13 3/20

Renal &  Pulmonary

LC 202 P&S 202

LPCC 202

LPCC 202

CS 202

CS 202

32 3/27

33 4/3

I n t e g r a t e d E x a m

April 34 35 36 37 4/10 4/17 4/24 5/1

HCEM II

E x a m

May 38 39 40 5/8 5/15 5/22

USMLE PREPARATION

October 10 11 10/10 10/17

Multi‐Systems

9 10/3

Spring Break

8 9/26

Spring Break 

7 9/19

Winter Break

September 5 6 9/5 9/12

Winter Break

4 8/29

Physician & Society

3 8/22

Healthcare Emergency Management: Physician Emergency Responder

M1

Orientation

8/1

August 1 2 8/8 8/15


M3 M4

June

July

August

September

October

November

December

January

February

March

April

May

June

Pathway L

Family Medicine y

Neuroscience

Pediatrics

OB/GYN /

Pediatrics

OB/GYN

OB/GYN

Pediatrics

OB/GYN

Pediatrics

& Pediatrics H C E M I I I : C B R N E D i s a s t e r s

Pediatrics

OB/GYN /

OB/GYN /

Neuroscience

OB/GYN /

OB/GYN /

Pediatrics

Surgery

Internal Medicine

Surgery B r e a k

Surgery

Internal Medicine

Internal Medicine

I n t e r s e s s i o n

S C LK SH P

Pediatrics

S C LK SH P

OB/GYN /

S C LK SH P

S C LK SH P

Family Medicine y

OB/GYN /

OB/GYN /

Pediatrics

OB/GYN /

Pediatrics

Internal Medicine

Surgery g y

Internal Medicine

Surgery g y

Surgery g y

Internal Medicine

g y Surgery

Internal Medicine

Pediatrics W i n t e r

Internal Medicine

Surgery

Family Medicine y

I n t e r s e s s i o n

Pediatrics

S C LK SH P

B r e a k

Neuroscience

S C LK SH P

S C LK SH P

Psychiatry y y

Psychiatry y y

S C LK SH P

S C LK SH P

Psychiatry y y

Psychiatry y y

Neuroscience

Family Medicine

Psychiatry

Family Medicine

Neuroscience

Psychiatry

S C LK SH P

Family Medicine y

Neuroscience

W i n t e r

S C LK SH P

Neuroscience

Family Medicine y

S C LK SH P

Psychiatry y y

Psychiatry y y

Family Medicine y

S C LK SH P

I n t e r s e s s i o n

Psychiatry y y

Neuroscience

Psychiatry y y

S C LK SH P

Family Medicine y

Neuroscience

S C LK SH P

Pathway K

Neuroscience

I n t e r s e s s i o n

Psychiatry

Neuroscience

Family Medicine

S C LK SH P

Pathway J

Internal Medicine

S C LK SH P

Pathway G y

Pathway I

Surgery g y

Family Medicine y

M3

Pathway H y

Internal Medicine

S C LK SH P

Pathway F y

Surgery g y

S C LK SH P

Pathway E y

Surgery g y

S C LK SH P

Pathway D y

Surgery g y

Internal Medicine

S C LK SH P

Pathway C y

I n t e r s e s s i o n

S C LK SH P

Pathway B y

Internal Medicine

S C LK SH P

Pathway A y

S C LK SH P

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Break 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 6/20 6/27 7/4 7/11 7/18 7/25 8/1 8/8 8/15 8/22 8/29 9/5 9/12 9/19 9/26 10/3 10/10 10/17 10/24 10/31 11/7 11/14 11/21 11/28 12/5 12/12 12/19 12/26 1/2 1/9 1/16 1/23 1/30 2/6 2/13 2/20 2/27 3/6 3/13 3/20 3/27 4/3 4/10 4/17 4/24 5/1 5/8 5/15 5/22 5/29 6/5 6/12 6/19

Psychiatry

Family Medicine

Neuroscience

SELECTIVE  CLERKSHIP (2 week electives):   ANESTHESIOLOGY, CARDIOVASCULAR ICU, CLINICAL ONCOLOGY, DERMATOLOGY, EMERGENCY MEDICIINE, GERIATRIC MEDICINE, MEDICAL  ICU, OPHTHALMOLOGY, ORTHOPAEDIC SURGERY, OTOLARYNGOLOGY, PATHOLOGY AND LABORATORY MEDICINE, PEDIATRIC CARDIOLOGY, PEDIATRIC INFECTIOUS DISEASES;,  PEDIATRIC RHEUMATOLOGY, RADIOLOGY, UROLOGY                                                                                                                                                                                                                                              September August October November June December January February March April May July 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Break 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 7/5 7/11 7/18 7/25 8/1 8/8 8/15 8/22 8/29 9/5 9/12 9/19 9/26 10/3 10/10 10/17 10/24 10/31 11/7 11/14 11/21 11/28 12/5 12/12 12/19 12/26 1/2 1/9 1/16 1/23 1/30 2/6 2/13 2/20 2/27 3/6 3/13 3/20 3/27 4/3 4/10 4/17 4/24 5/1 5/8 5/15 5/22 5/29 6/5 6/12 6/19 M4  Internal Med Acting  Acting Internship (4  Internal Medicine  Internship (4 wks) wks) Selective (4 wks) Intesive Clinical Experience (ICE) (12 wks) Undesignated Electives (8 wks) 1

*HCEM IV: Disaster Medicine (Blackboard online course)

51


CincyMedEd Curricular Committee Structure Charter    Rationale  The rationale our committee structure is to ensure that our efforts toward refining our curriculum and  continuous improvement are supported and coordinated.  This is especially important as medical  education nationally and internationally is undergoing a transformation.  Based on numerous  conversations with clinicians, basic scientists and students, we’ve updated the committee structure to  better:         

Articulate roles & responsibilities of chairs and members.  Describe how the various committees interact, support each other, and ultimately foster the  continuous improvement of CincyMedEd.  Verify the alignment of our curricular structure to LCME standards and the AAMC EPA’s and  associated competencies.  Identify stronger assessment tools that align with our competencies and provide data that  allows us to make strategic interventions in the curriculum.  Promote the stronger coordination of our clinical experiences through all four years of the  curriculum.  Create an intra‐and inter‐professional framework to ensure that our curriculum is moving  toward an Inter‐professional framework and that we can communicate what it is we are doing  to internal and external stakeholders.  Identify opportunities for inter and intra‐institutional scholarly collaborations on medical  education.  Meet LCME compliance standards at next reaccreditation site visit. 

Overview 1. CincyMedEd advisory committees guide and make decisions concerning the medical curriculum  in alignment with LCME standards and AAMC EPA’s and associated competencies established by  the AAMC.    2. Advisory committee membership will generally serve three‐year terms, with one‐third of the  committee rotating off annually; terms end and begin at the conclusion of each academic year  to allow for a smooth transition.  3. All committee appointments will be made by the Associate Deans for Medical Education, based  upon recommendations from committee chairs, faculty, and staff committee liaisons following a  careful consideration of a list of volunteers as well as other sources.  Chairs of the committees  will also be appointed by the Senior Associate Dean for Medical Education, with thoughtful  consideration given to recommendations of committee members, faculty and/or staff liaisons.  4. Most advisory committee appointments will be made approximately three months in advance of  the end of the academic year.  Newly appointed members will be added to committee listservs  at that time, so that new members can prepare for their service in advance of their first  committee meeting at the end of the academic year.    5. All active members hold voting privileges. *  6. All advisory committees will hold monthly meetings.   *Note that you must hold a primary faculty/staff or faculty appointment in the College of Medicine to vote.   Medical Students have voting privileges on all committees with the exception of the Education Policy Committee  (EPC).  

1


Committee Member Responsibilities  Faculty  In addition to specific roles required by membership on individual committees, members of CincyMedEd  committees are expected to actively participate in the work of the committee, provide thoughtful input  to committee deliberations, and focus on the best interests of CincyMedEd and committee goals.   Members will be expected to:       

Review all relevant material before committee meetings.  Attend committee meetings and contribute to discussions on issues.  Pay attention to related activities that affect or are affected by the committee's work and share  with committee members, as appropriate.  Provide thoughtful input to committee deliberations, and focus on the best interests of  CincyMedEd rather than on personal or specialty interests.  Support the efforts of the committee chair and carry out individual assignments made by the  chair.  Work as part of the committee to ensure that the committee's work and recommendations are  in keeping with the LCME and AAMC guidelines and competencies. 

Students The aforementioned role identified for faculty committee members also applies to students with the  additional expectations:  The continuous improvement of the curriculum by the faculty depends upon the student  representatives to solicit, organize, and deliver feedback from the student body to ensure that the  students’ learning needs and interests are accurately reflected in any changes in curricular design and  implementation.  

  

 

Student representatives are chosen from a pool of interested students.  o Students must be at least a second‐semester M1 to serve on the Education Policy  Committee.  o Students may stand for re‐nomination, but it is the goal of OME to provide as many  students as possible with this professional development experience.  A call for submission of applications to be a student representative will occur at the beginning of  the academic year.  Interested students will submit their application to the Medical Student Association board.   The Medical Student Association board will interview applicants for OME Committee  representatives with a view to identify students who are in solid academic standing and  represents diversity including but not limited to gender, ancestry, and background. (OME will  verify the academic standing of nominated students.).    All final nominees for representatives and alternates put forth by the Medical Student  Association board must meet with the Associate Deans of Medical Education for final approval.   Following approval, nominees will receive a brief orientation.  Each autumn semester the MSA will nominate three first year students including one MSTP  student to serve on the M1/2 Curriculum Committee 

2


  

Each autumn semester the MSA will also nominate one first year student to serve on the EPC.    In June of each year, two rising third year students and one MD/PhD student will move from the  M1/2 committee to the M3/4 committee.  One MD/PhD student will move from the M1/2  committee to the EPC.     Student representatives’ responsibilities include the following:  o Student representatives are expected to conduct themselves in a professional manner  which includes accurate and respectful reporting of all discussions and decisions made  by a committee.    o Prior to the meetings, student representatives are expected to consult with their peers  to collect feedback on key issues that have been identified on upcoming agendas with  the view that they will present this feedback to the committee.  o Prior to the meetings, student representatives are expected to ask their peers if there  are any issues/concerns that need to be raised with the committee (i.e. use Google  Groups of Facebook to send out a SurveyMonkey link for feedback and to report back to  your classmates, class meetings)  o Prior to the meetings, student representatives are required to submit agenda items.  o During the meetings student representatives may participate in discussion of all issues.  o After the meetings student representatives are expected to share committee  discussions/decisions with their peers based on the issues/concerns raised.    o Remain mindful that student representatives are there to represent their peers—not to  drive a personal agenda.  (Please note that the same is expected of our faculty as well.)  o Student representatives are expected to attend all meetings unless there is a valid  excuse approved by one of the Associate Deans for Medical Education.  In the event that  the student representative is not able to attend, the alternate should be present.  

Committee Chair Responsibilities  In addition to specific roles required by the activities of individual committees, chairs of CincyMedEd  committees are expected to guide their committees and work with staff to develop necessary work  plans and meeting agendas.  Chairs will be expected to:    

Review reports of committee meetings before their distribution.  Report to the committee members on feedback and decisions of the Education Policy  Committee (see committee structure below).    Where appropriate, guide the committee in proposing new initiatives that will further the  mission and goals of CincyMedEd. 

Structuring the Meeting   

  

With the help of the OME staff liaison, provide an agenda sheet with the beginning and ending  times for the meeting, meeting location, a list of committee members, and the agenda of topics.  Sequence agenda items thoughtfully. Start the meeting with topics that will unify the  committee, and with topics that will require mental energy, creativity, and clear thinking. Do not  put difficult topics back‐to‐back.   Provide at least minimal written background information for each agenda item.  Indicate whether the item is for discussion only or if action is expected.  Identify the person who is presenting each item. 

3


Relegate informational updates to email communications so that committee time can be spent  discussing/deciding substantive issues. 

Facilitating the Meeting           

The committee belongs to the CincyMedEd, not to the chair: the chair's primary role is as facilitator.  Guide, mediate, probe, and stimulate discussion. Monitor talkative members and draw out silent  ones.  Encourage a clash of ideas, but not of personalities. If emotions run high over a difficult issue,  return the floor to a neutral person, seek a purely factual answer, or take a break.  Keep discussions on track; periodically re‐state the issue and the goal of the discussion.  In moving toward a decision, call on the least senior or vocal members first to express their views.  Discussions tend to close down after senior members express strong views.  Seek consensus; unanimity is not required.  Announce the results of actions taken and explain the follow‐up to be taken and by whom.  Close the meeting by noting achievements.  Following adjournment, meet briefly with the staff liaison to agree on follow‐up actions and locus of  responsibility.  Facilitate meetings using Robert’s Rules of Order. 

Staff Liaison  Each committee has one OME staff member who serves as liaison and performs a variety of tasks,  including:  

   

Providing orientation for each new committee member and chair about their responsibilities  and work schedule. This will include a written overview of CincyMedEd committee structure and  function, access to the Blackboard organization which includes committee rosters and contact  information, minutes of previous committee meetings (excluding PAC), background on recent  committee activities, information about key people with whom the committee or chair is likely  to interact.  Developing and maintaining committee descriptions, procedural information, and minutes and  activity reports for committees on CincyMedEd Blackboard Site.  Working with the chairs of the committees to ensure that committee responsibilities are fulfilled  and meeting agendas are set.  Providing administrative assistance to the chair in setting up and conducting meetings.  Facilitating communications between committees and CincyMedEd leadership. 

Written Report of Committee Meeting     

Include the date, time, and place of the meeting. Note the name of the chair, members present  and absent, and other key people in attendance.  Note all formal motions and report on passage or defeat.  Note all decisions reached, including motions passed and follow‐up actions to be taken, with  deadlines for implementation.  Include brief summary of discussions. Do not attribute comments to members except possibly  where formal motions are introduced. 

4


 

Provide information on the time and place of the next meeting.  Meeting reports should be prepared as soon as possible (and within 15 days) after the meeting.  They may be shared with the committee with a request that members contact the chair or staff  liaison if errors are noted. 

COMMITTEE MEETING TIMES  Education Policy Committee      Assessment and Alignment Curriculum Team  M1/2 Curriculum Committee      M3/4 Curriculum Committee      Clinical Core Competencies Team     Research Steering Committee       

         

1st Thursday of every month from 3:00‐4:30  2nd Thursday of every month from 3:30‐5:00  2nd Thursday of every month from 12:00‐1:30  3rd Thursday of every month from 3:00‐5:00  3rd Thursday of every month from 1:00‐3:00  TBD 

CincyMedEd Communication & Committee Structure  As part of the new CincyMedEd Curricular Structure we will be creating two new communication tools:   A CincyMedEd Blackboard Organization that houses meeting minutes (excluding the PAC  committees) and other resources.   A periodic electronic news source that will highlight key initiatives in CincyMedEd such as  medical education research as well as newsworthy items in Medical Education. 

5


Overall Committee Structure

6


Committee Chairs  • • • • • • • • • • •

EPC   AACT    RCC    M3/4     M1/2    CCCT    MSTP    PAC 2020  PAC 2019  PAC 2018  PAC 2017 

Phil Diller, MD, PhD  Pamela Baker, PhD, Chair, Steve Baxter, MD, Vice‐Chair  Andrew Thompson, PhD, Chair, Amy Thompson, MD, Vice‐Chair  Robert Neel, MD  Steve Baxter, MD  Lisa Kelly, MD  George Deepe, MD  Mike Lieberman, PhD  Rocky Ellis, MD  Sarah Ronan‐Bentle, MD  DJ Lowrie, PhD 

EPC 2016‐2017   Committee Membership List  Pamela Baker, PhD  Steve Baxter, MD  Aurora Bennett, MD  (To be elected Oct 2016)  Parthib Das  George Deepe, MD  Phil Diller, MD, PhD  Ned Donnelly  Brian Evans, DO  Andy Filak, MD  Ryan Gamlin  Justin Gibson  Bruce Giffin, PhD  Lisa Kelly, MD  Andrew Kim  DJ Lowrie, PhD   Laurah Lukin, PhD  Mia Mallory, MD  Laura Malosh, PhD  Chip Montrose, PhD  Rob Neel, MD  Robbie Paulsen, MD  Dana Sall, MD  Leslie Schick, MS,   Tina Whalen, PhD  James Whiteside, MD 

Associate Dean, DME/OME M1/M2 Chair, Learning Communities Director  Associate Dean, Student Affairs   M1 Student Representative M2 Student Representative MSTP Program Chair, Family Medicine Chairman OME Staff Liaison Program Director, Psychiatry Senior Associate Dean College of Medicine M3 Student Representative M4 Student Representative Associate Dean, OME/DME Physician & Society, Co‐Director MSTP Student Representative Medical Education Assistant Dean, DME/OME Associate Dean, Diversity and Inclusion  Assistant Dean, Student Affairs Physiology M3/M4 Chair, Intersessions Emergency Medicine Internal Medicine Associate Dean, Health Sciences Library Interprofessional Representative (Interim Dean, Allied Health  Sciences)  Program Director, OBGYN

7


AACT 2016‐2017  Committee Membership List  Pamela Baker,  PhD  Steve Baxter,  MD  Amy Bunger, PhD  Bruce Giffin, PhD  Amy Guiot, MD  Lisa Kelly, MD  Jack Kues, PhD  Laurah Lukin, PhD  Anil Menon, PhD  Rob Neel, MD  John Quinlan, MD  Sarah Ronan‐Bentle, MD 

Chair, Associate Dean  Vice‐Chair, Learning Communities Director Assistant DIO Associate Dean, DME/OME  Director of Intersession Physician & Society, Co‐Director  Associate Dean, MED‐Continuous Professional Dev Assistant Dean, OME/DME  Director, Medical Sciences Program  Director of Clinical Programs  Clerkship Director, Neurology  EM AI and 4th Year Education Director, Emergency  Medicine  OME Staff Liaison  Clerkship Director, OB‐GYN  Residency Director, Internal Medicine  Anesthesiology

Catherine Smith  Amy Thompson, MD  Eric Warm, MD  Paul Wojciechowski, MD 

CCCT 2016‐2017  Committee Membership List  Pamela Baker, PhD  Steve Baxter, MD  Gina Burg  Tiffiny Diers, MD  Amy Guiot, MD 

Associate Dean, DME/OME Learning Communities Director  OME Staff Liaison Interprofessional Education COM Pediatrics CCHMC AFF Faculty, Director of  Intersessions  Chair, Physician & Society, Co‐Director  LPCC, Co‐Director Physician & Society, Co‐Director  Assistant Dean, DME/OME COM Pediatrics CCHMC Aff Faculty  Assistant Dean, Student Affairs  Career Development Director, Student Affairs MSTP Student Representative  LPCC, Co‐Director Clinical Skills & SIM

Lisa Kelly, MD  Roohi Kharofa, MD  Joe Kiesler, MD  Laurah Lukin, PhD  Kathi Makoroff, MD  Laura Malosh, PhD  Alice Mills, MD, MPH  Talia Nasr  Sarah Pickle, MD  Mike Sostok, MD 

8


M1/ M2 Curriculum 2016‐2017  Committee Membership List  Pamela Baker, PhD  Steve Baxter, MD  Aurora Bennett, MD  Edmund Choi, PhD  Heather Christensen, PhD  George Deepe, MD/PhD  Tiffiny, Diers, MD  Phil Diller, MD, PhD  Mercedes Falciglia, MD  Bruce Giffin, PhD  Mark Goddard, MD  Lisa Kelly, MD  Roohi Kharofa, MD  Joe Kiesler, MD  Terry Kirley, PhD  John Lorenz, PhD  DJ Lowrie, PhD  Laurah Lukin, PhD  Kathi Makoroff, MD  Laura Malosh, PhD  Aaron Marshall, PhD  John Monaco, PhD  Rob Neel, MD  Sarah Pickle, MD  John Quinlan, MD  Max Reif, MD  Michael Sostok, MD  Keith Stringer, MD  Andy Thompson, PhD  Becky Trippel  Kay Vonderschmidt, PhDc  Laura Wexler, MD  Kathryn Wikenheiser‐Brokamp, MD, PhD Taylor Brooks  Kieffer Hock  Robert Kleven  Kelly Lamiman  Benjamin McGlothlin  Nirali Shah    Michael Turgeon 

Faculty Associate Dean, OME/DME Chair, Learning Communities Director Associate Dean, Student Affairs Co‐Course Director, Fundamentals of Cellular Medicine Faculty Co‐Course Director, Multi‐Systems Course Director, IPEX Chairman, Family and Community Medicine  Co‐Course Director, GI/Endo/Repro Co‐Course Director, Brain, Mind and Behavior  Co‐Course Director, Musculoskeletal‐Integumentary  Course Director, Physician and Society Co‐Course Director, LPCC Course Director, Physician and Society Faculty Consultant, Pharmacology Faculty Consultant, Physiology Co‐Course Director, Multi‐Systems Co‐Course Director, Blood and Cardiovascular System  Co‐Course Director, Renal and Pulmonary  Assistant Dean, OME/DME Faculty Consultant, Human Growth & Development  Assistant Dean, Student Affairs Co‐Course Director, GI/Endo/Repro Co‐Course Director, Fundamentals of Molecular Medicine Chair, M3/M4 & Clinical Programs Co‐Course Director, LPCC Co‐Course Director, Brain, Mind and Behavior  Co‐Course Director, Renal and Pulmonary  Course Director, Clinical Skills Co‐Course Director, Fundamentals of Molecular Medicine Co‐Course Director, Fundamentals of Cellular Medicine Co‐Course Director, Musculoskeletal‐Integumentary  OME Staff Liaison, Fundamentals of Molecular Medicine First Responder/Disaster Preparedness/ED  Co‐Course Director, Blood and Cardiovascular System  Co‐Course Director, Renal and Pulmonary  Students M3 Student Representative M4 Student Representative MSTP Student Representative M2 Student Representative M3 Student Representative M2 Student Representative  M4 Student Representative

9


M3/ M4 Curriculum 2016‐2017  Committee Membership List  Brian Adams, MD  Krishna Athota, MD  Pamela Baker, PhD  Steve Baxter, MD  Aurora Bennett, MD   John Campbell, MD  Steven Carleton, MD  LeAnn Coberly, MD  George Deepe, MD  Reena Dhanda‐Patil, MD  Robert Ellis, MD  Andy Filak, MD  Barb Gadzinski, BA  Bruce Giffin, PhD  Brian Grawe, MD  Amy Guiot, MD  Thomas James, MD  Peirce Johnston, MD  Jeffrey Keller, MD  Lisa Kelly, MD  Greg Kennebeck, MD  Shagufta Khan, MD  Jordan Kharofa, MD  Corinne Lehmann, MD   Jaime Lewis, MD   Laurah Lukin, PhD  Mia Mallory, MD  Laura Malosh, PhD  Anil Menon, PhD  Alice Mills  Rob Neel, MD  Nilesh Patil, MD  Robbie Paulsen  Anjali Pearce  John Quinlan, MD  Rocco Rossi, MD  Jennifer Scheler, MD  Leslie Schick, MSLS  Jeff Schlaudecker, MD  Michael Sostok, MD  John Stiles, PhD  Amy Thompson, MD  Gylynthia Trotman, MD, PhD  Kay Vonderschmidt, PhDc  Lily Wang, MBBS  James Whiteside, MD 

Faculty Specialty Clerkship Director‐ Dermatology Core Clerkship Director, Surgery Associate Dean, OME/DME M1/2 Curriculum Committee Associate Dean, Student Affairs Specialty Clerkship Director, Emergency Medicine Faculty Representative Core Clerkship Director, Internal Medicine Faculty Representative, MSTP Specialty Clerkship Director, Otolaryngology  Core Clerkship Director, Family Medicine Senior Associate Dean, College of Medicine Registrar, College of Medicine Associate Dean, Medical Education Specialty Clerkship Director, Orthopedic Surgery Associate Clerkship Director, Pediatrics Specialty Clerkship Director, Anesthesia  Core Clerkship Director, Psychiatry Educational Program Director, Neurosurgery  Specialty Clerkship Director, Ophthalmology Core Clerkship Assistant Director ‐ IM Specialty Clerkship Director, Pathology Specialty Clerkship Director – Clinical Oncology Core Clerkship Director, Pediatrics Core Clerkship Assistant Director, Surgery Assistant Dean , OME/DME Associate Dean, Diversity and Inclusion Assistant Dean, Student Affairs Medical Education Academic Director, Student Affairs Chair, Director of Clinical Programs Specialty Clerkship Director, Urology EM AI and 4th Year Education Director – Emergency Medicine  Core Clerkship Assistant Director ‐ IM Core Clerkship Director, Neuroscience Specialty Clerkship ‐ OBGyn Specialty Clerkship Director, Radiology Associate Dean, Health Sciences Library Specialty Clerkship Director, Geriatric  Director, Clinical Skills Lab/Simulation Center Assistant Dean for Student Financial Planning Core Clerkship Director, Obstetrics/Gynecology Specialty Clerkship Director – Pediatric/Adolescent Gyn  First Responder/Disaster Preparedness/ED Specialty Clerkship Director ‐ Radiology Specialty Clerkship Director – OB/Gyn

10


Residents No one at current time  No one at current time  Taylor Brooks  Kiefer Hock  Benjamin McGlothlin  Keith Saum  Michael Turgeon  Kristin Barnes  John Bi  Deana Brown  Karen Coleman  LoRain Drais  Ned Donnelly  Mary Duke   Tosha Feldkamp  Shannon Foote   Barbara Gadzinski  Christina Gibson  Sharon Harding  Nancy Jamison  Julie Lefebvre  Melissa Murphy  Mark McCuisition  Andrea Oaks  Bennie Patrick  Mimi Pence  Jordan Perry  Kimberly Reising  Janet Rosing  Mahima Sathe  Jessica Sloniker  Emily Wagner  Jennifer West  Lydia Wocher  Perri Wright  Michele Wyan  Beverly York 

Resident Member Resident Member Students M3 Student Representative M4 Student Representative M3 Student Representative MSTP Student Representative M4 Student Representative Staff MSTP Coordinator IT Support Clerkship Coordinator, Ob/Gyn  Clerkship Coordinator, Radiation Oncology Program Manager, OME Associate Director, OME Clerkship Coordinator, PMR  Clerkship Coordinator, Radiology  Clerkship Coordinator, Anesthesia  Registrar, Student Affairs Clerkship Coordinator, Psychiatry  Admin Secretary, Geriatrics Clerkship Coordinator, Family Medicine  Clerkship Coordinator, Internal Medicine  Clerkship Coordinator, Emergency Medicine IT Support IT Manager Clerkship Coordinator, Surgery  Clerkship Coordinator, Pediatric  Clerkship Coordinator, Dermatology  Clerkship Coordinator, Orthopaedic Surgery  OME Staff Liaison, M3/4 Curriculum Coordinator Clerkship Coordinator, Neuroscience  Clerkship Coordinator, Pathology  Academic Director, OME Clerkship Coordinator, NeuroSurgery  Clerkship Coordinator, Oncology  Clerkship Coordinator, Urology  Clerkship Coordinator, Ophthalmology  Hoxworth

11


RSC 2016‐2017  Committee Membership *  Lo’Rain Drais  Andrew Thompson, PhD  Amy Thompson, MD  Aaron Marshall, PhD  Laurah Lukin, PhD  Abby Tissot, PhD 

OME Staff Liaison Chair Vice‐Chair, Core Clerkship Director, ObGyn  Co‐Course Director, GI/Endo/Repro  Assistant Dean , OME/DME Assistant Dean, Admissions/Recruitment 

* A call will be made to identify faculty interested in participating on this committee. 

MSTP 2016‐2017  Committee Membership     George Deepe, MD  Gurjit Khurana Hershey, MD, PhD  Tim LeCras, PhD  Louis Muglia, MD, PhD  Arnold Strauss, MD  Kathryn Wikenheiser‐Brokamp, MD, PhD 

OME Staff Liaison Chair Peds‐Allergy/Immunology Pediatrics Pediatrics Pediatrics Co‐Course Director, Renal and Pulmonary 

Committee responsibilities adapted from Educause. 

12


Curricular Committee Structure LCME Curricular Management Committee (Standard 8.1)

What is the #CincyMedEd Committee Structure? #CincyMedEd curricular committees guide and make decisions concerning the medical curriculum in alignment with LCME Standards and AAMC Entrustable Professional Activities (EPA’s).

EPC (Education Policy Committee)

A medical school has in place an institutional body that oversees the medical education program as a whole and has responsibility for the overall design, management, integration, evaluation, and enhancement of a coherent and coordinated medical curriculum.

AACT (Alignment & Assessment Curriculum Team)

MSTP (Medical Scientist Training Program)

PACs (Performance and Advancement Committee)

How It All Works

The Role of Medical Students

The continuous improvement of the curriculum depends upon the student representatives to solicit, organize, and deliver feedback from the student body to ensure that the students' learning needs and interests are accurately reflected in any changes in curricular design and implementation.

M1.M2 (Curriculum Committee)

M3.M4 (Curriculum Committee)

Our committee structure framework provides opportunities for continuous improvement, collaboration, innovation and scholarly activities to better prepare our graduates for the challenges 21st Century Clinicians face. Key strengths: •Entrusts faculty. •Creates a model that ensures alignment of the #CincyMedEd curriculum with LCME Standards and AAMC EPA’s. •Encourages collaboration across all medical education programs in CoM (BMS, UME, and GME). •Fosters Interprofessional collaborations. •Solicits student input.

CCCT (Clinical Core Competencies Team) RCC (Research Steering Committee)

#CincyMedEd Committees EPC reviews and approves all UC CoM curricula and new educational initiatives, monitors the learning environment and reviews the educational program performance in the context of the LCME accreditation requirements and AAMC EPA’s as well as makes recommendations for further innovation.

AACT analyzes assessment data to ensure alignment with LCME Standards and AAMC EPA’s as well as to make recommendations for the continuous improvement of the curriculum.

M1.M2 oversees the first two years of our curricular structure and makes recommendations for improvements and new initiatives.

CCCT members collaborate to ensure that the clinical and co-curricular component (career development, learning environment, wellness, and diversity) is coordinated and integrated across all four years.

M3.M4 oversees the third and fourth year of our curricular structure and makes recommenda- RCC provides oversight of all research tions for improvements and new initiatives related to medical education initiatives. and coordinates working groups.

PACs monitors the progress of students and makes recommendations for promotion, retention, and dismissal. MSTP provides feedback and partners with #CincyMedEd on the curricular structure for students enrolled in the MD/PhD program.


Curriculum Committee Meeting Schedule Meeting Clinical Core Competencies Team    Alignment & Assessment  Curriculum Team  Education Policy  Committee/Committee Chairs  M1/2 Curriculum Committee  M3/4 Curriculum  Committee/Coordinators  Research Steering Committee   

Acronym Frequency CCCT

Day

AACT

Monthly   Monthly 

EPC

Monthly

M1/2

Monthly

M3/4

Monthly

Second Thursday  Third Thursday 

TBA

TBA

RSC

Time

Duration hours /  month 

Chair

OME

Third Thursday 

1:00‐3:00

2

Kelly

Burg

Second Thursday  First Thursday 

3:30‐5:00

1.5

Baker

Smith

3‐4:30

1.5

Diller

Donnelly

12:00‐1:30

1.5

Baxter

Trippel

3:00‐5:00

2

Neel

Rosing

TBA

TBA

Thompson, A.  Drais 

Location Lucas Board  Room  MSB 3352  Lucas Board  Room  Lucas Board  Room  MSB 2001  TBA 


Performance & Advancement Committee (PAC)     

The PAC regularly monitors the progress of each student  and makes decisions on promotion, retention,   dismissal, leave of absence and compliance with CoM  standards. 


10/28/2016

PAC Update EPC This presentation has previously been given to the M1/M2 course directors, and the M3/M4 clerkship directors and their coordinators

Objectives of the meeting ● Discuss role of the PAC ● Discuss changes in Student Handbook ● Discuss professionalism/reporting ● Discuss communication amongst course/clerkship directors concerning students with ongoing problems

1


10/28/2016

PAC chairs Class of 2017 - DJ Lowrie Class of 2018 - Sarah Ronan-Bentle Class of 2019 - Rocky Ellis Class of 2020 - Mike Lieberman (also coordinator of PAC chairs; monthly meetings with Andy Filak, Aurora Bennett and PAC chairs) Ned Donnelly provides administrative support for all the PACs

Role of the PAC • Longitudinal, follow students for all four years; meet once a month • A student will be moved to a different PAC if they have a delay in graduation (leave of absence, repeating a year) • Monitor student academic progress, work with Student Affairs to address academic difficulties • Monitor student professionalism issues, looking for patterns (tardiness, excessive absences), and then meeting with students to correct them (in conjunction with Student Affairs) • Have the ability to recommend to the Dean dismissal of the student from the program • Acknowledge students who are doing well

2


10/28/2016

Handbook changes • The Student Handbook can be found on MedOneStop under “Quick Links” on the right hand side of the page • Changes for the upcoming academic year: •

Language has been clarified to indicate that the PAC may recommend a student for dismissal after just one failing grade during their medical student career

Language has been added to indicate that upon accumulation of three failures during a student’s career an AUTOMATIC recommendation of dismissal would be forthcoming

Language has been added to indicate that if a student elects to take a leave of absence for academic enrichment after the second year of medical school (a research position, for example) the student must sit for the Step 1 exam before embarking on the leave.

Language has been added to indicate that if a student accumulates 3 “C” grades during the third and fourth year then such grades may result in a recommendation of dismissal (currently it leads to a mandatory leave of absence)

Handbook changes (continued) • More Changes •

The Accommodations for Religous Beliefs was rewritten to reflect what is currently done under those conditions

The class rank system may be changing (to be voted on at EPC), so the old system is in place for existing students - the Class of 2020 will use the new system, if approved

The dress code has been updated to reflect the UCHealth dress code, with a statement to indicate that the students should adapt to an off site dress code if it is different than the UC Health dress code

Language has been added such that an incomplete grade can be used for year 1 and 2 classes

Language has been added to specify that if a student receives a “C” grade in a third year clerkship due to failing the shelf exam, failure of the retake of the shelf exam results in a failing grade for the clerkship

The section on policies and procedures for disabilities was updated to the current practice, as set forth by the University

3


10/28/2016

Reporting of professionalism issues • Reporting of professionalism issues is important for the PAC to be able to determine if a pattern of poor behaviour is evident, or is continuing • Lack of professionalism can be persistant tardniness, unexcused absences, asking to keep an absence confidential, disrepect towards other professional staff or patients, and a number of other items. Most likely to be seen in the first two years in LPCC and LC, but also in mandatory evaluations and small group settings. • Use a professionalism form (under Other Resources on MedOneStop) to detail the incident, and send it to Ned Donnelly • The PAC chair and Aurora Bennett will discuss the form and decide what action to take • Even if no action is taken, the filing of such forms helps us track student progress through the curriculum • The sooner a pattern is evident, the sooner a solution can be offered

More on Professionalism • Forms are not seen on student transcript • When a situation develops the PAC can issue a Professionalism warning, which specifies what a student must do to rectify his/her problem • Failure of the student to follow the guidelines set forth in the Professionalism warning can lead to a recommendation of dismissal by the PAC (but this is dependent on receiving another professionalism form detailing another student issue) • The PAC also has the ability to write a paragraph for the student’s MSPE detailing professionalism issues if they are not resolved

4


10/28/2016

Standards of Professionalism (Additional Education/Assistance) Student Name _____________________ Course ____________________ Evaluator(s)_________________________ Department(s)_________________ Date(s)___________________

This student has displayed the need for further education or assistance meeting expected standards of professionalism. Professional Characteristic

Respect for and relationships with patients and families

Needs further education or assistance with:

Please provide examples or explanation:

_____ establishing rapport with patients _____ being sensitive to the differing needs of patients and to patient differences (cultural, economic, developmental etc.) that may affect health care _____ not using medical jargon with patients/patient families _____ maintaining patient confidentiality

_____ thinking of ancillary personnel as members of the health care team Respect for health care team, faculty

_____ relating well to faculty _____ relating well to fellow students

members, and fellow students.

_____ establishing/maintaining boundaries _____ being a positive contributor to a healthy learning environment _____ inappropriate or excessive lobbying for higher grades

_____ assessing appropriate level of dress for clinical situations _____ assessing appropriate level of dress for non-clinical situations

Appearance

_____ fulfilling responsibilities in a dependable manner _____ learning how to complete assigned tasks in a timely manner _____ learning how to complete assigned tasks at a level expected of a college graduate _____ arriving at required functions on-time

Reliability

_____ attentiveness and engagement in required activities

Motivation &

_____ seeking out learning experiences on own

commitment

_____ completing assignments in an accurate and thorough manner

_____ accepting and incorporating constructive feedback Self improvement and adaptability

_____ giving constructive feedback to others _____ admitting personal errors

( Honor & integrity)

_____ adapting to change _____ comprehending the function of grades.

Level of confidence

_____ recognizing limitations and seeking assistance Report given to student:________________________(Date)

Discussed with student: ________________________(Date)

Report (check all that applies) sent to: _____ Associate Dean for Student Affairs (Dr. Bennett) for counseling

Date:________________________

_____ PAC Chair for review and possible action

Date:________________________

Revised 10/2/14

Standards of Professionalism (Exemplary/Outstanding)    Student Name _____________________ Course ____________________ Evaluator(s)_________________________ Department(s)_________________ Date(s)___________________ Professional Characteristic

This student has displayed exemplary/outstanding behavior in:

Please provide examples or explanation:

_____ establishing rapport with patients Respect for and relationships with patients and families

_____ being sensitive to the differing needs of patients and to patient differences (cultural, economic, developmental, etc.) that may affect health care _____ not using medical jargon with patients/patient families _____ maintaining patient confidentiality _____ thinking of ancillary personnel as members of the health care team _____ relating well to faculty

Respect for health care team, faculty members, and fellow students

_____ relating well to fellow students _____ establishing/maintaining boundaries _____ begin a positive contributor to a healthy learning environment _____ inappropriate or excessive lobbying for higher grades _____ assessing appropriate level of dress for clinical situations

Appearance

_____ assessing appropriate level of dress for non-clinical situations _____ fulfilling responsibilities in a dependable manner _____ learning how to complete assigned tasks in a timely manner

Reliability

_____ learning how to complete assigned tasks at a level expected of a college graduate _____ arriving at required functions on-time _____ attentiveness and engagement in required activities

Motivation & commitment

_____ seeking out learning experiences on own _____ completing assignments in an accurate and thorough manner _____ accepting and incorporating constructive feedback

Self improvement and adaptability

_____ giving constructive feedback to others

(Honor & Integrity)

_____ adapting to change

_____ admitting personal errors _____ comprehending the function of grades

Level of confidence

_____ recognizing limitations and seeking assistance. Report given to student: Report (check all that applies) sent to: _____ Associate Dean for Student Affairs for counseling _____ PAC Chair for review and possible action

(Date)

Discussed with student:

(Date)

Date: Date:

Professionalism(Exemplary).doc  Revised 10‐2‐14 

5


10/28/2016

Grades • First two years are pass/fail, but the final percentage score is utilized to determine class rank. M3 utilizes the letter scores, but the final percentage score is utilized to determine class rank. • Courses/clerkships should enforce the penalties for unprofessional behavior in terms of late or missed assignments, otherwise certain students will continue the behavior through the third and fourth years • Any questions concerning non-professional behavior can be directed to either me or Aurora

Grades (continued) • Only the third year grades count for class rank • In fourth year courses we’ve had examples of students not taking the course seriously •

Initial grades of F were reported

Subsequently changed to P since preceptor didn’t want to “hurt” the students progress through the fourth year (or even delay their residency)

Wanted grade to be “the lowest pass” - but the level of pass is irrelevant in the fourth year, since the grades do not count for class rank

Clerkship directors should stick to their guns if the student’s performance is not satisfactory

6


10/28/2016

Student issues - communication? • If the PAC is following a student with professionalism issues the Course/Clerkship Directors agreed that whey would want to know about it before the student entered their Course/Clerkship. • Best done by a short communication from the PAC chair to the clerkship director, indicating the nature of the problem. • Allows appropriate placement of students so they can receive adequate supervision

Questions and Discussion If you have any questions, or an item to discuss, call or email me at any time (or your appropriate PAC chair) X85645 (513-558-5645) lieberma@ucmail.uc.edu

7


FUNCTIONS AND STRUCTURE OF A MEDICAL SCHOOL Standards for Accreditation of Medical Education Programs Leading to the MD Degree

Published March 2016 For surveys in the 2017-18 academic year Standards and Elements Effective July 1, 2017


March 2016

LCME® Functions and Structure of a Medical School Standards for Accreditation of Medical Education Programs Leading to the MD Degree

© Copyright April 2016, Liaison Committee on Medical Education (LCME®). All material subject to this copyright may be photocopied for the noncommercial purpose of scientific or educational advancement, with citation. LCME® is a registered trademark of the Association of American Medical Colleges and the American Medical Association.

LCME® Functions and Structure of a Medical School

i


March 2016

Table of Contents Introduction .............................................................................................................................................. iii Standard 1: Mission, Planning, Organization, and Integrity ..................................................................... 1 Standard 2: Leadership and Administration .............................................................................................. 3 Standard 3: Academic and Learning Environments.................................................................................. 4 Standard 4: Faculty Preparation, Productivity, Participation, and Policies............................................... 5 Standard 5: Educational Resources and Infrastructure ............................................................................. 6 Standard 6: Competencies, Curricular Objectives, and Curricular Design ............................................... 8 Standard 7: Curricular Content ............................................................................................................... 10 Standard 8: Curricular Management, Evaluation, and Enhancement ..................................................... 12 Standard 9: Teaching, Supervision, Assessment, and Student and Patient Safety .................................. 14 Standard 10: Medical Student Selection, Assignment, and Progress ...................................................... 16 Standard 11: Medical Student Academic Support, Career Advising, and Educational Records ............ 18 Standard 12: Medical Student Health Services, Personal Counseling, and Financial Aid Services ....... 20 Glossary of Terms for LCME Accreditation Standards and Elements ................................................... 22 Mapping of the 2014-15 Standards and 2017-18 Standards and Elements sorted by the 2014-15 Standards ................................................................................................................................................. 27 Mapping of the 2014-15 Standards and 2017-18 Standards and Elements sorted by the 2017-18 Elements .................................................................................................................................................. 31

LCMEÂŽ Functions and Structure of a Medical School

ii


March 2016

Introduction Accreditation is a voluntary, peer-review process designed to attest to the educational quality of new and established educational programs. The Liaison Committee on Medical Education (LCME®) accredits complete and independent medical education programs leading to the MD degree in which medical students are geographically located in the United States or Canada for their education and which are operated by universities or medical schools chartered in the United States or Canada. Accreditation of Canadian medical education programs is undertaken in cooperation with the Committee on Accreditation of Canadian Medical Schools. By judging the compliance of medical education programs with nationally accepted standards of educational quality, the LCME serves the interests of the general public and of the medical students enrolled in those programs. To achieve and maintain accreditation, a medical education program leading to the MD degree in the U.S. must meet the standards and elements contained in this document. The accreditation process requires a medical education program to provide assurances that its graduates exhibit general professional competencies that are appropriate for entry to the next stage of their training and that serve as the foundation for lifelong learning and proficient medical care. While recognizing the existence and appropriateness of diverse institutional missions and educational objectives, the LCME subscribes to the proposition that local circumstances do not justify accreditation of a substandard program of medical education leading to the MD degree. The LCME regularly reviews the content of the standards and elements, and seeks feedback on their validity and clarity from its sponsor organizations and members of the medical education community. Changes to existing standards and elements that impose new or additional compliance requirements are reviewed by the LCME’s sponsoring organizations and are considered at a public hearing before being adopted. Once approved, new or revised standards are published in Functions and Structure of a Medical School (F&S) and in the relevant version of the Data Collection Instrument (DCI), which will indicate when the changes become effective. Such periodic review may result in the creation or elimination of a specific standard and/or element, or a substantial reorganization of F&S content. The F&S is organized according to 12 accreditation standards, each with an accompanying set of elements. Each of the 12 LCME accreditation standards includes a concise statement of the principles that represent the standard. The elements of each standard specify the components that collectively constitute the standard; they are statements that identify the variables that need to be examined in evaluating a medical education program’s compliance with the standard. The LCME will consider the totality of a program’s responses to each of the elements associated with a specific standard in their determination of the program’s compliance with that standard. New this year, the Glossary of Terms for LCME Accreditation Standards and Elements has been incorporated into the F&S for the reader’s convenience. The glossary provides the LCME’s definitions of terms used in the F&S. As you read through this document, please note the following:  

The 12 standards are organized to flow from the level of the institution to the level of the student. As a background reference, tables at the end of this document provide a mapping of the standards as formatted for academic year 2014-15 to the standards and elements format in place for academic year 2017-18.

LCME® Functions and Structure of a Medical School

iii


March 2016

Additional information about the accreditation process and the standards and elements can be obtained from the LCME offices listed below or from the LCME website (www.lcme.org). LCME速 Secretariat Association of American Medical Colleges 655 K Street, NW Suite 100 Washington, DC 20001-2399 Phone: 202-828-0596 LCME速 Secretariat American Medical Association 330 North Wabash Avenue Suite 39300 Chicago, IL 60611-5885 Phone: 312-464-4933

Visit the LCME速 website at: www.lcme.org

LCME速 Functions and Structure of a Medical School

iv


March 2016

Standard 1: Mission, Planning, Organization, and Integrity A medical school has a written statement of mission and goals for the medical education program, conducts ongoing planning, and has written bylaws that describe an effective organizational structure and governance processes. In the conduct of all internal and external activities, the medical school demonstrates integrity through its consistent and documented adherence to fair, impartial, and effective processes, policies, and practices. ________________________________________________________________________________ 1.1

Strategic Planning and Continuous Quality Improvement

A medical school engages in ongoing planning and continuous quality improvement processes that establish short and long-term programmatic goals, result in the achievement of measurable outcomes that are used to improve programmatic quality, and ensure effective monitoring of the medical education program’s compliance with accreditation standards. 1.2

Conflict of Interest Policies

A medical school has in place and follows effective policies and procedures applicable to board members, faculty members, and any other individuals who participate in decision-making affecting the medical education program to avoid the impact of conflicts of interest in the operation of the medical education program, its associated clinical facilities, and any related enterprises. 1.3

Mechanisms for Faculty Participation

A medical school ensures that there are effective mechanisms in place for direct faculty participation in decision-making related to the medical education program, including opportunities for faculty participation in discussions about, and the establishment of, policies and procedures for the program, as appropriate. 1.4

Affiliation Agreements

In the relationship between a medical school and its clinical affiliates, the educational program for all medical students remains under the control of the medical school’s faculty, as specified in written affiliation agreements that define the responsibilities of each party related to the medical education program. Written agreements are necessary with clinical affiliates that are used regularly for required clinical experiences; such agreements may also be warranted with other clinical facilities that have a significant role in the clinical education program. Such agreements provide for, at a minimum the following:     

The assurance of medical student and faculty access to appropriate resources for medical student education The primacy of the medical education program’s authority over academic affairs and the education/assessment of medical students The role of the medical school in the appointment and assignment of faculty members with responsibility for medical student teaching Specification of the responsibility for treatment and follow-up when a medical student is exposed to an infectious or environmental hazard or other occupational injury The shared responsibility of the clinical affiliate and the medical school for creating and maintaining an appropriate learning environment

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1.5

Bylaws

A medical school promulgates bylaws or similar policy documents that describe the responsibilities and privileges of its administrative officers, faculty, medical students, and committees. 1.6

Eligibility Requirements

A medical school ensures that its medical education program meets all eligibility requirements of the LCME for initial and continuing accreditation, including receipt of degree-granting authority and accreditation by a regional accrediting body by either the medical school or its parent institution.

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Standard 2: Leadership and Administration A medical school has a sufficient number of faculty in leadership roles and of senior administrative staff with the skills, time, and administrative support necessary to achieve the goals of the medical education program and to ensure the functional integration of all programmatic components. ________________________________________________________________________________ 2.1

Administrative Officer and Faculty Appointments

The senior administrative staff and faculty of a medical school are appointed by, or on the authority of, the governing board of the institution. 2.2

Dean’s Qualifications

The dean of a medical school is qualified by education, training, and experience to provide effective leadership in medical education, scholarly activity, patient care, and other missions of the medical school. 2.3

Access and Authority of the Dean

The dean of a medical school has sufficient access to the university president or other institutional official charged with final responsibility for the medical education program and to other institutional officials in order to fulfill his or her responsibilities; there is a clear definition of the dean’s authority and responsibility for the medical education program. 2.4

Sufficiency of Administrative Staff

A medical school has in place a sufficient number of associate or assistant deans, leaders of organizational units, and senior administrative staff who are able to commit the time necessary to accomplish the missions of the medical school. 2.5

Responsibility of and to the Dean

The dean of a medical school with one or more regional campuses is administratively responsible for the conduct and quality of the medical education program and for ensuring the adequacy of faculty at each campus. The principal academic officer at each campus is administratively responsible to the dean. 2.6

Functional Integration of the Faculty

At a medical school with one or more regional campuses, the faculty at the departmental and medical school levels at each campus are functionally integrated by appropriate administrative mechanisms (e.g., regular meetings and/or communication, periodic visits, participation in shared governance, and data sharing).

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Standard 3: Academic and Learning Environments A medical school ensures that its medical education program occurs in professional, respectful, and intellectually stimulating academic and clinical environments, recognizes the benefits of diversity, and promotes students’ attainment of competencies required of future physicians. ________________________________________________________________________________ 3.1

Resident Participation in Medical Student Education

Each medical student in a medical education program participates in one or more required clinical experiences conducted in a health care setting in which he or she works with resident physicians currently enrolled in an accredited program of graduate medical education. 3.2

Community of Scholars/Research Opportunities

A medical education program is conducted in an environment that fosters the intellectual challenge and spirit of inquiry appropriate to a community of scholars and provides sufficient opportunities, encouragement, and support for medical student participation in the research and other scholarly activities of its faculty. 3.3

Diversity/Pipeline Programs and Partnerships

A medical school has effective policies and practices in place, and engages in ongoing, systematic, and focused recruitment and retention activities, to achieve mission-appropriate diversity outcomes among its students, faculty, senior administrative staff, and other relevant members of its academic community. These activities include the use of programs and/or partnerships aimed at achieving diversity among qualified applicants for medical school admission and the evaluation of program and partnership outcomes. 3.4

Anti-Discrimination Policy

A medical school does not discriminate on the basis of age, creed, gender identity, national origin, race, sex, or sexual orientation. 3.5

Learning Environment/Professionalism

A medical school ensures that the learning environment of its medical education program is conducive to the ongoing development of explicit and appropriate professional behaviors in its medical students, faculty, and staff at all locations and is one in which all individuals are treated with respect. The medical school and its clinical affiliates share the responsibility for periodic evaluation of the learning environment in order to identify positive and negative influences on the maintenance of professional standards, develop and conduct appropriate strategies to enhance positive and mitigate negative influences, and identify and promptly correct violations of professional standards. 3.6

Student Mistreatment

A medical education program defines and publicizes its code of professional conduct for the relationships between medical students, including visiting medical students, and those individuals with whom students interact during the medical education program. A medical school develops effective written policies that address violations of the code, has effective mechanisms in place for a prompt response to any complaints, and supports educational activities aimed at preventing inappropriate behavior. Mechanisms for reporting violations of the code of professional conduct are understood by medical students, including visiting medical students, and ensure that any violations can be registered and investigated without fear of retaliation.

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Standard 4: Faculty Preparation, Productivity, Participation, and Policies The faculty members of a medical school are qualified through their education, training, experience, and continuing professional development and provide the leadership and support necessary to attain the institution's educational, research, and service goals. ________________________________________________________________________________ 4.1

Sufficiency of Faculty

A medical school has in place a sufficient cohort of faculty members with the qualifications and time required to deliver the medical curriculum and to meet the other needs and fulfill the other missions of the institution. 4.2

Scholarly Productivity

The faculty of a medical school demonstrate a commitment to continuing scholarly productivity that is characteristic of an institution of higher learning. 4.3

Faculty Appointment Policies

A medical school has clear policies and procedures in place for faculty appointment, renewal of appointment, promotion, granting of tenure, remediation, and dismissal that involve the faculty, the appropriate department heads, and the dean and provides each faculty member with written information about his or her term of appointment, responsibilities, lines of communication, privileges and benefits, performance evaluation and remediation, terms of dismissal, and, if relevant, the policy on practice earnings. 4.4

Feedback to Faculty

A medical school faculty member receives regularly scheduled and timely feedback from departmental and/or other programmatic or institutional leaders on his or her academic performance and progress toward promotion and, when applicable, tenure. 4.5

Faculty Professional Development

A medical school and/or its sponsoring institution provides opportunities for professional development to each faculty member in the areas of discipline content, curricular design, program evaluation, student assessment methods, instructional methodology, and or research to enhance his or her skills and leadership abilities in these areas. 4.6

Responsibility for Educational Program Policies

At a medical school, the dean and a committee of the faculty determine the governance and policymaking processes of the program.

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Standard 5: Educational Resources and Infrastructure A medical school has sufficient personnel, financial resources, physical facilities, equipment, and clinical, instructional, informational, technological, and other resources readily available and accessible across all locations to meet its needs and to achieve its goals. ________________________________________________________________________________ 5.1

Adequacy of Financial Resources

The present and anticipated financial resources of a medical school are derived from diverse sources and are adequate to sustain a sound program of medical education and to accomplish other programmatic and institutional goals. 5.2

Dean’s Authority/Resources

The dean of a medical school has sufficient resources and budgetary authority to fulfill his or her responsibility for the management and evaluation of the medical curriculum. 5.3

Pressures for Self-Financing

A medical school admits only as many qualified applicants as its total resources can accommodate and does not permit financial or other influences to compromise the school’s educational mission. 5.4

Sufficiency of Buildings and Equipment

A medical school has, or is assured the use of, buildings and equipment sufficient to achieve its educational, clinical, and research missions. 5.5

Resources for Clinical Instruction

A medical school has, or is assured the use of, appropriate resources for the clinical instruction of its medical students in ambulatory and inpatient settings and has adequate numbers and types of patients (e.g., acuity, case mix, age, gender). 5.6

Clinical Instructional Facilities/Information Resources

Each hospital or other clinical facility affiliated with a medical school that serves as a major location for required clinical learning experiences has sufficient information resources and instructional facilities for medical student education. 5.7

Security, Student Safety, and Disaster Preparedness

A medical school ensures that adequate security systems are in place at all locations and publishes policies and procedures to ensure student safety and to address emergency and disaster preparedness.

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5.8

Library Resources/Staff

A medical school provides ready access to well-maintained library resources sufficient in breadth of holdings and technology to support its educational and other missions. Library services are supervised by a professional staff that is familiar with regional and national information resources and data systems and is responsive to the needs of the medical students, faculty members, and others associated with the institution. 5.9

Information Technology Resources/Staff

A medical school provides access to well-maintained information technology resources sufficient in scope to support its educational and other missions. The information technology staff serving a medical education program has sufficient expertise to fulfill its responsibilities and is responsive to the needs of the medical students, faculty members, and others associated with the institution. 5.10

Resources Used By Transfer/Visiting Students

The resources used by a medical school to accommodate any visiting and transfer medical students in its medical education program do not significantly diminish the resources available to already enrolled medical students. 5.11

Study/Lounge/Storage Space/Call Rooms

A medical school ensures that its medical students have, at each campus and affiliated clinical site, adequate study space, lounge areas, personal lockers or other secure storage facilities, and secure call rooms if students are required to participate in late night or overnight clinical learning experiences. 5.12

Required Notifications to the LCME

A medical school notifies the LCME of any substantial change in the number of enrolled medical students; of any decrease in the resources available to the institution for its medical education program, including faculty, physical facilities, or finances; of its plans for any major modification of its medical curriculum; and/or of anticipated changes in the affiliation status of the program’s clinical facilities. The program also provides prior notification to the LCME if it plans to increase entering medical student enrollment on the main campus and/or in one or more existing regional campuses above the threshold of 10 percent, or 15 medical students in one year or 20 percent in three years; or to start a new or to expand an existing regional campus; or to initiate a new parallel curriculum (track).

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Standard 6: Competencies, Curricular Objectives, and Curricular Design The faculty of a medical school define the competencies to be achieved by its medical students through medical education program objectives and is responsible for the detailed design and implementation of the components of a medical curriculum that enable its medical students to achieve those competencies and objectives. Medical education program objectives are statements of the knowledge, skills, behaviors, and attitudes that medical students are expected to exhibit as evidence of their achievement by completion of the program. ________________________________________________________________________________ 6.1

Program and Learning Objectives

The faculty of a medical school define its medical education program objectives in outcome-based terms that allow the assessment of medical students’ progress in developing the competencies that the profession and the public expect of a physician. The medical school makes these medical education program objectives known to all medical students and faculty. In addition, the medical school ensures that the learning objectives for each required learning experience (e.g., course, clerkship) are made known to all medical students and those faculty, residents, and others with teaching and assessment responsibilities in those required experiences. 6.2

Required Clinical Experiences

The faculty of a medical school define the types of patients and clinical conditions that medical students are required to encounter, the skills to be performed by medical students, the appropriate clinical settings for these experiences, and the expected levels of medical student responsibility. 6.3

Self-Directed and Life-Long Learning

The faculty of a medical school ensure that the medical curriculum includes self-directed learning experiences and time for independent study to allow medical students to develop the skills of lifelong learning. Self-directed learning involves medical students’ self-assessment of learning needs; independent identification, analysis, and synthesis of relevant information; and appraisal of the credibility of information sources. 6.4

Inpatient/Outpatient Experiences

The faculty of a medical school ensure that the medical curriculum includes clinical experiences in both outpatient and inpatient settings. 6.5

Elective Opportunities

The faculty of a medical school ensure that the medical curriculum includes elective opportunities that supplement required learning experiences and that permit medical students to gain exposure to and deepen their understanding of medical specialties reflecting their career interests and to pursue their individual academic interests.

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6.6

Service-Learning

The faculty of a medical school ensure that the medical education program provides sufficient opportunities for, encourages, and supports medical student participation in service-learning and community service activities. 6.7

Academic Environments

The faculty of a medical school ensure that medical students have opportunities to learn in academic environments that permit interaction with students enrolled in other health professions, graduate and professional degree programs, and in clinical environments that provide opportunities for interaction with physicians in graduate medical education programs and in continuing medical education programs. 6.8

Education Program Duration

A medical education program includes at least 130 weeks of instruction.

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Standard 7: Curricular Content The faculty of a medical school ensure that the medical curriculum provides content of sufficient breadth and depth to prepare medical students for entry into any residency program and for the subsequent contemporary practice of medicine. ________________________________________________________________________________ 7.1

Biomedical, Behavioral, Social Sciences

The faculty of a medical school ensure that the medical curriculum includes content from the biomedical, behavioral, and socioeconomic sciences to support medical students' mastery of contemporary scientific knowledge and concepts and the methods fundamental to applying them to the health of individuals and populations. 7.2

Organ Systems/Life Cycle/Primary Care/Prevention/Wellness/Symptoms/Signs/ Differential Diagnosis, Treatment Planning, Impact of Behavioral and Social Factors

The faculty of a medical school ensure that the medical curriculum includes content and clinical experiences related to each organ system; each phase of the human life cycle; continuity of care; and preventive, acute, chronic, rehabilitative, end-of-life, and primary care in order to prepare students to:      7.3

Recognize wellness, determinants of health, and opportunities for health promotion and disease prevention Recognize and interpret symptoms and signs of disease Develop differential diagnoses and treatment plans Recognize the potential health-related impact on patients of behavioral and socioeconomic factors Assist patients in addressing health-related issues involving all organ systems Scientific Method/Clinical/Translational Research

The faculty of a medical school ensure that the medical curriculum includes instruction in the scientific method (including hands-on or simulated exercises in which medical students collect or use data to test and/or verify hypotheses or address questions about biomedical phenomena) and in the basic scientific and ethical principles of clinical and translational research (including the ways in which such research is conducted, evaluated, explained to patients, and applied to patient care). 7.4

Critical Judgment/Problem-Solving Skills

The faculty of a medical school ensure that the medical curriculum incorporates the fundamental principles of medicine, provides opportunities for medical students to acquire skills of critical judgment based on evidence and experience, and develops medical students' ability to use those principles and skills effectively in solving problems of health and disease. 7.5

Societal Problems

The faculty of a medical school ensure that the medical curriculum includes instruction in the diagnosis, prevention, appropriate reporting, and treatment of the medical consequences of common societal problems.

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7.6

Cultural Competence and Health Care Disparities

The faculty of a medical school ensure that the medical curriculum provides opportunities for medical students to learn to recognize and appropriately address gender and cultural biases in themselves, in others, and in the health care delivery process. The medical curriculum includes instruction regarding the following:     

7.7

The manner in which people of diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments The basic principles of culturally competent health care The recognition and development of solutions for health care disparities The importance of meeting the health care needs of medically underserved populations The development of core professional attributes (e.g., altruism, accountability) needed to provide effective care in a multidimensional and diverse society Medical Ethics

The faculty of a medical school ensure that the medical curriculum includes instruction for medical students in medical ethics and human values both prior to and during their participation in patient care activities and requires its medical students to behave ethically in caring for patients and in relating to patients' families and others involved in patient care. 7.8

Communication Skills

The faculty of a medical school ensure that the medical curriculum includes specific instruction in communication skills as they relate to communication with patients and their families, colleagues, and other health professionals. 7.9

Interprofessional Collaborative Skills

The faculty of a medical school ensure that the core curriculum of the medical education program prepares medical students to function collaboratively on health care teams that include health professionals from other disciplines as they provide coordinated services to patients. These curricular experiences include practitioners and/or students from the other health professions.

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Standard 8: Curricular Management, Evaluation, and Enhancement The faculty of a medical school engage in curricular revision and program evaluation activities to ensure that that medical education program quality is maintained and enhanced and that medical students achieve all medical education program objectives and participate in required clinical experiences and settings. ________________________________________________________________________________ 8.1

Curricular Management

A medical school has in place an institutional body (e.g., a faculty committee) that oversees the medical education program as a whole and has responsibility for the overall design, management, integration, evaluation, and enhancement of a coherent and coordinated medical curriculum. 8.2

Use of Medical Educational Program Objectives

The faculty of a medical school, through the faculty committee responsible for the medical curriculum, ensure that the medical curriculum uses formally adopted medical education program objectives to guide the selection of curriculum content, review and revise the curriculum, and establish the basis for evaluating programmatic effectiveness. The faculty leadership responsible for each required course and clerkship link the learning objectives of that course or clerkship to the medical education program objectives. 8.3

Curricular Design, Review, Revision/Content Monitoring

The faculty of a medical school are responsible for the detailed development, design, and implementation of all components of the medical education program, including the medical education program objectives, the learning objectives for each required curricular segment, instructional and assessment methods appropriate for the achievement of those objectives, content and content sequencing, ongoing review and updating of content, and evaluation of course, clerkship, and teacher quality. These medical education program objectives, learning objectives, content, and instructional and assessment methods are subject to ongoing monitoring, review, and revision by the faculty to ensure that the curriculum functions effectively as a whole to achieve medical education program objectives. 8.4

Program Evaluation

A medical school collects and uses a variety of outcome data, including national norms of accomplishment, to demonstrate the extent to which medical students are achieving medical education program objectives and to enhance medical education program quality. These data are collected during program enrollment and after program completion. 8.5

Medical Student Feedback

In evaluating medical education program quality, a medical school has formal processes in place to collect and consider medical student evaluations of their courses, clerkships, and teachers, and other relevant information. 8.6

Monitoring of Completion of Required Clinical Experiences

A medical school has in place a system with central oversight that monitors and ensures completion by all medical students of required clinical experiences in the medical education program and remedies any identified gaps.

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8.7

Comparability of Education/Assessment

A medical school ensures that the medical curriculum includes comparable educational experiences and equivalent methods of assessment across all locations within a given course and clerkship to ensure that all medical students achieve the same medical education program objectives. 8.8

Monitoring Student Time

The medical school faculty committee responsible for the medical curriculum and the program’s administration and leadership ensure the development and implementation of effective policies and procedures regarding the amount of time medical students spend in required activities, including the total number of hours medical students are required to spend in clinical and educational activities during clerkships.

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Standard 9: Teaching, Supervision, Assessment, and Student and Patient Safety A medical school ensures that its medical education program includes a comprehensive, fair, and uniform system of formative and summative medical student assessment and protects medical students’ and patients’ safety by ensuring that all persons who teach, supervise, and/or assess medical students are adequately prepared for those responsibilities. ________________________________________________________________________________ 9.1

Preparation of Resident and Non-Faculty Instructors

In a medical school, residents, graduate students, postdoctoral fellows, and other non-faculty instructors in the medical education program who supervise or teach medical students are familiar with the learning objectives of the course or clerkship and are prepared for their roles in teaching and assessment. The medical school provides resources to enhance residents’ and non-faculty instructors’ teaching and assessment skills, and provides central monitoring of their participation in those opportunities. 9.2

Faculty Appointments

A medical school ensures that supervision of medical student learning experiences is provided throughout required clerkships by members of the school’s faculty. 9.3

Clinical Supervision of Medical Students

A medical school ensures that medical students in clinical learning situations involving patient care are appropriately supervised at all times in order to ensure patient and student safety, that the level of responsibility delegated to the student is appropriate to his or her level of training, and that the activities supervised are within the scope of practice of the supervising health professional. 9.4

Assessment System

A medical school ensures that, throughout its medical education program, there is a centralized system in place that employs a variety of measures (including direct observation) for the assessment of student achievement, including students’ acquisition of the knowledge, core clinical skills (e.g., medical historytaking, physical examination), behaviors, and attitudes specified in medical education program objectives, and that ensures that all medical students achieve the same medical education program objectives. 9.5

Narrative Assessment

A medical school ensures that a narrative description of a medical student’s performance, including his or her non-cognitive achievement, is included as a component of the assessment in each required course and clerkship of the medical education program whenever teacher-student interaction permits this form of assessment. 9.6

Setting Standards of Achievement

A medical school ensures that faculty members with appropriate knowledge and expertise set standards of achievement in each required learning experience in the medical education program.

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9.7

Formative Assessment and Feedback

The medical school's curricular governance committee ensures that each medical student is assessed and provided with formal formative feedback early enough during each required course or clerkship to allow sufficient time for remediation. Formal feedback occurs at least at the midpoint of the course or clerkship. A course or clerkship less than four weeks in length provides alternate means by which a medical student can measure his or her progress in learning. 9.8

Fair and Timely Summative Assessment

A medical school has in place a system of fair and timely summative assessment of medical student achievement in each course and clerkship of the medical education program. Final grades are available within six weeks of the end of a course or clerkship. 9.9

Student Advancement and Appeal Process

A medical school ensures that the medical education program has a single standard for the advancement and graduation of medical students across all locations and a fair and formal process for taking any action that may affect the status of a medical student, including timely notice of the impending action, disclosure of the evidence on which the action would be based, an opportunity for the medical student to respond, and an opportunity to appeal any adverse decision related to advancement, graduation, or dismissal.

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Standard 10: Medical Student Selection, Assignment, and Progress A medical school establishes and publishes admission requirements for potential applicants to the medical education program, and uses effective policies and procedures for medical student selection, enrollment, and assignment. ________________________________________________________________________________ 10.1

Premedical Education/Required Coursework

Through its requirements for admission, a medical school encourages potential applicants to the medical education program to acquire a broad undergraduate education that includes the study of the humanities, natural sciences, and social sciences, and confines its specific premedical course requirements to those deemed essential preparation for successful completion of its medical curriculum. 10.2

Final Authority of Admission Committee

The final responsibility for accepting students to a medical school rests with a formally constituted admission committee. The authority and composition of the committee and the rules for its operation, including voting privileges and the definition of a quorum, are specified in bylaws or other medical school policies. Faculty members constitute the majority of voting members at all meetings. The selection of individual medical students for admission is not influenced by any political or financial factors. 10.3

Policies Regarding Student Selection/Progress and Their Dissemination

The faculty of a medical school establish criteria for student selection and develop and implement effective policies and procedures regarding, and make decisions about, medical student application, selection, admission, assessment, promotion, graduation, and any disciplinary action. The medical school makes available to all interested parties its criteria, standards, policies, and procedures regarding these matters. 10.4

Characteristics of Accepted Applicants

A medical school selects applicants for admission who possess the intelligence, integrity, and personal and emotional characteristics necessary for them to become competent physicians. 10.5

Technical Standards

A medical school develops and publishes technical standards for the admission, retention, and graduation of applicants or medical students with disabilities, in accordance with legal requirements. 10.6

Content of Informational Materials

A medical school’s catalog and other informational, advertising, and recruitment materials present a balanced and accurate representation of the mission and objectives of the medical education program, state the academic and other (e.g., immunization) requirements for the MD degree and all associated joint degree programs, provide the most recent academic calendar for each curricular option, and describe all required courses and clerkships offered by the medical education program.

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10.7

Transfer Students

A medical school ensures that any student accepted for transfer or admission with advanced standing demonstrates academic achievements, completion of relevant prior coursework, and other relevant characteristics comparable to those of the medical students in the class that he or she would join. A medical school accepts a transfer medical student into the final year of a medical education program only in rare and extraordinary personal or educational circumstances. 10.8

Visiting Students

A medical school does all of the following:        10.9

Verifies the credentials of each visiting medical student Ensures that each visiting medical students demonstrates qualifications comparable to those of the medical students he or she would join in educational experiences Maintains a complete roster of visiting medical students Approves each visiting medical student’s assignments Provides a performance assessment for each visiting medical student Establishes health-related protocols for such visiting medical students Identifies the administrative office that fulfills these responsibilities Student Assignment

A medical school assumes ultimate responsibility for the selection and assignment of medical students to each location and/or parallel curriculum (i.e., track) and identifies the administrative office that fulfills this responsibility. A process exists whereby a medical student with an appropriate rationale can request an alternative assignment when circumstances allow for it.

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Standard 11: Medical Student Academic Support, Career Advising, and Educational Records A medical school provides effective academic support and career advising to all medical students to assist them in achieving their career goals and the school’s medical education program objectives. All medical students have the same rights and receive comparable services. ________________________________________________________________________________ 11.1

Academic Advising

A medical school has an effective system of academic advising in place for medical students that integrates the efforts of faculty members, course and clerkship directors, and student affairs staff with its counseling and tutorial services and ensures that medical students can obtain academic counseling from individuals who have no role in making assessment or promotion decisions about them. 11.2

Career Advising

A medical school has an effective career advising system in place that integrates the efforts of faculty members, clerkship directors, and student affairs staff to assist medical students in choosing elective courses, evaluating career options, and applying to residency programs. 11.3

Oversight of Extramural Electives

If a medical student at a medical school is permitted to take an elective under the auspices of another medical school, institution, or organization, a centralized system exists in the dean’s office at the home school to review the proposed extramural elective prior to approval and to ensure the return of a performance assessment of the student and an evaluation of the elective by the student. Information about such issues as the following are available, as appropriate, to the student and the medical school in order to inform the student’s and the school’s review of the experience prior to its approval:       11.4

Potential risks to the health and safety of patients, students, and the community The availability of emergency care The possibility of natural disasters, political instability, and exposure to disease The need for additional preparation prior to, support during, and follow-up after the elective The level and quality of supervision Any potential challenges to the code of medical ethics adopted by the home school Provision of MSPE

A medical school provides a Medical Student Performance Evaluation required for the residency application of a medical student only on or after October 1 of the student's final year of the medical education program. 11.5

Confidentiality of Student Educational Records

At a medical school, medical student educational records are confidential and available only to those members of the faculty and administration with a need to know, unless released by the student or as otherwise governed by laws concerning confidentiality.

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11.6

Student Access to Educational Records

A medical school has policies and procedures in place that permit a medical student to review and to challenge his or her educational records, including the Medical Student Performance Evaluation, if he or she considers the information contained therein to be inaccurate, misleading, or inappropriate.

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Standard 12: Medical Student Health Services, Personal Counseling, and Financial Aid Services A medical school provides effective student services to all medical students to assist them in achieving the program’s goals for its students. All medical students have the same rights and receive comparable services. ________________________________________________________________________________ 12.1

Financial Aid/Debt Management Counseling/Student Educational Debt

A medical school provides its medical students with effective financial aid and debt management counseling and has mechanisms in place to minimize the impact of direct educational expenses (i.e., tuition, fees, books, supplies) on medical student indebtedness. 12.2

Tuition Refund Policy

A medical school has clear, reasonable, and fair policies for the refund of a medical student’s tuition, fees, and other allowable payments (e.g., payments made for health or disability insurance, parking, housing, and other similar services for which a student may no longer be eligible following withdrawal). 12.3

Personal Counseling/Well-Being Programs

A medical school has in place an effective system of personal counseling for its medical students that includes programs to promote their well-being and to facilitate their adjustment to the physical and emotional demands of medical education. 12.4

Student Access to Health Care Services

A medical school provides its medical students with timely access to needed diagnostic, preventive, and therapeutic health services at sites in reasonable proximity to the locations of their required educational experiences and has policies and procedures in place that permit students to be excused from these experiences to seek needed care. 12.5

Non-Involvement of Providers of Student Health Services in Student Assessment/ Location of Student Health Records

The health professionals who provide health services, including psychiatric/psychological counseling, to a medical student have no involvement in the academic assessment or promotion of the medical student receiving those services. A medical school ensures that medical student health records are maintained in accordance with legal requirements for security, privacy, confidentiality, and accessibility. 12.6

Student Health and Disability Insurance

A medical school ensures that health insurance and disability insurance are available to each medical student and that health insurance is also available to each medical student’s dependents. 12.7

Immunization Requirements and Monitoring

A medical school follows accepted guidelines in determining immunization requirements for its medical students and monitors students’ compliance with those requirements.

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12.8

Student Exposure Policies/Procedures

A medical school has policies in place that effectively address medical student exposure to infectious and environmental hazards, including the following:   

The education of medical students about methods of prevention The procedures for care and treatment after exposure, including a definition of financial responsibility The effects of infectious and environmental disease or disability on medical student learning activities

All registered medical students (including visiting students) are informed of these policies before undertaking any educational activities that would place them at risk.

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Glossary of Terms for LCME Accreditation Standards and Elements Adequate types and numbers of patients (e.g., acuity, case mix, age, gender): Medical student access, in both ambulatory and inpatient settings, to a sufficient mix of patients with a range of severity of illness and diagnoses, ages, and both genders to meet medical educational program objectives and the learning objectives of specific courses, modules, and clerkships. (Element 5.5) Admission requirements: A comprehensive listing of both objective and subjective criteria used for screening, selection, and admission of applicants to a medical education program. (Standard 10) Admission with advanced standing: The acceptance by a medical school and enrollment in the medical curriculum of an applicant (e.g., a doctoral student), typically as a second or third-year medical student, when that applicant had not previously been enrolled in a medical education program. (Element 10.7) Any related enterprises: Any additional medical school-sponsored activities or entities. (Element 1.2) Assessment: The systematic use of a variety of methods to collect, analyze, and use information to determine whether a medical student has acquired the competencies (e.g., knowledge, skills, behaviors, and attitudes) that the profession and the public expect of a physician. (Element 1.4) Benefits of diversity: In a medical education program, the facts that having medical students and faculty members from a variety of socioeconomic backgrounds, racial and ethnic groups, and other life experiences can 1) enhance the quality and content of interactions and discussions for all students throughout the preclinical and clinical curricula and 2) result in the preparation of a physician workforce that is more culturally aware and competent and better prepared to improve access to healthcare and address current and future health care disparities. (Standard 3) Central [or centralized] monitoring: Tracking by institutional (e.g., decanal) level offices and/or committees (e.g., the curriculum committee) of desired and expected learning outcomes by students and their completion of required learning experiences. (Element 8.6) Clinical affiliates: Those institutions providing ambulatory and/or inpatient medical care that have formal agreements with a medical school to provide clinical experiences for the education of its medical students. (Element 1.4) Clinical and translational research: The conduct of medical studies involving human subjects, the data from which are intended to facilitate the translation and application of the studies’ findings to medical practice in order to enhance the prevention, diagnosis, and treatment of medical conditions. (Element 7.3) Comparable educational experiences: Learning experiences that are sufficiently similar so as to ensure that medical students are achieving the same learning objectives at all educational sites at which those experiences occur. (Element 8.7) Competency: Statements of defined skills or behavioral outcomes (i.e., that a physician should be able to do) in areas including, but not limited to, patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism and ethics, and systems-based practice for which a medical student is required to demonstrate mastery prior to completion of his or her medical education program and receipt of the MD degree. (Element 8.7) Core curriculum: The required components of a medical curriculum, including all required courses/modules and clinical clerkships/rotations. (Element 7.9)

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Clinical reasoning: The integration, organization, and interpretation of information gathered as a part of medical problem-solving. (Elements 7.4 and 9.4) Coherent and coordinated curriculum: The design of a complete medical education program, including its content and modes of presentation, to achieve its overall educational objectives. Coherence and coordination include the following characteristics: 1) the logical sequencing of curricular segments, 2) coordinated and integrated content within and across academic periods of study (i.e., horizontal and vertical integration), and 3) methods of instruction and student assessment appropriate to the achievement of the program's educational objectives. (Element 8.1) Critical judgment/critical thinking: The consideration, evaluation, and organization of evidence derived from appropriate sources and related rationales during the process of decision-making. The demonstration of critical thinking requires the following steps: 1) the collection of relevant evidence, 2) the evaluation of that evidence, 3) the organization of that evidence, 4) the presentation of appropriate evidence to support any conclusions, and 5) the coherent, logical, and organized presentation of any response. (Elements 7.4 and 9.4) Curriculum management: Involves the following activities: leading, directing, coordinating, controlling, planning, evaluating, and reporting. An effective system of curriculum management exhibits the following characteristics: 1) evaluation of program effectiveness by outcomes analysis, using national norms of accomplishment as a frame of reference, 2) monitoring of content and workload in each discipline, including the identification of omissions and unplanned redundancies, and 3) review of the stated objectives of each individual curricular component and of methods of instruction and student assessment to ensure their linkage to and congruence with programmatic educational objectives. (Element 8.1) Direct educational expenses: The following educational expenses of an enrolled medical student: tuition, mandatory fees, books and supplies, and a computer, if one is required by the medical school. (Element 12.1) Direct faculty participation in decision-making: Faculty involvement in institutional governance wherein faculty input to decisions is made by the faculty members themselves or by representatives chosen by faculty members (e.g., versus appointed by administrators). (Element 1.3) Diverse sources [of financial revenues]: Multiple sources of predictable revenues that include, but are not unduly dependent upon any one of, the following: tuition, gifts, clinical revenue, governmental support, research grants, endowment, etc. (Element 5.1) Effective: Supported by evidence that the policy, practice, and/or process has produced the intended or expected result(s). (Standard 1) Eligibility requirements‌for initial and continuing accreditation: Receipt and maintenance of authority to grant the MD degree from the appropriate governmental agency and initial and continuing accreditation by one of the six regional accrediting bodies. (Element 1.6) Equivalent methods of assessment: The use of methods of medical student assessment that are as close to identical as possible across all educational sites at which core curricular activities take place. (Element 8.7) Evaluation: The systematic use of a variety of methods to collect, analyze, and use information to determine whether a program is fulfilling its mission(s) and achieving its goal(s). (Element 3.3) Fair and formal process for taking any action that may affect the status of a medical student: The use of policies and procedures by any institutional body (e.g., student promotions committee) with responsibility for making decisions about the academic progress, continued enrollment, and/or graduation of a medical student that ensure: 1) that the student will be assessed by individuals who have not previously formed an

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opinion of the student’s abilities, professionalism, and/or suitability to become a physician and 2) that the student has received timely notice of the proceedings, information about the purpose of the proceedings, and any evidence to be presented at the proceedings; his or her right to participate in and provide information or otherwise respond to participants in the proceedings; and any opportunity to appeal any adverse decision resulting from the proceedings. (Element 9.9) Fair and timely summative assessment: A criterion-based determination, made as soon as possible after the conclusion of a curricular component (e.g., course/module, clinical clerkship/rotation) by individuals familiar with a medical student’s performance, regarding the extent to which he or she has achieved the learning objective(s) for that component such that the student can use the information provided to improve future performance in the medical curriculum. (Element 9.8) Final responsibility for accepting students rests with a formally constituted admission committee: Ensuring that the sole basis for selecting applicants for admission to the medical education program are the decisions made by the faculty committee charged with medical student selection in accordance with appropriately approved selection criteria. (Element 10.2) Formative feedback: Information communicated to a medical student in a timely manner that is intended to modify the student’s thinking or behavior in order to improve his or her subsequent learning and performance in the medical curriculum. (Element 9.7) Functionally integrated: Coordination of the various components of the medical school and medical education program by means of policies, procedures, and practices that define and inform the relationships among them. (Element 2.6) Health care disparities: Differences between groups of people, based on a variety of factors including, but not limited to, race, ethnicity, residential location, sex, age, and socioeconomic, educational, and disability status, that affect their access to health care, the quality of the health care they receive, and the outcomes of their medical conditions. (Element 7.6) Independent study: Opportunities either for medical student-directed learning in one or more components of the core medical curriculum, based on structured learning objectives to be achieved by students with minimal faculty supervision, or for student-directed learning on elective topics of specific interest to the student. (Element 6.3) Integrated institutional responsibility: Oversight by an appropriate central institutional body (commonly a curriculum committee) of the medical education program as a whole. An effective central curriculum authority exhibits the following characteristics: 1) participation by faculty, students, and administrators, 2) the availability of expertise in curricular design and methods of instruction, student assessment, and program evaluation, and 3) empowerment, through bylaws or decanal mandate, to work in the best interests of the medical education program without regard for parochial or political influences or departmental pressures. (Element 8.1) Learning objectives: A statement of the specific, observable, and measurable expected outcomes (i.e., what the medical students will be able to do) of each specific component (e.g., course, module, clinical clerkship, rotation) of a medical education program that defines the content of the component and the assessment methodology and that is linked back to one or more of the medical education program objectives. (Element 6.1) Major location for required clinical learning experiences: A clinical affiliate of the medical school that is the site of one or more required clinical experiences for its medical students. (Element 5.6)

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Medical education program objectives: Broad statements, in measurable terms, of the knowledge, skills, behaviors, and attitudes (typically linked to a statement of expected competencies) that a medical student is expected to exhibit as evidence of his or her achievement of all programmatic requirements by the time of medical education program completion. (Standard 6 and Element 6.1) Medical education track: A parallel program of study for a subset of the medical student body that requires participating students to complete specific programmatic learning objectives (e.g., in research, primary care, leadership) in addition to the medical educational program objectives required of all medical students. (Element 5.12) Medical problem-solving: The initial generation of hypotheses that influence the subsequent gathering of information. (Elements 7.4 and 9.4) Mission-appropriate diversity: The inclusion, in a medical education program’s student body and among its faculty and staff and based on the program’s mission, goals, and policies, of persons from different racial, ethnic, economic, and/or social backgrounds and with differing life experiences to enhance the educational environment for all medical students. (Element 3.3) Narrative assessment: Written comments from faculty that assess student performance and achievement in meeting the objectives of a course or clerkship. (Element 9.5) National norms of accomplishment: Those data sources that would permit comparison of relevant medical school-specific medical student performance data to national data for all medical schools and medical students (e.g., USMLE scores, AAMC GQ data, specialty certification rates). (Element 8.4) Need to know: The requirement that information in a medical student’s educational record be provided only to those members of the medical school’s faculty or administration who have a legitimate reason to access that information in order to fulfill the responsibilities of their faculty or administrative position. (Element 11.5) Outcome-based terms: Descriptions of observable and measurable desired and expected outcomes of learning experiences in a medical curriculum (e.g., knowledge, skills, attitudes, and behavior). (Element 6.1) Primacy of the medical education program’s authority over academic affairs and the education/assessment of medical students: The affirmation and acknowledgement that all decisions regarding the creation and implementation of educational policy and the teaching and assessment of medical students are, first and foremost, the prerogative of the medical education program. (Element 1.4) Principal academic officer at each campus is administratively responsible to the dean: The administrator identified by the dean or the dean’s designee (e.g., associate or assistant dean, site director) as having primary responsibility for implementation and evaluation of the components of the medical education program that occur at that campus. (Element 2.5) Program objectives: See definition for Medical education program objectives above. Publishes: Communicates in hard-copy and/or on-line in a manner that is easily available to and accessible by the public. (Standard 10) Regional accrediting body: The six bodies recognized by the US Department of Education that accredit institutions of higher education located in their regions of the US: 1) Higher Education Commission, 2) Middle States Commission on Higher Education, 3) New England Association of Schools and Colleges Commission on Institutions of Higher Education, 4) Northwest Commission on Colleges and Universities, 5)

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Southern Association of Colleges and Schools Commission on Colleges, and 6) Western Association of Schools and Colleges Senior Colleges and University Commission. (Element 1.6) Regional campus: A medical school with a regional campus is a school that has two or more campuses, with each campus offering one or more complete years of the medical education program. (Element 2.5) Regularly scheduled and timely feedback: Information communicated periodically and sufficiently often (based on institutional policy, procedure, or practice) to a faculty member to ensure that the faculty member is aware of the extent to which he or she is (or is not) meeting institutional expectations regarding future promotion and/or tenure. (Element 4.4) Self-directed learning: Includes medical students’ self-assessment of their learning needs; their independent identification, analysis, and synthesis of relevant information; and their appraisal of the credibility of information sources. (Element 6.3) Senior administrative staff: People in academic leadership roles, to include but not limited to, associate/assistant deans, directors, academic department chairs, and people who oversee the operation of affiliated clinical facilities and other educational sites. Many, if not most, of these people also have faculty appointments, and for tracking purposes should only be counted in one category when completing tables such as those listed in the DCI under Element 3.3. (Standard 2 and Elements 2.1, 2.4, and 3.3) Service-learning: Educational experiences that involve: 1) medical students’ service to the community in activities that respond to community-identified concerns, 2) student preparation, and 3) student reflection on the relationships among their participation in the activity, their medical school curriculum, and their roles as citizens and medical professionals. (Element 6.6) Single standard for the promotion and graduation of medical students across all locations: The academic and non-academic criteria and levels of performance defined by a medical education program and published in programmatic policies that must be met by all medical students on all medical school campuses at the conclusion of each academic year for promotion to the next academic year and at the conclusion of the medical education program for receipt of the MD degree and graduation. (Element 9.9) Standards of achievement: Criteria by which to measure a medical student’s attainment of relevant learning objectives and that contribute to a summative grade. (Element 9.6) Technical standards for admission, retention, and graduation of medical students with disabilities: A statement by a medical school of the: 1) essential academic and non-academic abilities, attributes, and characteristics in the areas of intellectual-conceptual, integrative, and quantitative abilities; 2) observational skills; 3) physical abilities; 4) motor functioning; 5) emotional stability; 6) behavioral and social skills; and 7) ethics and professionalism that a medical school applicant or enrolled medical student must possess or be able to acquire, with or without reasonable accommodation, in order to be admitted to, be retained in, and graduate from that school’s medical educational program. (Element 10.5) Transfer: The permanent withdrawal by a medical student from one medical school followed by his or her enrollment (typically in the second or third year of the medical curriculum) in another medical school. (Element 5.10) Visiting students: Students enrolled at one medical school who participate in clinical (typically elective) learning experiences for a grade sponsored by another medical school without transferring their enrollment from one school to the other. (Element 5.10)

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Mapping of the 2014-15 Standards and 2017-18 Standards and Elements Sorted by the 2014-15 Standards 2014-15 STANDARD IS-1 IS-2 IS-3 IS-4 IS-5 IS-6 IS-7 IS-8 IS-9 IS-10 IS-11 IS-12 IS-13 IS-14 IS-14-A IS-16

2017-18 ELEMENT 1.1 deleted 1.6 1.5 1.2 deleted 2.1 2.3 2.3 2.2 2.4 6.7 3.2 3.2 6.6 3.3 and 7.6

2014-15 STANDARD ED-1 ED-1-A ED-2 ED-3 ED-4 ED-5 ED-5-A ED-6 ED-7 ED-8 ED-9 ED-10 ED-11 ED-12 ED-13 ED-14 ED-15 ED-16

2017-18 ELEMENT 8.2 6.1 6.2 and 8.6 6.1 6.8 reflected in Standard 7 6.3 7.4 deleted 8.7 5.12 7.1 and 7.2 7.1 7.3 7.2 7.2 7.2 6.4

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2014-15 STANDARD ED-17 ED-17-A ED-18 ED-19 ED-19-A ED-20 ED-21 ED-22 ED-23 ED-24 ED-25 ED-25-A ED-26 ED-27 ED-28 ED-29 ED-30 ED-31 ED-32 ED-33 ED-34 ED-35 ED-36 ED-37 ED-38 ED-39 ED-40 ED-41 ED-42 ED-43 ED-44 ED-46 ED-47

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2017-18 ELEMENT requested in data collection instrument 7.3 6.5 7.8 7.9 7.5 7.6 7.6 7.7 9.1 9.2 9.3 9.4 9.4 9.4 9.6 4.5 and 9.8 9.7 9.5 8.1 8.3 and Standard 6 8.3 5.2 8.3 8.8 2.5 2.5 2.6 9.9 10.9 reflected in Standards 11 and 12 8.4 8.5

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2014-15 STANDARD MS-1 MS-2 MS-3 MS-4 MS-5 MS-6 MS-7 MS-8 MS-9 MS-10 MS-11 MS-12 MS-13 MS-14 MS-15 MS-16 MS-17 MS-18 MS-19 MS-20 MS-21 MS-22 MS-23 MS-24 MS-25 MS-26 MS-27 MS-27-A MS-28 MS-29 MS-30 MS-31 MS-31-A MS-32 MS-33 MS-34 MS-35 MS-36 MS-37

LCME® Functions and Structure of a Medical School

2017-18 ELEMENT 10.1 10.1 10.3 10.2 10.4 10.4 10.2 3.3 10.5 10.6 10.3 5.10 10.7 10.7 10.7 10.8 10.8 11.1 11.2 11.3 deleted 11.4 12.1 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 3.4 3.5 3.6 10.3 9.9 11.5 11.6 5.11

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2014-15 STANDARD FA-2 FA-3 FA-4 FA-5 FA-6 FA-7 FA-8 FA-9 FA-10 FA-11 FA-12 FA-13 FA-14

2017-18 ELEMENT 4.1 deleted 4.5 4.2 10.3 and 11.2 4.3 1.2 4.3 4.4 4.5 4.6 1.3 1.3

2014-15 STANDARD ER-1 ER-2 ER-3 ER-4 ER-5 ER-6 ER-7 ER-8 ER-9 ER-10 ER-11 ER-12 ER-13 ER-14

2017-18 ELEMENT 5.12 5.1 5.3 5.4 5.7 5.5 5.6 and 5.11 3.1 1.4 and 5.12 1.4 5.8 5.8 5.9 5.9

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Mapping of the 2014-15 Standards and 2017-18 Standards and Elements Sorted by the 2017-18 Elements 2017-18 ELEMENT

2014-15 STANDARD

1.1 1.2 1.3 1.4 1.5 1.6

IS-1 IS-5 and FA-8 FA-13 and FA-14 ER-9 and ER-10 IS-4 IS-3

2017-18 ELEMENT 2.1 2.2 2.3 2.4 2.5 2.6

2014-15 STANDARD IS-7 IS-10 IS-8 and IS-9 IS-11 ED-39 and ED-40 ED-41

2017-18 ELEMENT 3.1 3.2 3.3 3.4 3.5 3.6

2014-15 STANDARD ER-8 IS-13 and IS-14 IS-16 and MS-8 MS-31 MS-31-A MS-32

2017-18 ELEMENT 4.1 4.2 4.3 4.4 4.5 4.6

2014-15 STANDARD FA-2 FA-5 FA-7 and FA-9 FA-10 ED-30, FA-4, FA-11 FA-12

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2017-18 ELEMENT 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12

2014-15 STANDARD ER-2 ED-36 ER-3 ER-4 ER-6 ER-7 ER-5 ER-11 and ER-12 ER-13 and ER-14 MS-12 MS-37 and ER-7 ED-9, ER-1, ER-9

2017-18 ELEMENT 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8

2014-15 STANDARD ED-1-A and ED-3 ED-2 ED-5-A ED-16 ED-18 IS-14-A IS-12 ED-4

2017-18 ELEMENT 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9

2014-15 STANDARD ED-10 and ED-11 ED-10, ED-13, ED-14, ED-15 ED-12 and ED-17-A ED-6 ED-20 IS-16, ED-21, ED-22 ED-23 ED-19 ED-19-A

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2017-18 ELEMENT 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8

2014-15 STANDARD ED-33 ED-1 ED-34, ED-35, ED-37 ED-46 ED-47 ED-2 ED-8 ED-38

2017-18 ELEMENT 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9

2014-15 STANDARD ED-24 ED-25 ED-25-A ED-26, ED-27, ED-28 ED-32 ED-29 ED-31 ED-30 ED-42 and MS-34

2017-18 ELEMENT 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9

2014-15 STANDARD MS-1 and MS-2 MS-4 and MS-7 MS-3, MS-11, MS-33, FA-6 MS-5, MS-6 MS-9 MS-10 MS-13, MS-14, MS-15 MS-16, MS-17 ED-43

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2017-18 ELEMENT 11.1 11.2 11.3 11.4 11.5 11.6

2014-15 STANDARD MS-18 MS-19 and FA-6 MS-20 MS-22 MS-35 MS-36

2017-18 ELEMENT 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8

2014-15 STANDARD MS-23 and MS-24 MS-25 MS-26 MS-27 MS-27-A MS-28 MS-29 MS-30

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DATA COLLECTION INSTRUMENT FOR FULL ACCREDITATION SURVEYS

Published April 2016 For Medical Education Programs with Full Accreditation Surveys in the 2017-18 academic year


April 2016

LCME® Data Collection Instrument, for Full Accreditation Surveys in AY 2017-18

© Copyright April 2016, American Medical Association and Association of American Medical Colleges. All material subject to this copyright may be photocopied for the noncommercial purpose of scientific or educational advancement, with citation. LCME® is a registered trademark of the Association of American Medical Colleges and the American Medical Association.

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For further information, contact: LCME速 Secretariat Association of American Medical Colleges 655 K Street, NW Suite 100 Washington, DC 20001 Phone: 202-828-0596 LCME速 Secretariat American Medical Association 330 North Wabash Avenue Suite 39300 Chicago, IL 60611 Phone: 312-464-4933

Visit the LCME速 website at: www.lcme.org

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TABLE OF CONTENTS STANDARD 1: MISSION, PLANNING, ORGANIZATION, AND INTEGRITY .................................................................... 1 1.1 STRATEGIC PLANNING AND CONTINUOUS QUALITY IMPROVEMENT ................................................................. 2  1.2 CONFLICT OF INTEREST POLICIES .................................................................................................................................. 3  1.3 MECHANISMS FOR FACULTY PARTICIPATION ............................................................................................................ 4  1.4 AFFILIATION AGREEMENTS ............................................................................................................................................. 5  1.5 BYLAWS................................................................................................................................................................................. 6  1.6 ELIGIBILITY REQUIREMENTS .......................................................................................................................................... 7  STANDARD 2: LEADERSHIP AND ADMINISTRATION ........................................................................................................ 8  2.1 ADMINISTRATIVE OFFICER AND FACULTY APPOINTMENTS .................................................................................. 9  2.2 DEAN’S QUALIFICATIONS ............................................................................................................................................... 10  2.3 ACCESS AND AUTHORITY OF THE DEAN .................................................................................................................... 11  2.4 SUFFICIENCY OF ADMINISTRATIVE STAFF ................................................................................................................ 12  2.5 RESPONSIBILITY OF AND TO THE DEAN ..................................................................................................................... 14  2.6 FUNCTIONAL INTEGRATION OF THE FACULTY ........................................................................................................ 15  STANDARD 3: ACADEMIC AND LEARNING ENVIRONMENTS ...................................................................................... 16  3.1 RESIDENT PARTICIPATION IN MEDICAL STUDENT EDUCATION .......................................................................... 17  3.2 COMMUNITY OF SCHOLARS/RESEARCH OPPORTUNITIES ..................................................................................... 18  3.3 DIVERSITY/PIPELINE PROGRAMS AND PARTNERSHIPS .......................................................................................... 19  3.4 ANTI-DISCRIMINATION POLICY .................................................................................................................................... 21  3.5 LEARNING ENVIRONMENT/PROFESSIONALISM ........................................................................................................ 22  3.6 STUDENT MISTREATMENT ............................................................................................................................................. 23  STANDARD 4: FACULTY PREPARATION, PRODUCTIVITY, PARTICIPATION, AND POLICIES ........................... 27  4.1 SUFFICIENCY OF FACULTY ............................................................................................................................................ 28  4.2 SCHOLARLY PRODUCTIVITY ......................................................................................................................................... 30  4.3 FACULTY APPOINTMENT POLICIES .............................................................................................................................. 31  4.4 FEEDBACK TO FACULTY ................................................................................................................................................. 32  4.5 FACULTY PROFESSIONAL DEVELOPMENT................................................................................................................. 33  4.6 RESPONSIBILITY FOR EDUCATIONAL PROGRAM POLICIES .................................................................................. 34  STANDARD 5: EDUCATIONAL RESOURCES AND INFRASTRUCTURE ........................................................................ 35  5.1 ADEQUACY OF FINANCIAL RESOURCES ..................................................................................................................... 37  5.2 DEAN’S AUTHORITY/RESOURCES................................................................................................................................. 39  5.3 PRESSURES FOR SELF-FINANCING ............................................................................................................................... 40  5.4 SUFFICIENCY OF BUILDINGS AND EQUIPMENT ........................................................................................................ 41  5.5 RESOURCES FOR CLINICAL INSTRUCTION ................................................................................................................. 43  5.6 CLINICAL INSTRUCTIONAL FACILITIES/INFORMATION RESOURCES ................................................................. 45  5.7 SECURITY, STUDENT SAFETY, AND DISASTER PREPAREDNESS .......................................................................... 46  5.8 LIBRARY RESOURCES/STAFF ......................................................................................................................................... 47  5.9 INFORMATION TECHNOLOGY RESOURCES/STAFF................................................................................................... 49  5.10 RESOURCES USED BY TRANSFER/VISITING STUDENTS ........................................................................................ 51  5.11 STUDY/LOUNGE/STORAGE SPACE/CALL ROOMS ................................................................................................... 52  5.12 REQUIRED NOTIFICATIONS TO THE LCME ............................................................................................................... 54  STANDARD 6: COMPETENCIES, CURRICULAR OBJECTIVES, AND CURRICULAR DESIGN ................................ 55  6.1 PROGRAM AND LEARNING OBJECTIVES .................................................................................................................... 57  6.2 REQUIRED CLINICAL EXPERIENCES ............................................................................................................................ 58  6.3 SELF-DIRECTED AND LIFE-LONG LEARNING............................................................................................................. 59  6.4 INPATIENT/OUTPATIENT EXPERIENCES ..................................................................................................................... 61  6.5 ELECTIVE OPPORTUNITIES ............................................................................................................................................. 62  6.6 SERVICE-LEARNING ......................................................................................................................................................... 63  6.7 ACADEMIC ENVIRONMENTS .......................................................................................................................................... 64  6.8 EDUCATION PROGRAM DURATION .............................................................................................................................. 66 

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STANDARD 7: CURRICULAR CONTENT............................................................................................................................... 67 7.1 BIOMEDICAL, BEHAVIORAL, SOCIAL SCIENCES....................................................................................................... 68  7.2 ORGAN SYSTEMS/LIFE CYCLE/PRIMARY CARE/PREVENTION/WELLNESS/ SYMPTOMS/SIGNS/DIFFERENTIAL DIAGNOSIS, TREATMENT PLANNING, IMPACT OF BEHAVIORAL AND SOCIAL FACTORS .................................................................................................................................................................... 70  7.3 SCIENTIFIC METHOD/CLINICAL/ TRANSLATIONAL RESEARCH............................................................................ 71  7.4 CRITICAL JUDGMENT/PROBLEM-SOLVING SKILLS .................................................................................................. 72  7.5 SOCIETAL PROBLEMS ...................................................................................................................................................... 73  7.6 CULTURAL COMPETENCE AND HEALTH CARE DISPARITIES ................................................................................ 74  7.7 MEDICAL ETHICS .............................................................................................................................................................. 76  7.8 COMMUNICATION SKILLS .............................................................................................................................................. 77  7.9 INTERPROFESSIONAL COLLABORATIVE SKILLS ...................................................................................................... 78  STANDARD 8: CURRICULAR MANAGEMENT, EVALUATION, AND ENHANCEMENT ............................................ 79  8.1 CURRICULAR MANAGEMENT ........................................................................................................................................ 80  8.2 USE OF MEDICAL EDUCATIONAL PROGRAM OBJECTIVES .................................................................................... 81  8.3 CURRICULAR DESIGN, REVIEW, REVISION/CONTENT MONITORING .................................................................. 82  8.4 PROGRAM EVALUATION ................................................................................................................................................. 84  8.5 MEDICAL STUDENT FEEDBACK .................................................................................................................................... 86  8.6 MONITORING OF COMPLETION OF REQUIRED CLINICAL EXPERIENCES ........................................................... 87  8.7 COMPARABILITY OF EDUCATION/ASSESSMENT ...................................................................................................... 88  8.8 MONITORING STUDENT TIME ........................................................................................................................................ 89  STANDARD 9: TEACHING, SUPERVISION, ASSESSMENT, AND STUDENT AND PATIENT SAFETY .................... 90  9.1 PREPARATION OF RESIDENT AND NON-FACULTY INSTRUCTORS ....................................................................... 92  9.2 FACULTY APPOINTMENTS .............................................................................................................................................. 94  9.3 CLINICAL SUPERVISION OF MEDICAL STUDENTS.................................................................................................... 95  9.4 ASSESSMENT SYSTEM ..................................................................................................................................................... 96  9.5 NARRATIVE ASSESSMENT .............................................................................................................................................. 98  9.6 SETTING STANDARDS OF ACHIEVEMENT .................................................................................................................. 99  9.7 FORMATIVE ASSESSMENT AND FEEDBACK ............................................................................................................ 100  9.8 FAIR AND TIMELY SUMMATIVE ASSESSMENT ....................................................................................................... 102  9.9 STUDENT ADVANCEMENT AND APPEAL PROCESS ................................................................................................ 103  STANDARD 10: MEDICAL STUDENT SELECTION, ASSIGNMENT, AND PROGRESS .............................................. 104  10.1 PREMEDICAL EDUCATION/REQUIRED COURSEWORK ........................................................................................ 106  10.2 FINAL AUTHORITY OF ADMISSION COMMITTEE .................................................................................................. 107  10.3 POLICIES REGARDING STUDENT SELECTION/PROGRESS AND THEIR DISSEMINATION ............................ 108  10.4 CHARACTERISTICS OF ACCEPTED APPLICANTS................................................................................................... 109  10.5 TECHNICAL STANDARDS ............................................................................................................................................ 110  10.6 CONTENT OF INFORMATIONAL MATERIALS ......................................................................................................... 111  10.7 TRANSFER STUDENTS .................................................................................................................................................. 112  10.8 VISITING STUDENTS ..................................................................................................................................................... 114  10.9 STUDENT ASSIGNMENT ............................................................................................................................................... 115  STANDARD 11: MEDICAL STUDENT ACADEMIC SUPPORT, CAREER ADVISING, AND EDUCATIONAL RECORDS .................................................................................................................................................................................... 116  11.1 ACADEMIC ADVISING .................................................................................................................................................. 118  11.2 CAREER ADVISING........................................................................................................................................................ 119  11.3 OVERSIGHT OF EXTRAMURAL ELECTIVES ............................................................................................................ 121  11.4 PROVISION OF MSPE ..................................................................................................................................................... 122  11.5 CONFIDENTIALITY OF STUDENT EDUCATIONAL RECORDS .............................................................................. 123  11.6 STUDENT ACCESS TO EDUCATIONAL RECORDS .................................................................................................. 124  STANDARD 12: MEDICAL STUDENT HEALTH SERVICES, PERSONAL COUNSELING, AND FINANCIAL AID SERVICES .................................................................................................................................................................................... 125  12.1 FINANCIAL AID/DEBT MANAGEMENT COUNSELING/STUDENT EDUCATIONAL DEBT............................... 127  12.2 TUITION REFUND POLICY ........................................................................................................................................... 129  12.3 PERSONAL COUNSELING/WELL-BEING PROGRAMS ............................................................................................ 130  12.4 STUDENT ACCESS TO HEALTH CARE SERVICES ................................................................................................... 132  LCME® Data Collection Instrument, Full, 2017-18

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12.5 NON-INVOLVEMENT OF PROVIDERS OF STUDENT HEALTH SERVICES IN STUDENT ASSESSMENT/ LOCATION OF STUDENT HEALTH RECORDS .................................................................................................................. 133 12.6 STUDENT HEALTH AND DISABILITY INSURANCE ................................................................................................ 134  12.7 IMMUNIZATION REQUIREMENTS AND MONITORING ......................................................................................... 135  12.8 STUDENT EXPOSURE POLICIES/PROCEDURES ...................................................................................................... 136  GLOSSARY OF TERMS FOR LCME ACCREDITATION STANDARDS AND ELEMENTS ......................................... 137 

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STANDARD 1: MISSION, PLANNING, ORGANIZATION, AND INTEGRITY A medical school has a written statement of mission and goals for the medical education program, conducts ongoing planning, and has written bylaws that describe an effective organizational structure and governance processes. In the conduct of all internal and external activities, the medical school demonstrates integrity through its consistent and documented adherence to fair, impartial, and effective processes, policies, and practices. STANDARD 1 SUPPORTING DOCUMENTATION Table 1.0-1 | Faculty and Enrollment Provide the requested faculty and enrollment data from the academic year (AY) of the program’s previous full survey self-study, and for the AY used to prepare for the current full survey. AY of Previous Self-study AY Entering class size Total medical student enrollment Number of residents and fellows Number of full-time basic science faculty Number of full-time clinical faculty 1. Provide maps illustrating the location of affiliated hospitals and any regional campuses.

STANDARD 1 NARRATIVE RESPONSE a. Provide the academic year during which the program conducted the self-study for its previous full LCME survey visit. b. Provide a brief history of the medical school, noting key points in its development.

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1.1 STRATEGIC PLANNING AND CONTINUOUS QUALITY IMPROVEMENT A medical school engages in ongoing planning and continuous quality improvement processes that establish short and long-term programmatic goals, result in the achievement of measurable outcomes that are used to improve programmatic quality, and ensure effective monitoring of the medical education program’s compliance with accreditation standards. 1.1 NARRATIVE RESPONSE a. Provide the mission and vision statements of the medical school. b. Describe the process used by the medical school to develop its most recent strategic plan, including the school’s mission, vision, goals, and associated outcomes. How often is the strategic plan reviewed and/or revised? c. Describe how, when, and by whom the outcomes of the school’s strategic plan are monitored. d. Describe the process used and resources available for quality improvement activities related to the medical education program. For example, is there an office or dedicated staff to support quality improvement activities at the levels of the medical school or university? e. Describe how the medical school monitors ongoing compliance with LCME accreditation elements. The response should address the following questions: 1. 2. 3. 4.

Which elements are monitored (e.g., all standards, a subset of standards)? How often is compliance with elements reviewed (mid-cycle, yearly, at some other interval)? What data sources are used to monitor compliance? What individuals or groups receive the results?

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 1.1 1. The strategic goals and objectives of the medical school. 2. An executive summary of the most recent medical school strategic plan. 3. Two examples of outcomes based on recent strategic goals/objectives, and a description of the actions or activities undertaken to evaluate the outcomes. Also note if the desired outcomes have been achieved. 4. One example of an action taken resulting from CQI monitoring of LCME accreditation elements.

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1.2 CONFLICT OF INTEREST POLICIES A medical school has in place and follows effective policies and procedures applicable to board members, faculty members, and any other individuals who participate in decision-making affecting the medical education program to avoid the impact of conflicts of interest in the operation of the medical education program, its associated clinical facilities, and any related enterprises. 1.2 NARRATIVE RESPONSE a. Place an “X” next to each unit for which the primary institutional governing board is directly responsible: University system Parent university Health science center Medical school Other (describe ):

b. If the institutional primary board is responsible for any units in addition to the medical school (e.g., other colleges), is there a separate/subsidiary board for the medical school? c. Is the medical school part of a for-profit, investor-owned entity? If so, identify any board members, administrators, or faculty members who are shareholders/investors/administrators in the holding company for the medical school. d. Place an “X” next to each area in which the medical school or university has a faculty conflict of interest policy: Conflict of interest in research Conflict of private interests of faculty with academic/teaching/ responsibilities Conflict of interest in commercial support of continuing medical education e. Describe the strategies for managing actual or perceived conflicts of interest as they arise for the following groups: 1. Governing board members 2. University and medical school administrators 3. Medical school faculty SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 1.2 1. Policies and procedures intended to prevent or address financial or other conflicts of interest among governing board members, administrators, and faculty (including recusal from discussions or decisions if a potential conflict occurs). 2. Documentation, such as minutes illustrating relevant recusals or affirmations, that conflict of interest policies are being followed.

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1.3 MECHANISMS FOR FACULTY PARTICIPATION A medical school ensures that there are effective mechanisms in place for direct faculty participation in decision-making related to the medical education program, including opportunities for faculty participation in discussions about, and the establishment of, policies and procedures for the program, as appropriate. 1.3 SUPPORTING DATA Table 1.3-1 | Standing Committees List all major standing committees of the medical school and provide the requested information for each, including whether members are all appointed (A), all elected (E), or whether the committee has both appointed and elected members (B), and whether the committee is charged with making recommendations (R), is empowered to take action (A), or both (B). Membership Total Voting Total Faculty Authority Committee Reports to Selection Members Voting Members (R/A/B) (A/E/B)

1.3 NARRATIVE RESPONSE a. Summarize how the selection process for faculty committees ensures that there is input from the general faculty into the governance process. How are individuals whose perspectives are independent from that of departmental leadership or from that of central administration included in standing committees? Note whether committees include elected members or members nominated or selected through a faculty-administered process (e.g., through a “committee on committees”). b. Describe how faculty are made aware of policy and other types of changes that require faculty comment and how such input from faculty is obtained. Describe some recent opportunities for faculty to provide such input. c. List the number and type of general faculty meetings held during the past academic year. Indicate whether these meetings were held “virtually” or in-person. Describe the means by which faculty were made aware of meeting agendas and outcomes. d. Describe any mechanisms other than faculty meetings (such as written or electronic communications) that are used to inform faculty about issues of importance at the medical school.

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1.4 AFFILIATION AGREEMENTS In the relationship between a medical school and its clinical affiliates, the educational program for all medical students remains under the control of the medical school’s faculty, as specified in written affiliation agreements that define the responsibilities of each party related to the medical education program. Written agreements are necessary with clinical affiliates that are used regularly for required clinical experiences; such agreements may also be warranted with other clinical facilities that have a significant role in the clinical education program. Such agreements provide for, at a minimum the following:     

The assurance of medical student and faculty access to appropriate resources for medical student education The primacy of the medical education program’s authority over academic affairs and the education/assessment of medical students The role of the medical school in the appointment and assignment of faculty members with responsibility for medical student teaching Specification of the responsibility for treatment and follow-up when a medical student is exposed to an infectious or environmental hazard or other occupational injury The shared responsibility of the clinical affiliate and the medical school for creating and maintaining an appropriate learning environment

1.4 SUPPORTING DATA Table 1.4-1 | Affiliation Agreements For each inpatient clinical teaching site used for the inpatient portion of required clinical clerkships, provide the page number in the current affiliation agreement where passages containing the following information appear. Add rows as needed.

1. Assurance of medical student and faculty access to appropriate resources for medical student education. 2. Primacy of the medical education program’s authority over academic affairs and the education/assessment of medical students. 3. Role of the medical school in the appointment and assignment of faculty members with responsibility for medical student teaching. 4. Specification of the responsibility for treatment and follow-up when a medical student is exposed to an infectious or environmental hazard or other occupational injury. 5. Shared responsibility of the clinical affiliate and the medical school for creating and maintaining an appropriate learning environment. Clinical teaching site

Date agreement signed

(1) Access to resources

Page Number(s) in Agreement (2) (3) (4) Primacy of Faculty Environmental program appointments hazard

(5) Learning environment

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 1.4 1. The signed/executed affiliation agreement for each clinical teaching site at which students complete the inpatient portions of required (core) clinical clerkships and/or integrated longitudinal clerkships. This does not include clinical teaching sites only used for electives or selectives or those used for ambulatory teaching. Note: Each affiliation agreement should be saved as a separate document and named according to the following convention: 1.4._AA_Site Name.

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1.5 BYLAWS A medical school promulgates bylaws or similar policy documents that describe the responsibilities and privileges of its administrative officers, faculty, medical students, and committees. 1.5 NARRATIVE RESPONSE a. Provide the date of the most recent revision of the bylaws that apply to the medical school. b. List the topics that are included in the bylaws that apply to the medical school (e.g., committees, definition of faculty) c. Describe the process for changing bylaws, including the individuals and groups that must approve changes. d. Briefly describe how the bylaws are made available to the faculty. Note: the full bylaws that apply to the medical school should be available in the survey team’s home room during the survey visit or available online.

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1.6 ELIGIBILITY REQUIREMENTS A medical school ensures that its medical education program meets all eligibility requirements of the LCME for initial and continuing accreditation, including receipt of degree-granting authority and accreditation by a regional accrediting body by either the medical school or its parent institution. 1.6 SUPPORTING DATA a. Provide the state in which the institution is chartered/legally authorized to offer the MD degree. b. Place an “X” next to the institutional (regional) accrediting body that accredits the medical school or parent institution: Middle States Association of Colleges and Schools New England Association of Schools and Colleges North Central Association of Colleges and Schools Northwest Commission on Colleges and Universities Southern Association of Colleges and Schools Western Association of Colleges and Schools c. Provide the current institutional accreditation status. d. Provide the year of the next institutional accreditation survey.

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STANDARD 2: LEADERSHIP AND ADMINISTRATION A medical school has a sufficient number of faculty in leadership roles and of senior administrative staff with the skills, time, and administrative support necessary to achieve the goals of the medical education program and to ensure the functional integration of all programmatic components.

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2.1 ADMINISTRATIVE OFFICER AND FACULTY APPOINTMENTS The senior administrative staff and faculty of a medical school are appointed by, or on the authority of, the governing board of the institution. 2.1 NARRATIVE RESPONSE a. Briefly describe the role of the primary institutional governing board in the appointment of members of the medical school administration, including the dean, the dean’s staff, and members of the faculty. Note if the governing board has delegated the responsibility for some or all of these appointments to another individual (e.g., the university president, provost, medical school dean).

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2.2 DEAN’S QUALIFICATIONS

The dean of a medical school is qualified by education, training, and experience to provide effective leadership in medical education, scholarly activity, patient care, and other missions of the medical school. 2.2 NARRATIVE RESPONSE a. Indicate whether the dean has ultimate responsibility for all missions of the medical school or if some of these (e.g., patient care) are under the authority of another administrator. b. Provide a brief summary of the dean’s experience and qualifications to provide leadership in each area of the medical school’s missions for which he/she has responsibility. c. Describe the process used to evaluate the dean, including the interval at which this evaluation takes place.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 2.2 1. Dean’s abbreviated curriculum vitae.

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2.3 ACCESS AND AUTHORITY OF THE DEAN The dean of a medical school has sufficient access to the university president or other institutional official charged with final responsibility for the medical education program and to other institutional officials in order to fulfill his or her responsibilities; there is a clear definition of the dean’s authority and responsibility for the medical education program. 2.3 NARRATIVE RESPONSE a. Summarize the dean’s access to university and health system administrators. Provide examples to illustrate how the dean’s access to these administrators has ensured that the needs of the medical education program are included in planning activities at these levels. b. Describe the dean’s authority and responsibility for the medical education program based on the position description provided in the supporting documentation and/or codified in the bylaws.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 2.3 1. Organizational chart illustrating the relationship of the medical school dean to university administration, to the deans of other schools and colleges, and to the administrators of the health science center and affiliated teaching hospitals (if relevant). If the medical school is part of a larger non-academic entity (not-for-profit or for-profit/investor-owned), the chart should include the relationship of the dean or other senior academic officer to the board of directors or officers of that entity. 2. Dean’s position description. If the dean has an additional role (e.g., vice president for health/academic affairs, provost), include that position description, as well. 3. Relevant excerpts from the faculty bylaws or related documents describing the dean’s role and/or authority regarding the medical education program.

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2.4 SUFFICIENCY OF ADMINISTRATIVE STAFF A medical school has in place a sufficient number of associate or assistant deans, leaders of organizational units, and senior administrative staff who are able to commit the time necessary to accomplish the missions of the medical school. 2.4 SUPPORTING DATA

Table 2.4-1 | Office of the Associate Dean of/for Students Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of students who were satisfied/very satisfied (aggregated) with the Office of the Associate Dean of/for Students. GQ 2016 GQ 2017 School % National % School % National % Accessibility Awareness of student concerns Responsiveness to student problems

Table 2.4-2 | Office of the Associate Dean of/for Students Provide data from the Independent Student Analysis (ISA), by curriculum year, on the percentage of students who were satisfied/very satisfied (aggregated) with the Office of the Associate Dean of/for Students. If requested ISA data are not available, enter N/A as appropriate. Add rows as needed for additional survey questions relevant to the topic. YEAR 1 YEAR 2 YEAR 3 YEAR 4 Accessibility Awareness of student concerns Responsiveness to student problems

Table 2.4-3 | Office of the Associate Dean for Educational Programs/Medical Education Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of students who were satisfied/very satisfied (aggregated) with the Office of the Associate Dean for Educational Programs/Medical Education. GQ 2016 GQ 2017 School % National % School % National % Accessibility Awareness of student concerns Responsiveness to student problems

Table 2.4-4 | Office of the Associate Dean for Educational Programs/Medical Education Provide data from the Independent Student Analysis (ISA), by curriculum year, on the percentage of students who were satisfied/very satisfied (aggregated) with the Office of the Associate Dean for Educational Programs/Medical Education. If requested ISA data are not available, enter N/A as appropriate. Add rows as needed for additional ISA survey questions relevant to the topic. YEAR 1 YEAR 2 YEAR 3 YEAR 4

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Accessibility Awareness of student concerns Responsiveness to student problems Table 2.4-5 | Department Chair Staffing Provide the requested information regarding current department chairs. For each interim/acting appointment, provide the date the previous incumbent left office. Add rows as needed. For acting/interim chairs, date Name of Department Name of Incumbent Date appointed previous incumbent left

Table 2.4-6 | Number of Department Chair Vacancies Indicate the number of vacant/interim department chair positions for each of the listed academic years (as available). Use January 1st of the given academic year. AY 2015-16 AY 2016-17 AY 2017-18

Table 2.4-7 | Dean’s Office Administrative Staffing Provide the requested information regarding members of the dean’s office staff. For each interim/acting appointment, provide the date the previous incumbent left office. Add rows as needed. For acting/interim dean’s % Effort dedicated to Name of Incumbent Title Date appointed office staff, date previous administrative role incumbent left

2.4 NARRATIVE RESPONSE a. If any members of the dean’s staff hold interim/acting appointments, describe the status of recruitment efforts to fill the position(s). b. If there are any department chair vacancies, including interim/acting chairs, describe the status of recruitment efforts to fill the position(s). c. Briefly describe how, how often, and by whom the performance of dean’s office staff and department chairs is reviewed.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 2.4 1. Organizational chart of the dean’s office.

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2.5 RESPONSIBILITY OF AND TO THE DEAN The dean of a medical school with one or more regional campuses is administratively responsible for the conduct and quality of the medical education program and for ensuring the adequacy of faculty at each campus. The principal academic officer at each campus is administratively responsible to the dean. Note: Only schools operating one or more regional campus (es) should respond to element 2.5. See the Glossary of Terms for LCME Accreditation Standards and Elements at the end of this DCI for the LCME definition of regional campus.

2.5 SUPPORTING DATA Table 2.5-1 | Regional Campus(es) Provide the requested information for each regional campus. Add rows as needed. Campus Location Name and Title of Principal Academic Officer

2.5 NARRATIVE RESPONSE a. Describe the role of the medical school dean/designated chief academic officer in overseeing the conduct and quality of the medical education program at all regional campuses. Provide examples of how this individual monitors the adequacy of faculty at regional campus (es) and works with the principal academic officer(s) at each campus to remedy any deficiencies. b. Describe the reporting relationship between the medical school dean/chief academic officer and the principal academic officer at each regional campus. c. Describe the reporting relationships of other campus administrators (e.g., student affairs). d. Describe the ways in which the principal academic officer(s) at regional campus (es) are integrated into the administrative and governance structures of the medical school.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 2.5 1. Position description for the role of principal academic officer at a regional campus.

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2.6 FUNCTIONAL INTEGRATION OF THE FACULTY At a medical school with one or more regional campuses, the faculty at the departmental and medical school levels at each campus are functionally integrated by appropriate administrative mechanisms (e.g., regular meetings and/or communication, periodic visits, participation in shared governance, and data sharing). Note: Only schools operating one or more regional campus (es) should respond to element 2.6. See the Glossary of Terms for LCME Accreditation Standards and Elements at the end of this DCI for the LCME definition of regional campus. 2.6 NARRATIVE RESPONSE a. Describe the means by which faculty members in each discipline are functionally integrated across regional campuses, including activities such as faculty meetings/retreats and visits by departmental leadership. Provide examples of the occurrence of such activities in the past two years. b. Describe how institutional policies and/or faculty bylaws support the participation of faculty based at regional campuses in medical school governance (e.g., committee membership). c. List the following: 1. faculty or senior administrative staff based at regional campuses serving on the medical school’s curriculum committee 2. faculty or senior administrative staff based at regional campuses serving on the medical school’s admission committee 3. faculty or senior administrative staff based at regional campuses serving on the medical school’s executive committee

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 2.6 1. Organizational chart(s) illustrating the relationship of pre-clerkship course site directors to course directors (if relevant). 2. Organizational chart(s) illustrating the relationship of clerkship site directors to clerkship directors (if relevant).

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STANDARD 3: ACADEMIC AND LEARNING ENVIRONMENTS A medical school ensures that its medical education program occurs in professional, respectful, and intellectually stimulating academic and clinical environments, recognizes the benefits of diversity, and promotes students’ attainment of competencies required of future physicians.

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3.1 RESIDENT PARTICIPATION IN MEDICAL STUDENT EDUCATION Each medical student in a medical education program participates in one or more required clinical experiences conducted in a health care setting in which he or she works with resident physicians currently enrolled in an accredited program of graduate medical education. 3.1 SUPPORTING DATA Table 3.1-1 | Resident Involvement in Core Clinical Clerkships List each clinical facility at which one or more medical students take a required core clinical clerkship (other than ambulatory, community-based sites). For each clerkship, place a “Y” to indicate that residents in an ACGME-accredited program are involved in medical student education, or an “N” to indicate that residents are not involved in medical student education in that discipline. If there is no clerkship in that discipline at that site, leave the cell blank. Add rows as needed. Family Internal Facility Name Ob-Gyn Pediatrics Psychiatry Surgery Medicine Medicine

3.1 NARRATIVE RESPONSE a. Provide the percentage of medical students in the current academic year who will complete one or more thirdyear/third-academic period clerkships at a site where residents participate in medical student teaching/supervision. For schools with regional campuses, provide these data by campus. b. If some or all students do not have the opportunity to complete one or more clerkships where residents participate in medical student teaching/supervision, describe other (non-clerkship) required clinical experiences where students would have the opportunity to interact with residents. c. If residents are not present at any of the sites where required clinical experiences are conducted for some or all students (e.g., at a longitudinal integrated clerkship site, a rural clerkship site, or a regional campus), describe how medical students learn about the expectations and requirements of the next phase of their training.

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3.2 COMMUNITY OF SCHOLARS/RESEARCH OPPORTUNITIES A medical education program is conducted in an environment that fosters the intellectual challenge and spirit of inquiry appropriate to a community of scholars and provides sufficient opportunities, encouragement, and support for medical student participation in the research and other scholarly activities of its faculty. 3.2 SUPPORTING DATA Table 3.2-1 | Student/Faculty Collaborative Research Provide school and national data from the AAMC Graduation Questionnaire (GQ) on the percentage of students reporting participation in a research project with a faculty member. GQ 2014 GQ 2015 GQ 2016 GQ 2017 School % National % School % National % School % National % School % National %

Table 3.2-2 | Research Opportunities Provide the total number and percentage of medical students involved in each type of research opportunity for the indicated academic years. AY 2015-16 AY 2016-17 MD/PhD program Summer research program Year-out for research Research elective Other: (describe)

3.2 NARRATIVE RESPONSE a. Are medical students required to complete a scholarly/research project at some point in the curriculum? If yes, please describe. b. If students are not required to complete a research project, briefly describe the opportunities for medical students to participate in research, including how medical students are informed about research opportunities. c. Describe the funding and other resources available to support medical student participation in research. d. Describe how faculty scholarship is fostered in the medical school. Is there a formal mentorship program to assist faculty in their development as scholars? Describe the infrastructure and resources available to support faculty scholarship (e.g., a research office, support for grant development, seed funding for research project development).

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3.3 DIVERSITY/PIPELINE PROGRAMS AND PARTNERSHIPS A medical school has effective policies and practices in place, and engages in ongoing, systematic, and focused recruitment and retention activities, to achieve mission-appropriate diversity outcomes among its students, faculty, senior administrative staff, and other relevant members of its academic community. These activities include the use of programs and/or partnerships aimed at achieving diversity among qualified applicants for medical school admission and the evaluation of program and partnership outcomes. 3.3 SUPPORTING DATA Table 3.3-1 | Diversity Categories and Definitions Provide definitions for the diversity categories identified in medical school policies that guide recruitment and retention activities for medical students, faculty, and senior administrative staff. Note that the medical school may use different diversity categories for each of these groups. If different diversity categories apply to any of these groups, provide each relevant definition. Medical Students Faculty Senior Administrative Staff* * See the Glossary of Terms for LCME Accreditation Standards and Elements at the end of this DCI for the LCME definition of senior administrative staff.

Table 3.3-2 | Offers Made to Applicants to the Medical School Provide the total number of offers of admission to the medical school made to individuals in the school’s identified diversity categories for the indicated academic years. Add rows as needed for each diversity category. 2016 Entering Class 2017 Entering Class School-identified # of Declined # of Enrolled Total # of Declined # of Enrolled Total Diversity Category Offers Students Offers Offers Students Offers

Table 3.3-3 | Offers Made for Faculty Positions Provide the total number of offers of employment made to individuals in the school’s identified diversity categories for faculty positions. Add rows as needed for each diversity category. AY 2015-16 AY 2016-17 School-identified # of Declined # of Faculty Total # of Declined # of Faculty Total Diversity Category Offers Hired Offers Offers Hired Offers

Table 3.3-4 | Offers Made for Senior Administrative Staff Positions Provide the total number of offers of employment made to individuals in the school’s identified diversity categories for senior administrative staff positions. Add rows as needed for each diversity category. AY 2015-16 AY 2016-17 School-identified # of Declined # of Staff Total # of Declined # of Staff Total Diversity Category Offers Hired Offers Offers Hired Offers

Table 3.3-5 | Students, Faculty and Senior Administrative Staff Provide the requested information on the number and percentage of enrolled students, employed faculty, and senior administrative staff in each of the school-identified diversity categories (as defined in table 3.3-1 above).

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School-identified Diversity Category

First-Year Students

All Students

Employed/ Full-time Faculty

Senior Administrative Staff

Table 3.3-6 | Pipeline Programs and Partnerships List each current program aimed at broadening diversity among qualified medical school applicants. Provide the average enrollment (by year or cohort), target participant group(s) (e.g., college, high school, other students), and a description of any partners/partnerships, if applicable. Add rows as needed. Program Year Initiated Target Participants Average Enrollment Partners

3.3 NARRATIVE RESPONSE a. Describe the programs related to the preparation, recruitment, and retention of medical students, faculty, and senior administrative leadership from school-defined diversity categories. In the description, include the following: 1. 2. 3. 4.

The funding sources that the medical school has available The individual personnel dedicated to these activities The time commitment of these individuals The organizational locus of the individuals involved in these efforts (e.g., the medical school dean’s office, a university office)

b. Describe the following for activities related to the administration and delivery of programs (e.g., “pipeline programs”) aimed at developing a diverse pool of medical school applicants, both locally and nationally: 1. 2. 3. 4.

The funding sources that the medical school has available The individuals dedicated to support these activities The time commitment of these individuals The organizational locus of the individuals involved in these efforts (e.g., the medical school dean’s office, a university office)

c. Describe the means by which the medical school monitors and evaluates the effectiveness of its pipeline programs and of its other programs to support school-defined diversity among its student body, faculty, and senior administrative staff. Provide evidence of program effectiveness in terms of program outcomes.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 3.3 1. Formal institutional policies specifically aimed at insuring a diverse student body, faculty, and senior administrative staff.

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3.4 ANTI-DISCRIMINATION POLICY A medical school does not discriminate on the basis of age, creed, gender identity, national origin, race, sex, or sexual orientation. 3.4 NARRATIVE RESPONSE a. Describe how the medical school’s anti-discrimination policy is made known to members of the medical education community. Is the policy readily available? SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 3.4 1. The medical school’s anti-discrimination policy (or the university policy that applies to the medical school).

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3.5 LEARNING ENVIRONMENT/PROFESSIONALISM A medical school ensures that the learning environment of its medical education program is conducive to the ongoing development of explicit and appropriate professional behaviors in its medical students, faculty, and staff at all locations and is one in which all individuals are treated with respect. The medical school and its clinical affiliates share the responsibility for periodic evaluation of the learning environment in order to identify positive and negative influences on the maintenance of professional standards, develop and conduct appropriate strategies to enhance positive and mitigate negative influences, and identify and promptly correct violations of professional standards. 3.5 SUPPORTING DATA Table 3.5-1 | Professional Attributes List the professional attributes (behaviors and attitudes) that medical students are expected to develop, the location in the curriculum where formal learning experiences related to these attributes occur, and the methods used to assess student attainment of each attribute. Add rows as needed. Attribute Location(s) in Curriculum Assessment Method(s)

3.5 NARRATIVE RESPONSE a. Describe how these professional attributes are made known to faculty, residents, and others in the medical education learning environment. b. Describe the methods used to evaluate the learning environment in order to identify positive and negative influences on the development of medical students’ professional attributes, especially in the clinical setting. Include the timing of these evaluations and the individuals or groups that are provided with the results. c. Provide examples of strategies used to enhance positive elements and mitigate negative elements identified through this evaluation process. d. Identify the individual(s) responsible for and empowered to ensure that there is an appropriate learning environment in each of the settings used for medical student education.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 3.5 1. Examples of the instrument(s) used to evaluate the learning environment.

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3.6 STUDENT MISTREATMENT A medical education program defines and publicizes its code of professional conduct for the relationships between medical students, including visiting medical students, and those individuals with whom students interact during the medical education program. A medical school develops effective written policies that address violations of the code, has effective mechanisms in place for a prompt response to any complaints, and supports educational activities aimed at preventing inappropriate behavior. Mechanisms for reporting violations of the code of professional conduct are understood by medical students, including visiting medical students, and ensure that any violations can be registered and investigated without fear of retaliation. 3.6 SUPPORTING DATA Table 3.6-1 | Awareness of Mistreatment Procedures Among Students Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of medical students that reported knowing school procedures for reporting the mistreatment of medical students for each listed year. GQ 2016 GQ 2017 School % National % School % National %

Table 3.6-2 | Awareness of Mistreatment Policies Among Students Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of medical students that reported awareness of school policies regarding the mistreatment of medical students for each listed year. GQ 2016 GQ 2017 School % National % School % National %

Table 3.6-3.a | Student Mistreatment Experiences Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) for the listed year on respondents' experiences with each of the following behaviors during medical school. GQ 2016 Never Once Occasionally Frequently National National National National School % School % School % School % % % % % Publicly embarrassed Publicly humiliated Threatened with physical harm Physically harmed Required to perform personal services Subjected to unwanted sexual advances Asked to exchange sexual favors for grades or other rewards Denied opportunities for training or rewards based on gender

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Subjected to offensive, sexist remarks/names Received lower evaluations/grades based on gender Denied opportunities for training or rewards based on race or ethnicity Subjected to racially or ethnically offensive remarks/names Received lower evaluations or grades solely because of race or ethnicity rather than performance Denied opportunities for training or rewards based on sexual orientation Subjected to offensive remarks, names related to sexual orientation Received lower evaluations or grades solely because of sexual orientation rather than performance Table 3.6-3.b | Student Mistreatment Experiences Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) for the listed year on respondents' experiences with each of the following behaviors during medical school. GQ 2017 Never Once Occasionally Frequently School National School National School National School National % % % % % % % % Publically embarrassed Publicly humiliated Threatened with physical harm Physically harmed Required to perform personal services Subjected to unwanted sexual advances Asked to exchange sexual favors for grades or other rewards Denied opportunities for training or rewards based on gender Subjected to offensive, sexist remarks/names Received lower evaluations/grades based on gender Denied opportunities for training or rewards based on race or ethnicity Subjected to racially or ethnically offensive remarks/names

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Received lower evaluations or grades solely because of race or ethnicity rather than performance Denied opportunities for training or rewards based on sexual orientation Subjected to offensive remarks, names related to sexual orientation Received lower evaluations or grades solely because of sexual orientation rather than performance Table 3.6-4 | Student Mistreatment Experiences by Curriculum Year Provide data on student mistreatment from the ISA by curriculum year on student satisfaction (somewhat satisfied/very satisfied) with the following. Add rows for each additional question on the student survey. Survey Question YEAR 1 YEAR 2 YEAR 3 YEAR 4 Adequacy of the school’s mistreatment policy Adequacy of the mechanisms to report mistreatment Adequacy of the school’s activities to prevent mistreatment

3.6 NARRATIVE RESPONSE a. Describe how medical students, residents, faculty (full-time, part-time, and volunteer), and appropriate professional staff are informed about the medical school’s standard of conduct in the faculty-student relationship and about medical student mistreatment policies. b. Describe how medical students, including visiting students, are informed about the procedures for reporting incidents of mistreatment. c. Summarize the procedures used by medical students, faculty, or residents to report observed incidents of mistreatment and unprofessional behavior in the learning environment. Describe how reports are made and identify the individuals to whom reports can be directed. Describe the way in which the medical school ensures that allegations of mistreatment can be made and investigated without fear of retaliation. Describe the process (es) used for follow-up when reports of unprofessional behavior have been made. d. How, by whom, and how often are data regarding the frequency of medical students experiencing negative behaviors (mistreatment) collected? How, by whom, and how often are the data on medical student mistreatment reviewed? How are these data used in efforts to reduce medical student mistreatment? Note recent actions that have been taken in response to the data from the AAMC GQ or student surveys related to the incidence of mistreatment. e. Refer to data from the independent student analysis related to mistreatment, including policies and procedures for reporting. Compare the findings from the independent student analysis with those from the AAMC GQ, illustrating any areas of consistency or inconsistency. f.

Describe recent educational activities for medical students, faculty, and residents that were directed at preventing student mistreatment.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 3.6 1. Formal medical school or university policies addressing the standards of conduct in the faculty-student

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relationship, including student mistreatment policies. 2. Formal policies and/or procedures for responding to allegations of medical student mistreatment, including the avenues for reporting and mechanisms for investigating reported incidents. 3. For medical education programs with regional campuses, provide data for each campus and comment on any differences among campuses.

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STANDARD 4: FACULTY PREPARATION, PRODUCTIVITY, PARTICIPATION, AND POLICIES The faculty members of a medical school are qualified through their education, training, experience, and continuing professional development and provide the leadership and support necessary to attain the institution's educational, research, and service goals.

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4.1 SUFFICIENCY OF FACULTY A medical school has in place a sufficient cohort of faculty members with the qualifications and time required to deliver the medical curriculum and to meet the other needs and fulfill the other missions of the institution. 4.1 SUPPORTING DATA Table 4.1-1 | Total Faculty Provide the total number of full-time, part-time, and volunteer faculty in the basic science and clinical departments for each listed academic year (as available). Full-Time Faculty Part-Time Faculty Volunteer Faculty Academic Year Basic Science Clinical Basic Science Clinical Basic Science Clinical 2013-14 2014-15 2015-16 2016-17 2017-18 Table 4.1-2 | Basic Science Faculty List each of the medical school’s basic science (pre-clerkship) departments and provide the number of faculty in each. Only list those departments (e.g., pathology) included in the faculty counts in table 4.1-1. Schools with one or more regional campus (es) should also provide the campus name. Add rows as needed. Full-Time Faculty Part-Time Faculty Associate Assistant Instructor/ Campus Department Professor Vacant Professor Professor Other

Table 4.1-3 | Basic Science Teaching Responsibilities List each of the medical school’s basic science (pre-clerkship) departments and indicate whether required courses are taught for each listed student-type (Y for yes, N for no). Only list courses for which departmental faculty have primary and ongoing responsibilities (e.g., reporting final grades to the registrar). Only include interdisciplinary courses once per department. Add rows as needed. Student Type Campus Department Medical Graduate Dental Nursing Allied Health Undergraduate

Table 4.1-4 | Clinical Faculty List each of the medical school’s clinical departments and provide the number of faculty in each. Only list departments included in the faculty counts in table 4.1-1. Schools with one or more regional campus should provide the campus name in each row. Add rows as needed. Full-Time Faculty Other / Not Full-Time Associate Assistant Instructor/ Part-Time Campus Department Professor Vacant Volunteer Professor Professor Other Faculty

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Table 4.1-5 | Clinical Teaching Responsibilities List each of the medical school’s clinical departments and indicate whether required courses are taught for each listed student-type (Y for yes, N for no). Only list courses for which departmental faculty have primary and ongoing effort (e.g., reporting final grades to the registrar). Only include interdisciplinary courses once per department. Only report Pathology data if Pathology is included as a clinical department in table 4.1-1. Add rows as needed. Student Type Other Campus Department Medical Dental Nursing Allied Health Public Health (specify)

Table 4.1-6 | Protected Faculty Time Provide the amount of protected time (i.e., time with salary support) that the following individuals have for their educational responsibilities (include a range if not consistent within each group). Add rows as needed. Faculty Type Amount Preclerkship/preclinical course directors, including directors of clinical skills courses Clerkship directors Chair of the curriculum committee

4.1 NARRATIVE RESPONSE a. List all faculty with substantial teaching responsibilities who are on-site at their teaching location for fewer than three months during the academic year. b. Describe any situations where there have been recent problems identifying sufficient faculty to teach medical students (e.g., to provide lectures in a specific content area, to serve as small group facilitators). c. Describe anticipated faculty attrition over the next three years, including faculty retirements. d. Describe faculty recruitment activities, by discipline, planned over the next three academic years and provide the anticipated timing of these activities. Note if these are new recruitments or to replace faculty who have retired/left the institution.

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4.2 SCHOLARLY PRODUCTIVITY The faculty of a medical school demonstrate a commitment to continuing scholarly productivity that is characteristic of an institution of higher learning. 4.2 SUPPORTING DATA Table 4.2-1 | Scholarly Productivity Provide the total number of each type of scholarly work, by department (basic science and clinical), from the most recently completed year (academic or calendar year, whichever is used in the medical school’s accounting of faculty scholarly efforts). Other peerArticles in Published books/ Faculty co-investigators or Department reviewed peer-review journals book chapters PI’s on extramural grants scholarship* *Provide a definition of “other peer-reviewed scholarship,” if this category is used:

Provide the year used for these data:

4.2 NARRATIVE RESPONSE a. Describe the institution’s expectations for faculty scholarship, including whether scholarly activities are required for promotion and retention of some or all faculty.

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4.3 FACULTY APPOINTMENT POLICIES A medical school has clear policies and procedures in place for faculty appointment, renewal of appointment, promotion, granting of tenure, remediation, and dismissal that involve the faculty, the appropriate department heads, and the dean, and provides each faculty member with written information about his or her term of appointment, responsibilities, lines of communication, privileges and benefits, performance evaluation and remediation, terms of dismissal, and, if relevant, the policy on practice earnings. 4.3 NARRATIVE RESPONSE a. Provide a brief description of each faculty track, including the qualifications required for each. Describe how and when faculty members are notified about and assigned to a specific track. b. Describe how and when faculty members are notified of the following: 1. Terms and conditions of employment, including privileges 2. Benefits 3. Compensation, including policies on practice earnings c. Describe how and when faculty members are initially notified about their responsibilities in teaching, research and, where relevant, patient care and whether such notification occurs on an ongoing basis.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 4.3 1.

Medical school or university policies for initial faculty appointment, renewal of appointment, promotion, granting of tenure (if relevant), and dismissal. Note when these policies were last reviewed and approved.

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4.4 FEEDBACK TO FACULTY A medical school faculty member receives regularly scheduled and timely feedback from departmental and/or other programmatic or institutional leaders on his or her academic performance and progress toward promotion and, when applicable, tenure. 4.4 NARRATIVE RESPONSE a. Describe how and when faculty members receive formal feedback from departmental leaders (i.e., the department chair or division/section chief) on their academic performance, progress toward promotion and, if relevant, tenure.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 4.4 1. Medical school or university policies that require faculty to receive regular formal feedback on their performance and their progress toward promotion and, if relevant, tenure, including the date when these policies were last reviewed and approved.

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4.5 FACULTY PROFESSIONAL DEVELOPMENT A medical school and/or its sponsoring institution provides opportunities for professional development to each faculty member in the areas of discipline content, curricular design, program evaluation, student assessment methods, instructional methodology, and or research to enhance his or her skills and leadership abilities in these areas. 4.5 NARRATIVE RESPONSE a. Describe the availability of knowledgeable individuals who can assist faculty in improving their teaching and assessment skills. Describe the organizational placement of such individuals (e.g., faculty development office, medical school dean’s office, university office). Note if faculty development is the primary responsibility of these individuals. If not, do they have sufficient time for this responsibility? b. Describe how faculty are informed about the availability of faculty development programming and the steps that are taken to ensure that faculty development is accessible at all instructional sites, including clinical affiliates and regional campuses. c. Describe the means by which problems identified with an individual faculty member’s teaching and assessment skills are remediated. d. Describe the availability of funding to support faculty participation in professional development activities related to their respective disciplines (e.g., attendance at professional meetings) and to their roles as teachers (e.g., attendance at regional/national medical education meetings). e. Provide examples of formal activities at the departmental, medical school, and/or university level used to assist faculty in enhancing their skills in research methodology, publication development, and/or grant procurement. List the personnel available to assist faculty in acquiring and enhancing such skills. f.

Describe the specific programs or activities offered to assist faculty in preparing for promotion.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 4.5 1.

Provide a list of the faculty development programs (e.g., workshops, lectures, seminars) that were provided during the most recent academic year, including general topic and attendance, and the locations where these programs were offered.

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4.6 RESPONSIBILITY FOR EDUCATIONAL PROGRAM POLICIES At a medical school, the dean and a committee of the faculty determine the governance and policymaking processes of the program. 4.6 NARRATIVE RESPONSE a. If there is an executive committee or other similar medical school leadership group responsible for working with the dean to determine medical school policies, describe its membership, its charge or purpose and how often it meets. Provide examples of the committee’s priority areas during the most recent academic year and how those priorities are set.

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STANDARD 5: EDUCATIONAL RESOURCES AND INFRASTRUCTURE A medical school has sufficient personnel, financial resources, physical facilities, equipment, and clinical, instructional, informational, technological, and other resources readily available and accessible across all locations to meet its needs and to achieve its goals.

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STANDARD 5 SUPPORTING DOCUMENTATION Table 5.0-1 | Medical School Revenue Sources Provide the requested revenue totals from the LCME Part I-A Annual Financial Questionnaire (AFQ) for each indicated fiscal year (FY) and the percentage of total revenues represented by each amount. Use the “total revenues” from the AFQ for this calculation. FY 2015 FY 2016 % of % of Total $ Total $ Revenues Revenues Total tuition and fees Medical students Other students Revenues from T&F assessed to grad. students in medical school programs Revenues from continuing medical education programs Other tuition and fees revenues) Total government and parent support Federal appropriations Adjusted state and parent support Local appropriations Total grants and contracts Federal direct State and local direct Other direct Total facilities and administration (indirect) Practice plans/Other medical services Total hospital revenues University-owned Department of Veterans Affairs Other affiliated hospitals Total gifts Restricted gift funds Revenues from unrestricted gift funds Endowment income Restricted endowment funds Income from unrestricted endowment funds Other revenues Total revenues Total expenses and transfers

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5.1 ADEQUACY OF FINANCIAL RESOURCES The present and anticipated financial resources of a medical school are derived from diverse sources and are adequate to sustain a sound program of medical education and to accomplish other programmatic and institutional goals. 5.1 NARRATIVE RESPONSE a. Summarize trends in each of the funding sources available to the medical school, including an analysis of their stability. Describe any substantive changes to the medical school budget during the three fiscal years prior to the date of the upcoming full survey visit in the following areas: 1. 2. 3. 4. 5. 6. 7. 8.

Total revenues Operating margin Revenue mix Market value of endowments Medical school reserves Debt service Outstanding debt Departmental reserves

b. Describe any substantive changes anticipated by the medical school in the following areas during the three fiscal years following the upcoming full survey visit, and explain the reasons for any anticipated changes. 1. 2. 3. 4.

Total revenues Revenue mix Obligations and commitments (e.g., ongoing commitments based on prior chair searches) Reserves (amount and sources)

c. Describe the medical school’s annual budget process and the budgetary authority of the medical school dean. d. Describe the ways in which the medical school’s governance, through its board of directors and its organizational structure, supports the effective management of its financial resources. Describe how lines of authority are defined, the internal controls that are in place, the degree of oversight provided by the state/parent/governing board in managing medical school resources, and the relationship between the medical school dean and department chairs in managing departmental resources. e. Describe the ways that current and projected capital needs for the missions of the medical school are being addressed. Describe the medical school’s policy with regard to the financing of deferred maintenance of medical school facilities (e.g., roof replacement). f.

Describe the extent to which financial reserves have been used to balance the operating budget in recent years.

g. Summarize the key findings resulting from any external financial audits of the medical school (including medical school departments) performed during the most recently completed fiscal year.

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SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 5.1 1. The school’s responses to the most recent LCME Part I-A Annual Financial Questionnaire, consisting of the following: a. b. c. d.

Signature Page Current Funds Revenues, Expenditures and Transfers - Data Entry Sheet Schedules A-E inclusive Revenues and Expenditures History

2. The school’s responses to the web-based companion survey to the LCME Part I-A Annual Financial Questionnaire, the “Overview of Organization and Financial Characteristics Survey.” 3. A revenue and expenditures summary for the fiscal year in which the full survey takes place (based on budget projections) and for each of the prior three fiscal years. Use the format and row labels from the “Revenues and Expenditures History” from the school’s completed LCME Part I-A Annual Financial Questionnaire (it is the last page of the AFQ). 4. A copy of the most recent audited financial statements for the medical school and/or the medical school's parent organization or company. For medical schools owned or operated by a parent organization or company, submit audited financial statements for the parent organization or company that are consolidated to include all related component units and entities controlled by the parent organization or company. Provide the most current information in the material submitted three months prior to the survey visit.

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5.2 DEAN’S AUTHORITY/RESOURCES The dean of a medical school has sufficient resources and budgetary authority to fulfill his or her responsibility for the management and evaluation of the medical curriculum. 5.2 NARRATIVE RESPONSE a. Provide the name and title of the individual responsible for the education program for medical students, referred to here as the chief academic officer (CAO). b. If the dean is not the CAO, and responsibility for the medical education program is delegated to an associate dean or other individual serving as CAO, provide the name and title of this individual, as well as the percentage of time he or she devotes to this administrative responsibility. Name

Title

% Time (if applicable)

c. Describe how the CAO participates in institution-level planning to ensure that the resource needs of the medical education program (e.g., funding, faculty, educational space, other educational infrastructure) are considered. d. Describe how and by whom the budget to support the medical education program is developed and approved, and how it is allocated. Note if funding allocation to departments and other units with teaching responsibility is done according to a formula (e.g., based on the amount of teaching done by a department) or based on some other method (e.g., historical precedent). e. Briefly describe the organizational locus (e.g., an office of medical education) of administrative and/or academic support for the planning, implementation, evaluation, and oversight of the curriculum and for the development and maintenance of the tools (such as a curriculum database) to support curriculum monitoring and management. Note the reporting relationships of the director(s) of any such office(s)/unit(s). f.

Provide the names and titles of the staff leadership (e.g., director of assessment, institutional computing) of groups/units responsible for providing administrative or academic support for the planning, implementation, and evaluation of the curriculum and for student assessment. Include the percentage of time contributed by each individual to this effort. Add rows as needed. Name of staff leader

LCMEÂŽ Data Collection Instrument, Full, 2017-18

Title

% Time (if applicable)

# of staff reporting to leader

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5.3 PRESSURES FOR SELF-FINANCING A medical school admits only as many qualified applicants as its total resources can accommodate and does not permit financial or other influences to compromise the school’s educational mission. 5.3 SUPPORTING DATA Table 5.3-1 | Tuition and Fees Percentage of total revenue from tuition and fees as reported on the LCME Part I-A Annual Financial Questionnaire (AFQ) for the indicated years. Note: This is derived using data from the AFQ section titled “Current Funds Revenues, Expenditures and Transfers – Data Entry Sheet”. Please divide “TOTAL TUITION AND FEES REVENUES” by “TOTAL REVENUES REPORTED”. FY 2013 FY 2014 FY 2015 FY 2016

5.3 NARRATIVE RESPONSE a. Describe how and at what institutional level (e.g., the medical school administration, the university administration, the board of trustees) the size of the medical school entering class is set. In making decisions about class size, describe how medical school resources, such as space, faculty numbers, and teaching responsibilities, are taken into account. b. Describe how and by whom tuition and fees are set for the medical school. c. If tuition and fees or any other revenue source comprises more than 50% of the medical school’s total annual revenues, describe any plans to diversify revenue sources. d. Describe any significant institutional pressures for the medical school to generate revenue from tuition, clinical care, and/or research (e.g., to address operating deficits or decreases in other revenue sources) and how these pressures are being managed to ensure the ongoing quality of the medical education program.

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5.4 SUFFICIENCY OF BUILDINGS AND EQUIPMENT A medical school has, or is assured the use of, buildings and equipment sufficient to achieve its educational, clinical, and research missions. 5.4 SUPPORTING DATA Table 5.4-1 | Year 1 Classroom Space Provide the requested information on the types of classroom space (e.g., lecture hall, laboratory, clinical skills teaching/ simulation space, small group discussion room, etc.) used for each instructional format during year one of the medical curriculum. Only include space used for regularly-scheduled medical school classes, including laboratories. Add rows as needed. Seating Capacity # of rooms Building(s) where Room Type/Purpose (provide a range if of this size/type rooms are located variable across rooms)

Table 5.4-2 | Year 2 Classroom Space Provide the requested information on the types of classroom space (e.g., lecture hall, laboratory, clinical skills teaching/ simulation space, small group discussion room, etc.) used for each instructional format during year two of the medical curriculum. Only include space used for regularly-scheduled medical school classes, including laboratories. Add rows as needed. Seating Capacity # of rooms Building(s) where Room Type/Purpose (provide a range if of this size/type rooms are located variable across rooms)

Table 5.4-3 | Faculty Offices and Research Labs Provide the number of faculty offices and research laboratories in each academic department of the medical school. Add rows as needed. Department name # of full-time faculty # of offices # of research labs* * If there are “open-plan” laboratories that are shared by faculty, describe here.

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5.4 NARRATIVE RESPONSE a. If educational spaces used for required classes in years one and two of the medical curriculum (e.g., lecture halls, laboratories, small group rooms) are shared with other schools/programs provide the office or individual responsible for scheduling the spaces and note if the medical education program has priority in any scheduling decisions. If classrooms or lecture halls are shared by students in years one and two of the curriculum, describe how and by whom the space is allocated. b. Describe any recent challenges in obtaining access to needed teaching space and how these have been resolved. c. Describe any recent teaching space renovations or construction. If there has been a recent increase in class size, note whether teaching space has also expanded (e.g., increases in room size and/or number). d. Describe the facilities used for teaching and assessment of students’ clinical and procedural skills. Note if this space is also used for patient care or research. Identify if students from other health professions programs or residents also use these facilities and describe how scheduling conflicts are resolved. e. Describe any substantive changes in facilities for education and/or research anticipated by the medical school over the next three years. Note if any renovation or new construction is planned.

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5.5 RESOURCES FOR CLINICAL INSTRUCTION A medical school has, or is assured the use of, appropriate resources for the clinical instruction of its medical students in ambulatory and inpatient settings and has adequate numbers and types of patients (e.g., acuity, case mix, age, gender). 5.5 SUPPORTING DATA Table 5.5-1 | Clinical-site Patient Volume Provide the requested information for each hospital used for the inpatient portion of one or more required clinical clerkships (or longitudinal integrated clinical clerkships). Schools with regional campuses should include the campus name for each facility. Add rows as needed. Facility Name/Campus Average daily # of admissions # of outpatient visits per # of beds in use (if applicable) occupancy per year year

Table 5.5-2 | Inpatient Teaching Facilities Provide the requested information for each required clinical clerkship (or longitudinal integrated clinical clerkship) taking place at an inpatient facility. Only provide information for services used for required clinical clerkships at each hospital. Schools with regional campuses should include the campus name for each facility. Add rows as needed. Average Average # of Students Per Clerkship (Range) Facility Name/Campus daily Clerkship School’s Medical students (if applicable) inpatient medical students from other schools census

Table 5.5-3 | Inpatient Teaching Sites by Clerkship List all inpatient teaching sites where medical students take one or more required clerkships. Indicate the clerkship(s) offered at each site by placing an “X” in the appropriate column. List other major core clerkships offered in different subjects (e.g., Interdisciplinary Primary Care, Women’s and Children’s Health). Schools with regional campuses should include the campus name for each facility. Add rows as needed. Facility Name/ Family Internal Other Ob-Gyn Pediatrics Psychiatry Surgery Campus(if applicable) Medicine Medicine (list)

Table 5.5-4 | Ambulatory Teaching Sites by Clerkship For each type of ambulatory teaching site used for one or more required clerkships, indicate the clerkship(s) offered at this type of site by placing an “X” in the appropriate column. Add other major core clerkships offered in different subjects (e.g., Interdisciplinary Primary Care, Women’s and Children’s Health. Add rows and columns as needed. Family Internal Other Facility Type Ob-Gyn Pediatrics Psychiatry Surgery Medicine Medicine (list) University Hospital Clinic Community Hospital Clinic Health Center Private Physician Office LCME® Data Collection Instrument, Full, 2017-18

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Rural Clinic/AHEC Other Type of Site (list)

5.5 NARRATIVE RESPONSE a. Describe how the medical school determines that the mix of inpatient and ambulatory settings used for required clinical clerkships provides adequate numbers and types of patients in each discipline. b. Describe any substantive changes anticipated by the medical school over the next three years in hospital and other clinical affiliations.

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5.6 CLINICAL INSTRUCTIONAL FACILITIES/INFORMATION RESOURCES Each hospital or other clinical facility affiliated with a medical school that serves as a major location for required clinical learning experiences has sufficient information resources and instructional facilities for medical student education. 5.6 SUPPORTING DATA Table 5.6-1 | Inpatient Hospital Clerkship Resources List each hospital used for the inpatient portion of one or more required clinical clerkships. Indicate whether the indicated resource is available for medical student use by placing an “X” in the appropriate column heading. Schools with regional campuses should include the campus name for each facility. Add rows as needed. Facility Name/ Lecture / Locker/Secure Study Areas Computers Call Rooms Campus (if applicable) Conf. Rooms Storage

Table 5.6-2 | Inpatient Hospital Clerkship Resources by Curriculum Year As available, provide data from a single, recent academic year from either the independent student analysis, clerkship evaluations, or other source, on student satisfaction with the resources pertaining to education available at hospitals used for the inpatient and outpatient portions of required clinical clerkships. Add rows for each relevant question, and indicate the year and source of these data. Survey Question YEAR 3 YEAR 4 Data year and source:

5.6 NARRATIVE RESPONSE a. Comment on the adequacy of resources to support medical student education at each inpatient site used for required core clinical clerkships, including space for clinical teaching (conferences/rounds), access to library resources, information technology (computers and internet access), and study space. b. If problems with the availability of resources were identified at one or more sites, provide the data by site and describe the steps being taken to address any identified problems.

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5.7 SECURITY, STUDENT SAFETY, AND DISASTER PREPAREDNESS A medical school ensures that adequate security systems are in place at all locations and publishes policies and procedures to ensure student safety and to address emergency and disaster preparedness. 5.7 SUPPORTING DATA

Table 5.7-1 | Student Safety and Security by Curriculum Year As available, provide data from the independent student analysis, by curriculum year, on the percentage of respondents who were satisfied/very satisfied (aggregated) with safety and security at all instructional sites. Add rows for each relevant question on the student survey, and/or for instructional sites. Instructional Site/Survey Question YEAR 1 YEAR 2 YEAR 3 YEAR 4

5.7 NARRATIVE RESPONSE a. Describe the security system(s) in place and the personnel available to provide a safe learning environment for medical students during the following times/situations. If the medical school has regional campuses, describe the security systems in place at each campus. 1. During regular classroom hours on campus 2. Outside of regular classroom hours on campus 3. At clinical teaching sites b. Describe the protections available to medical students at instructional sites that may pose special physical dangers (e.g., during interactions with patients in detention facilities). c. Describe how medical students and faculty are informed of institutional emergency and disaster preparedness policies and plans. SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 5.7

1. Copies of medical school or university emergency and disaster preparedness policies, procedures, and plans, as they relate to medical students, faculty, and staff.

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5.8 LIBRARY RESOURCES/STAFF A medical school provides ready access to well-maintained library resources sufficient in breadth of holdings and technology to support its educational and other missions. Library services are supervised by a professional staff that is familiar with regional and national information resources and data systems and is responsive to the needs of the medical students, faculty members, and others associated with the institution. 5.8 SUPPORTING DATA Table 5.8-1 | Student Satisfaction with the Library Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of respondents who were satisfied/very satisfied (aggregated) with the library. GQ 2015 GQ 2016 GQ 2017 School % National % School % National % School % National %

Table 5.8-2 | Student Satisfaction with the Library by Curriculum Year As available, provide data from the independent student analysis, by curriculum year, on the percentage of respondents who were satisfied/very satisfied (aggregated) with the library and library resources. Add rows for each additional question on the student survey. Survey Question YEAR 1 YEAR 2 YEAR 3 YEAR 4 Ease of access to library resources and holdings Quality of library support and services

Table 5.8-3 | Medical School Library Resources and Space Provide the following information for the most recent academic year. Schools with regional campuses may add rows for each additional library. Total current journal # of book titles # of Total user # of public Library/ Campus (as appropriate) subscriptions (all formats) (all formats) databases seating workstations

Table 5.8-4 | Medical School Library Staffing Provide the number of staff FTEs in the following areas, using the most recent academic year. Schools with regional campuses may add rows for each additional library/campus. Technical and Part-time Staff Professional Staff Paraprofessional Staff (e.g., student workers)

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5.8 NARRATIVE RESPONSE a. Provide the title and organizational locus of the individual to whom the library director reports. b. Describe whether the library staff is involved in curriculum planning, curriculum governance (e.g., by participation in the curriculum committee or its subcommittees), or in the delivery of any part of the medical education program? c. List any other schools and/or programs served by the main medical school library. d. Describe medical student and faculty access to electronic and other library resources across all sites, including regional campuses. Are the library collections listed above available to medical students and faculty at sites separate from the medical school campus? e. Briefly summarize any partnerships that extend the library’s access to information resources. For example, does the library interact with other university and/or affiliated hospital libraries? f.

List the regular library hours. If there are additional hours during which medical students have access to all or part of the library for study, provide these as well.

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5.9 INFORMATION TECHNOLOGY RESOURCES/STAFF A medical school provides access to well-maintained information technology resources sufficient in scope to support its educational and other missions. The information technology staff serving a medical education program has sufficient expertise to fulfill its responsibilities and is responsive to the needs of the medical students, faculty members, and others associated with the institution. 5.9 SUPPORTING DATA Table 5.9-1 | Student Satisfaction with Computer Resource Center Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on percentage of respondents who were satisfied/very satisfied (aggregated) with the computer resource center. GQ 2015 GQ 2016 GQ 2017 School % National % School % National % School % National %

Table 5.9-2 | Student Satisfaction with IT Resources by Curriculum Year As available, provide data from the independent student analysis, by curriculum year, on the percentage of respondents who were satisfied/very satisfied (aggregated) with computer/IT resources. Add rows for each additional question area on the student survey. Schools with regional campuses should specify the campus in each row. Survey Question (Campus as applicable) YEAR 1 YEAR 2 YEAR 3 YEAR 4 Accessibility of computer support Adequacy of computer learning resources

Table 5.9-3 | Medical School IT Resources Provide the following information based on the most recent academic year. Schools with regional campuses should specify the campus in each row. Are there sufficient electrical Is there a wireless How many How many outlets Is there a wireless network in computer computers or in educational Campus network classrooms and classrooms are workstations are in spaces to (if applicable) on campus? study spaces? accessible to each computer allow (Y/N) (Y/N) medical students? classroom? computer use? (Y/N)

Table 5.9-4 | Medical School IT Services Staffing Provide the number of IT staff FTEs in the following areas, using the most recent academic year. Schools with regional campuses may add rows for each additional campus. Total # of Technical and Part-time Staff IT Staff Professional Staff Support Staff (e.g., student workers) FTEs

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5.9 NARRATIVE RESPONSE a. If a wireless network is not available in classrooms and study spaces, describe the adequacy of internet access points in educational spaces (e.g., in large classrooms, small classrooms, student study space). b. Describe the availability of telecommunications technology that links all instructional sites/campuses and how Information Technology (IT) services support(s) the delivery of distributed education. Describe how medical students, residents, and faculty are able to access educational resources (e.g., curriculum materials) from offcampus sites. c. Provide the title and organization focus of the individual to whom the medical school IT director reports. List any other schools or programs served by the IT services unit(s). d. How does the medical school assess the adequacy of information technology resources to support the educational program? e. Describe the ways that staff members in the IT services unit are involved in curriculum planning and delivery for the medical school. For example, do IT services staff assist faculty in developing instructional materials, assist in developing or maintaining the curriculum database or other curriculum management applications, or help faculty learn to use the technology for distance education?

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5.10 RESOURCES USED BY TRANSFER/VISITING STUDENTS The resources used by a medical school to accommodate any visiting and transfer medical students in its medical education program do not significantly diminish the resources available to already enrolled medical students. 5.10 SUPPORTING DATA Table 5.10-1 | Visiting/Transfer Students Provide the number of visiting and transfer students for each indicated academic year. 2014-15 2015-16 Transfer students into the second year (or into the preclerkship phase for a three-year program) Transfer students into the third year (or into the beginning of the clerkship phase for a three-year program) Transfer students into the fourth year (or the third year of a three-year program) Visiting students completing required core clerkships Visiting students completing clinical electives and/or other courses

2016-17

5.10 NARRATIVE RESPONSE a. Describe how and by whom the following decisions are made: 1. The number of transfer students to be accepted into each year of the curriculum 2. The number of visiting students accepted for electives by departments b. Describe how the medical school ensures that resources are adequate to support the numbers of transfer and visiting students that are accepted. c. Describe who is responsible for maintaining an accurate roster of visiting medical students and ensuring that the program’s requirements for visiting medical students are being met.

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5.11 STUDY/LOUNGE/STORAGE SPACE/CALL ROOMS A medical school ensures that its medical students have, at each campus and affiliated clinical site, adequate study space, lounge areas, personal lockers or other secure storage facilities, and secure call rooms if students are required to participate in late night or overnight clinical learning experiences. 5.11 SUPPORTING DATA Table 5.11-1 | Student Satisfaction with Study Space Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of respondents who were satisfied/very satisfied (aggregated) with study space. GQ 2015 GQ 2016 GQ 2017 School % National % School % National % School % National %

Table 5.11-2 | Student Satisfaction with Study Space by Curriculum Year As available, provide data from the independent student analysis, by curriculum year, on the percentage of respondents who were satisfied/very satisfied (aggregated) with study space. Add rows for each additional question area on the student survey. Survey Question YEAR 1 YEAR 2 YEAR 3 YEAR 4 Adequacy of student study space Table 5.11-3 | Student Satisfaction with Relaxation Space Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of respondents who were satisfied/very satisfied (aggregated) with relaxation space. GQ 2015 GQ 2016 GQ 2017 School % National % School % National % School % National %

Table 5.11-4 | Student Satisfaction with Relaxation Space by Curriculum Year As available, provide data from the independent student analysis, by curriculum year, on the percentage of respondents who were satisfied/very satisfied (aggregated) with available relaxation space. Add rows for each additional question on the student survey. Survey Question YEAR 1 YEAR 2 YEAR 3 YEAR 4 Adequacy of student relaxation space Table 5.11-5 | Study Space Place an “X” under each type of study space available at the listed locations. If a type of study space is not available at all affiliated hospitals or regional campuses, describe the locations where study space is available for these students. Central Campus Affiliated Regional Campus(es) Library Classroom Hospitals Building(s) Small room used only for group study Classroom that may be used for study when free Individual study room Individual study carrel Individual open seating

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Table 5.11-6 | Call Room Availability List each hospital used for a required clinical clerkship at all locations, including regional campuses. Place a “Y” under each column as appropriate. Call rooms available for medical Hospital Call in one or more clerkships? students?

5.11 NARRATIVE RESPONSE a. Describe the locations of lounge/relaxation space and personal lockers or other secure storage areas for student belongings on the central campus, at each facility used for required clinical clerkships, and on each regional campus (if applicable) for students in the pre-clerkship and clerkship portions of the curriculum. Note if the space is solely for medical student use or if it is shared with others. b. Describe the availability and accessibility of secure call rooms, if needed for overnight call, at each site used for required clinical clerkships.

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5.12 REQUIRED NOTIFICATIONS TO THE LCME A medical school notifies the LCME of any substantial change in the number of enrolled medical students; of any decrease in the resources available to the institution for its medical education program, including faculty, physical facilities, or finances; of its plans for any major modification of its medical curriculum; and/or of anticipated changes in the affiliation status of the program’s clinical facilities. The program also provides prior notification to the LCME if it plans to increase entering medical student enrollment on the main campus and/or in one or more existing regional campuses above the threshold of 10 percent, or 15 medical students in one year or 20 percent in three years; or to start a new or to expand an existing regional campus; or to initiate a new medical education track. 5.12 SUPPORTING DATA Table 5.12-1 | New Medical Student Admissions Provide the number of new medical students (not repeating students) admitted in each of the indicated academic years. AY 2013-14 AY 2014-15 AY 2015-16 AY 2016-17 AY 2017-18

5.12 NARRATIVE RESPONSE a. If the class size increased over any of the indicated thresholds, was the LCME notified?

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 5.12 1. Examples of any notifications made to the LCME of changes in medical student enrollment, curriculum, finances, clinical affiliations, and/or other institutional resources.

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STANDARD 6: COMPETENCIES, CURRICULAR OBJECTIVES, AND CURRICULAR DESIGN The faculty of a medical school define the competencies to be achieved by its medical students through medical education program objectives and is responsible for the detailed design and implementation of the components of a medical curriculum that enable its medical students to achieve those competencies and objectives. Medical education program objectives are statements of the knowledge, skills, behaviors, and attitudes that medical students are expected to exhibit as evidence of their achievement by completion of the program. STANDARD 6 SUPPORTING DOCUMENTATION Table 6.0-1 | Year/Phase 1 Instructional Formats Using the most recently completed academic year, list each course from year/academic period one of the curriculum and provide the total number of instructional hours for each listed instructional format. Note that “small group” includes case-based or problem-solving sessions. Provide the total number of hours per course and instructional format. If “other” is selected, describe the other format in the text. Add rows as needed. Number Of Formal Instructional Hours Per Course Patient Course Small Group Lecture Lab Contact Other Total Total

Table 6.0-2 | Year/Phase 2 Instructional Formats Using the most recently-completed academic year, list each course from year/academic period two of the curriculum and provide the total number of instructional hours for each listed instructional format. Note that “small group” includes case-based or problem-solving sessions. Provide the total number of hours per course and instructional format. If “other” is selected, describe the other format in the text. Provide a definition of “other” if selected. Add rows as needed. Number Of Formal Instructional Hours Per Course Small Patient Course Lecture Lab Group Contact Other Total Total

Table 6.0-3 | Year/Phase 3-4 Weeks/Clerkship Length and Formal Instructional Hours per Clerkship Provide data from the most recently-completed academic year on the total number of weeks and formal instructional hours (lectures, conferences, and teaching rounds) for each required clerkship in years three-four of the curriculum. Provide a range of hours if there is significant variation across sites. Note that hours devoted to patient care activities should NOT be included. Clerkship Total Weeks Typical Hours per Week of Formal Instruction

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STANDARD 6 NARRATIVE RESPONSE a. Describe the general structure of the curriculum by year. b. Provide a separate, brief description of each parallel curriculum (“track”). Include the following information in each description, and highlight the difference(s) from the curriculum of the standard medical education program: 1. 2. 3. 4.

The location of the parallel curriculum (main campus or geographically distributed campus) The year the parallel curriculum was first offered The focus of the parallel curriculum, including the additional objectives that students must master The general curriculum structure (including the sequence of courses/clerkships in each curriculum year/phase) 5. The number of students participating in each year of the parallel curriculum

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6.1 PROGRAM AND LEARNING OBJECTIVES The faculty of a medical school define its medical education program objectives in outcome-based terms that allow the assessment of medical students’ progress in developing the competencies that the profession and the public expect of a physician. The medical school makes these medical education program objectives known to all medical students and faculty. In addition, the medical school ensures that the learning objectives for each required learning experience (e.g., course, clerkship) are made known to all medical students and those faculty, residents, and others with teaching and assessment responsibilities in those required experiences. 6.1 SUPPORTING DATA Table 6.1-1 | Competencies, Program Objectives, and Outcome Measures List each general competency expected of graduates, the related medical education program objectives, and the outcome measure(s) specifically used to assess students’ attainment of each related objective and competency. Add rows as needed. General Competency Medical Education Program Objective(s) Outcome Measure(s) for Objective

6.1 NARRATIVE RESPONSE a. Provide the year in which the current medical education program objectives were last reviewed and approved. b. Describe the process used to develop the medical education program objectives and to link them to relevant competencies. Identify the groups that were responsible for development, review, and approval of the most recent version of the medical education program objectives. c. Describe how the medical school has identified specific outcome measures and linked them to each medical education program objective. How does the medical school ensure that the outcome measures selected are sufficiently specific to allow a judgment that each of the medical education program objectives have been met? d. Describe how medical education program objectives are disseminated to each of the following groups: 1. Medical students 2. Faculty with responsibility for teaching, supervising, and/or assessing medical students 3. Residents with responsibility for teaching, supervising, and/or assessing medical students e. Describe how learning objectives for each required course and clerkship are disseminated to each of the following groups: 1. Medical students 2. Faculty with responsibility for teaching, supervising, and/or assessing medical students in that course or clerkship 3. Residents with responsibility for teaching, supervising, and/or assessing medical students in that course or clerkship Also see the response to element 9.1

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6.2 REQUIRED CLINICAL EXPERIENCES The faculty of a medical school define the types of patients and clinical conditions that medical students are required to encounter, the skills to be performed by medical students, the appropriate clinical settings for these experiences, and the expected levels of medical student responsibility. 6.2 SUPPORTING DATA Table 6.2-1 | Required Clinical Experiences For each required clinical clerkship or discipline within a longitudinal integrated clerkship, list and describe each patient type/clinical condition, required procedure/skill, and clinical setting that medical students are required to encounter, along with the corresponding level(s) of student responsibility. Clerkship/Clinical Patient Type/ Level of Student Procedures/Skills Clinical Setting(s) Discipline Clinical Condition Responsibility

6.2 NARRATIVE RESPONSE a. Provide a definition for the terms used under “Levels of Student Responsibility” in table 6.2-1. b. Describe how and by what individuals/groups the list of required clinical encounters and procedural skills was initially developed, reviewed, and approved. Note if the curriculum committee or other central oversight body (e.g., a clerkship directors committee) played a role in reviewing and approving the list of patient types/clinical conditions and skills across courses and clerkships. c. Describe which individuals and/or groups developed the list of alternatives designed to remedy gaps when students are unable to access a required encounter or perform a required skill. How was the list developed? Which individuals and groups approved the list? d. Describe how medical students, faculty, and residents are informed of the required clinical encounters and skills.

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6.3 SELF-DIRECTED AND LIFE-LONG LEARNING The faculty of a medical school ensure that the medical curriculum includes self-directed learning experiences and time for independent study to allow medical students to develop the skills of lifelong learning. Self-directed learning involves medical students’ self-assessment of learning needs; independent identification, analysis, and synthesis of relevant information; and appraisal of the credibility of information sources. 6.3 SUPPORTING DOCUMENTATION Table 6.3-1 Self-Directed Learning Provide data from the independent student analysis by curriculum year on student satisfaction (somewhat satisfied/very satisfied) with the following. Add rows for each additional question on the student survey. Survey Question YEAR 1 YEAR 2 YEAR 3 YEAR 4 Opportunities for self-directed learning in the first/second years Overall workload in the first/second years 6.3 NARRATIVE RESPONSE a. Describe the learning activities, and the courses in which these learning activities occur during the first two years (phases) of the curriculum, where students engage in all of the following components of self-directed learning as a unified sequence (use the names of relevant courses and clerkships from the Overview tables when answering): 1. 2. 3. 4.

Identify, analyze, and synthesize information relevant to their learning needs Assess the credibility of information sources Share the information with their peers and supervisors Receive feedback on their information-seeking skills

b. Referring to the sample weekly schedules requested below, describe the amount of unscheduled time in an average week available for medical students to engage in self-directed learning and independent study in the first two years (phases) of the curriculum. c. Note if medical students in the first two years (phases) of the curriculum have required activities outside of regularly-scheduled class time, such as assigned reading or online modules that include information to prepare them for in-class activities. Do not include time for regular study or review. Estimate the average amount of time students spend in such required activities and how this “out-of-class” time is accounted for in calculating student academic workload. d. Briefly summarize the content of any policies covering the amount of time per week that students spend in required activities during the pre-clerkship phase of the curriculum. Note whether the policy addresses only in-class activities or also includes required activities assigned to be completed outside of scheduled class time. How is the effectiveness of the policy or policies evaluated? e. Describe the frequency with which the curriculum committee and/or its relevant subcommittee(s) monitor the academic workload of medical students and their time for independent study in the pre-clerkship phase of the curriculum.

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SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 6.3 1. Sample weekly schedules that illustrate the amount of time in the pre-clerkship years of the curriculum that medical students spend in scheduled activities. 2. Formal policies or guidelines addressing the amount of scheduled time during a given week during the preclerkship phase of the curriculum.

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6.4 INPATIENT/OUTPATIENT EXPERIENCES The faculty of a medical school ensure that the medical curriculum includes clinical experiences in both outpatient and inpatient settings. 6.4 SUPPORTING DATA Table 6.4-1 | Percent Total Clerkship Time Provide the percentage of time that medical students spend in inpatient and ambulatory settings in each required clinical clerkship. If clerkship names differ from those in the table, substitute the name used by the medical school. If the amount of time spent in each setting varies across sites, provide a range. Percentage of Total Clerkship Time % Ambulatory % Inpatient Family medicine Internal medicine Ob-Gyn Pediatrics Psychiatry Surgery Other (list)

6.4 NARRATIVE RESPONSE a. Describe how the curriculum committee or other authority for the curriculum reviews the balance between inpatient and ambulatory experiences so as to ensure that medical students spend sufficient time in each type of setting to meet the objectives for clinical education and the expectations for required clinical encounters.

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6.5 ELECTIVE OPPORTUNITIES The faculty of a medical school ensure that the medical curriculum includes elective opportunities that supplement required learning experiences and that permit medical students to gain exposure to and deepen their understanding of medical specialties reflecting their career interests and to pursue their individual academic interests. 6.5 SUPPORTING DATA Table 6.5-1 | Required Elective Weeks Provide the number of required weeks of elective time in each year of the curriculum. Year Total Required Elective Weeks 1 2 3 4

6.5 NARRATIVE RESPONSE a. Describe the policies or practices that require or encourage medical students to use electives to pursue a broad range of interests in addition to their chosen specialty.

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6.6 SERVICE-LEARNING The faculty of a medical school ensure that the medical education program provides sufficient opportunities for, encourages, and supports medical student participation in service-learning and community service activities. 6.6 NARRATIVE RESPONSE a. Summarize the opportunities, as available, for medical students to participate in the following categories of service learning, including the general types of service-learning/community service activities that are available. See the Glossary of Terms for LCME Accreditation Standards and Elements at the end of this DCI for the LCME definition of service-learning. 1. Required service learning 2. Voluntary service learning/community service b. Describe how medical student participation in service-learning and community service activities is encouraged. How are students informed about the availability of these activities? c. Describe how the medical school supports service-learning activities through the provision of funding or staff support. d. Provide and discuss data from the Independent Student Analysis on student satisfaction with opportunities to participate in service-learning.

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6.7 ACADEMIC ENVIRONMENTS The faculty of a medical school ensure that medical students have opportunities to learn in academic environments that permit interaction with students enrolled in other health professions, graduate and professional degree programs, and in clinical environments that provide opportunities for interaction with physicians in graduate medical education programs and in continuing medical education programs. 6.7 SUPPORTING DATA Table 6.7-1 | Master’s and Doctoral Degree Students Taught by Medical School Faculty List the number of students enrolled in master’s and doctoral degree programs taught by medical school faculty. Include degree programs in the where students are taught by medical school faculty. Add rows as needed. Department or Program # of Master’s Students # of Doctoral Students

Table 6.7-2 | Graduate Medical Students Provide the total number of residents and clinical fellows on duty in ACGME-accredited programs that are the responsibility of the medical school faculty for the indicated academic years. If the medical school has one or more geographically distributed campuses, provide the campus in the first column. Also see the response to element 3.1. Campus AY 2014-15 AY 2015-16 AY 2016-17 AY 2017-18 (if more than one) Fellows: Residents:

Table 6.7-3 | Continuing Medical Education If the medical school and/or its clinical affiliates are accredited by the ACCME to sponsor continuing medical education for physicians, use the table below, adding rows as needed, to indicate each sponsoring organization’s current accreditation status, the length of accreditation granted, and the year of the next accreditation review. Program Sponsor Accreditation Status Length of Accreditation Term

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6.7 NARRATIVE RESPONSE a. List the health professions/professional degree programs located at the same campus as the medical school. b. Describe examples of formal and informal opportunities available for medical students to interact with students in graduate programs and how the medical school encourages such interactions. Also see the response to element 7.9 for required experiences with students in other health professions programs. c. Describe how medical students are exposed to continuing medical education activities for physicians and note if student participation in any continuing medical education programs is expected or required.

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6.8 EDUCATION PROGRAM DURATION A medical education program includes at least 130 weeks of instruction. 6.8 SUPPORTING DATA

Table 6.8-1 | Number of Scheduled Weeks per Year Use the table below to report the number of scheduled weeks of instruction in each academic year/phase of the medical curriculum (do not include vacation time). Refer to the overview section if the medical school offers one or more parallel curricula (tracks). Curriculum Year/Phase Number of Scheduled Weeks Year/Phase One Year/Phase Two Year/Phase Three Year/Phase Four Total Weeks of Scheduled Instruction

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STANDARD 7: CURRICULAR CONTENT The faculty of a medical school ensure that the medical curriculum provides content of sufficient breadth and depth to prepare medical students for entry into any residency program and for the subsequent contemporary practice of medicine. STANDARD 7 SUPPORTING DOCUMENTATION Table 7.0-1 | General Medical Education - Preparation for Residency Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of respondents who agree/strongly agree (aggregated) that they are prepared in the following ways to begin a residency program. GQ 2015 GQ 2016 GQ 2017 School % National % School % National % School % National % Acquired an understanding of common conditions and their management. Acquired basic skills in clinical decisionmaking and application of evidence-based information.

1. A schematic or diagram that illustrates the structure of the curriculum for the year of the self-study. The schematic or diagram should show the approximate sequencing of, and relationships among, required courses and clerkships in each academic period of the curriculum. 2. If the structure of the curriculum has changed significantly since the DCI and self-study were completed (i.e., a new curriculum or curriculum year has been implemented), include a schematic of the new curriculum, labeled with the year it was first introduced. 3. A schematic of any parallel curricula (tracks).

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7.1 BIOMEDICAL, BEHAVIORAL, SOCIAL SCIENCES The faculty of a medical school ensure that the medical curriculum includes content from the biomedical, behavioral, and socioeconomic sciences to support medical students' mastery of contemporary scientific knowledge and concepts and the methods fundamental to applying them to the health of individuals and populations. 7.1 SUPPORTING DATA Table 7.1-1 | Curricular Content For each topic area, place an “X” in the appropriate column to indicate whether the topic is taught separately as an independent required course and/or as part of a required integrated course. Place an “X” under each column to indicate the year(s) in which the learning objectives related to each topic are taught and assessed. Course Type Years/Phases Topic Areas Are Taught and Assessed Topic Areas Year/Phase Year/Phase Three Independent Integrated Year/Phase One Two and/or Four Course Course(s) Biochemistry Biostatistics and epidemiology Genetics Gross Anatomy Immunology Microbiology Pathology Pharmacology Physiology Behavioral Science Pathophysiology Table 7.1-2 | Basic Science Education Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of respondents who rated preparation for clinical clerkships and electives as excellent or good (aggregated) in the following sciences basic to medicine. GQ 2015 GQ 2016 GQ 2017 School % National % School % National % School % National % Biochemistry Biostatistics and epidemiology Genetics Gross Anatomy Immunology Microbiology Pathology Pharmacology Physiology Behavioral Science Pathophysiology of disease

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Table 7.1-3 | Curricular Content For each topic area, place an “X” in the appropriate column to indicate whether the topic is taught separately as an independent required course and/or as part of a required integrated course. Place an “X” under each column to indicate the year(s) in which the learning objectives related to each topic are taught and assessed. Years/Phases Topic Areas are Taught and Course Type Assessed Year/Phase Independent Integrated Year/Phase Year/Phase Three and/or Course Course(s) One Two Four Biomedical informatics Complementary/alternative health care Evidence-based medicine Global health issues Health care financing Human development/life cycle Human sexuality Law and medicine Medication management/compliance Medical socioeconomics Nutrition Pain management Palliative care Patient safety Population-based medicine

Table 7.1-4 | General Medical Education - Preparation for Residency Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of respondents who agree/strongly agree (aggregated) that they are prepared in the following area to begin a residency program: Fundamental understanding of the issues in social sciences of medicine (e.g., ethics, humanism, professionalism, organization and structure of the health care system). GQ 2015 GQ 2016 GQ 2017 School % National % School % National % School % National %

7.1 NARRATIVE RESPONSE a. Summarize any recent changes (e.g., in the last two academic years) in the extent or curricular placement of any of the content areas included in the tables above.

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7.2 ORGAN SYSTEMS/LIFE CYCLE/PRIMARY CARE/PREVENTION/WELLNESS/ SYMPTOMS/SIGNS/DIFFERENTIAL DIAGNOSIS, TREATMENT PLANNING, IMPACT OF BEHAVIORAL AND SOCIAL FACTORS The faculty of a medical school ensure that the medical curriculum includes content and clinical experiences related to each organ system; each phase of the human life cycle; continuity of care; and preventive, acute, chronic, rehabilitative, end-of-life, and primary care in order to prepare students to:     

Recognize wellness, determinants of health, and opportunities for health promotion and disease prevention Recognize and interpret symptoms and signs of disease Develop differential diagnoses and treatment plans Recognize the potential health-related impact on patients of behavioral and socioeconomic factors Assist patients in addressing health-related issues involving all organ systems

7.2 SUPPORTING DATA Table 7.2-1 | General Medical Education Provide data from the independent student analysis on the percentage of students in each class who were satisfied with the adequacy of their education in the following content areas. Year/Phase One Year/Phase Two Year/Phase Three Year/Phase Four Education to diagnose disease Education to manage disease Education in disease prevention Education in health maintenance

7.2 NARRATIVE RESPONSE a. Describe the location(s) in the pre-clerkship and clinical curriculum in which objectives related to the subjects listed below are taught and assessed. Refer to the overview section in the responses. 1. 2. 3. 4. 5.

Normal human development Adolescent medicine Geriatrics Continuity of care End of life care

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7.3 SCIENTIFIC METHOD/CLINICAL/ TRANSLATIONAL RESEARCH The faculty of a medical school ensure that the medical curriculum includes instruction in the scientific method (including hands-on or simulated exercises in which medical students collect or use data to test and/or verify hypotheses or address questions about biomedical phenomena) and in the basic scientific and ethical principles of clinical and translational research (including the ways in which such research is conducted, evaluated, explained to patients, and applied to patient care). 7.3 NARRATIVE RESPONSE a. List the course(s) that include instruction in and assessment of content related to the scientific method. Include hands-on or simulated exercises in which medical students collect or use data to test and/or verify hypotheses or to experimentally study biomedical phenomena. Do NOT include laboratory sessions where the main purpose is observation or description (such as gross anatomy or histology). For each listed experience, include the format used for the exercise (e.g., hands-on laboratory sessions, simulations). b. List all required courses and clerkships that include formal learning objectives that address the basic scientific and/or ethical principles of clinical and translational research and the methods for conducting such research. Note the location(s) in the curriculum in which medical students learn how such research is conducted, evaluated, explained to patients, and applied to patient care and how students’ acquisition of this knowledge is assessed.

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7.4 CRITICAL JUDGMENT/PROBLEM-SOLVING SKILLS The faculty of a medical school ensure that the medical curriculum incorporates the fundamental principles of medicine, provides opportunities for medical students to acquire skills of critical judgment based on evidence and experience, and develops medical students' ability to use those principles and skills effectively in solving problems of health and disease. 7.4 SUPPORTING DATA Table 7.4-1 | Critical Content and Problem Solving For each topic area, place an “X” in the appropriate column to indicate whether the topic is taught separately as an independent required course and/or as part of a required integrated course. Place an “X” under each column to indicate the year(s) in which the learning objectives related to each topic are taught and assessed. Course Type Years/Phases Topic Areas Are Taught/Assessed Topic Areas Independent Integrated One Two Three Four Course Course(s) Skills of critical judgment based on evidence Skills of medical problem solving

7.4 NARRATIVE RESPONSE a. Provide two detailed examples from the pre-clerkship phase of the curriculum of where students demonstrate and are assessed on each of the following skills. In each description, include the courses/clerkships where this instruction and assessment occurs and provide the relevant learning objectives. 1. Skills of critical judgment based on evidence and experience 2. Skills of medical problem solving

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7.5 SOCIETAL PROBLEMS The faculty of a medical school ensure that the medical curriculum includes instruction in the diagnosis, prevention, appropriate reporting, and treatment of the medical consequences of common societal problems. 7.5 NARRATIVE RESPONSE a. Describe the process used by faculty in the selection of societal problems included in the curriculum. b. Describe five common societal problems that are taught and assessed in the curriculum. For each of the five: 1. Describe where and how content related to the societal problem is taught in the curriculum. 2. Provide the relevant course and clerkship objectives that address the diagnosis, prevention, appropriate reporting (if relevant), and treatment of the medical consequences of these societal problem.

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7.6 CULTURAL COMPETENCE AND HEALTH CARE DISPARITIES The faculty of a medical school ensure that the medical curriculum provides opportunities for medical students to learn to recognize and appropriately address gender and cultural biases in themselves, in others, and in the health care delivery process. The medical curriculum includes instruction regarding the following:     

The manner in which people of diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments The basic principles of culturally competent health care The recognition and development of solutions for health care disparities The importance of meeting the health care needs of medically underserved populations The development of core professional attributes (e.g., altruism, accountability) needed to provide effective care in a multidimensional and diverse society

7.6 SUPPORTING DATA Table 7.6-1 | Cultural competence Provide the names of courses and clerkships that include objectives related to cultural competence in health care. For each, list the specific topic areas covered. Schools using the AAMC Tool for Assessing Cultural Competence Training (TACCT) may use the “Domains” table as a source for these data. Course/Clerkship Topic Area(s) Covered

Table 7.6-2 | Health Disparities, Demographic Influences, and Medically Underserved Populations Provide the names of courses and clerkships that include explicit learning objectives related to the listed topics areas. Topic Area(s) Covered Identifying and Providing Identifying Demographic Influences Meeting the Health Care Needs Course/Clerkship Solutions for Health on Health Care Quality and of Medically Underserved Disparities Effectiveness Populations

Table 7.6-3 | General Medical Education - Preparation for Residency Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of respondents who agree/strongly agree (aggregated) that they are prepared in the following area to begin a residency program: Prepared to care for patients from different backgrounds. GQ 2015 GQ 2016 GQ 2017 School % National % School % National % School % National %

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7.6 SUPPORTING DATA Table 7.6-4 Adequacy of Education Provide the percent of respondents to the ISA who were satisfied with the adequacy of education in caring for patients from different backgrounds. YEAR ONE YEAR TWO YEAR THREE YEAR FOUR

7.6 NARRATIVE RESPONSE a. Describe how the curriculum prepares medical students to be aware of their own gender and cultural biases and those of their peers and teachers.

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7.7 MEDICAL ETHICS The faculty of a medical school ensure that the medical curriculum includes instruction for medical students in medical ethics and human values both prior to and during their participation in patient care activities and requires its medical students to behave ethically in caring for patients and in relating to patients' families and others involved in patient care. 7.7 SUPPORTING DATA Table 7.7-1 | Medical Ethics For each topic area listed below, indicate whether the topic is taught separately as an independent required course and/or as part of a required integrated course and when in the curriculum these topics are included by placing an “X” in the appropriate columns. Course Type Years/Phases Topic Areas Are Taught/Assessed Independent Integrated One Two Three Four Course Course(s) Biomedical ethics Ethical decision-making Professionalism Table 7.7-2 | General Medical Education - Preparation for Residency Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of respondents who agree/strongly agree (aggregated) that they are prepared in the following area to begin a residency program: I understand the ethical and professional values that are expected of the profession. GQ 2015 GQ 2016 GQ 2017 School % National % School % National % School % National %

7.7 NARRATIVE RESPONSE a. Describe the methods used to assess medical students’ ethical behavior in the care of patients and to identify and remediate medical students’ breaches of ethics in patient care.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 7.7 1. Examples of instruments used in the formative and/or summative assessment of medical students’ ethical behavior during the pre-clerkship and clinical clerkship phases of the curriculum.

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7.8 COMMUNICATION SKILLS The faculty of a medical school ensure that the medical curriculum includes specific instruction in communication skills as they relate to communication with patients and their families, colleagues, and other health professionals. 7.8 SUPPORTING DATA Table 7.8-1 | Communication Skills Under each heading, provide the names of courses and clerkships that include explicit learning objectives related to the listed topics areas. Topic Areas Communicating with Non-physician Communicating with Patients Communicating with Physicians (e.g., Health Professionals and Patient’s Families as part of the medical team) (e.g., as part of the health care team)

Table 7.8-2 | General Medical Education - Preparation for Residency Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of respondents who agree/strongly agree (aggregated) that they are prepared in the following area to begin a residency program: Communication skills necessary to interact with patients and health professionals. GQ 2015 GQ 2016 GQ 2017 School % National % School % National % School % National %

7.8 NARRATIVE RESPONSE a. Describe the specific educational activities, including student assessment, and the relevant learning objectives included in the curriculum for each of the following topic areas: 1. Communicating with patients and patients’ families 2. Communicating with physicians (e.g., as part of the medical team) 3. Communicating with non-physician health professionals as members of the health care team

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7.9 INTERPROFESSIONAL COLLABORATIVE SKILLS The faculty of a medical school ensure that the core curriculum of the medical education program prepares medical students to function collaboratively on health care teams that include health professionals from other disciplines as they provide coordinated services to patients. These curricular experiences include practitioners and/or students from the other health professions. 7.9 SUPPORTING DATA Table 7.9-1 | Collaborative Practice Skills in Learning and Program Objectives Illustrate the linkage between course and clerkship learning objectives related to collaborative practice skills and the medical education program objectives. Course/Clerkship Learning Objective(s) Related Medical Education Program Objective(s) to Collaborative Practice Skills

7.9 NARRATIVE RESPONSE a. Provide three examples of required experiences where medical students are brought together with students or practitioners from other health professions to learn to function collaboratively on health care teams with the goal of providing coordinated services to patients. For each example, describe the following: 1. 2. 3. 4. 5. 6.

The name and curriculum year of the course or clerkship in which the experience occur The objectives of the experience related to the development of collaborative practice skills The duration of the experience (e.g., single session, course) The setting where the experience occurs (e.g., clinic, simulation center) The other health profession(s) students or practitioners involved The way(s) that the medical students’ attainment of the objectives of the experience is assessed

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 7.9 1. Sample copies of any forms used in the assessment of medical students’ collaborative practice skills. For each example, list the course or clerkship in which the form is used.

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STANDARD 8: CURRICULAR MANAGEMENT, EVALUATION, AND ENHANCEMENT The faculty of a medical school engage in curricular revision and program evaluation activities to ensure that that medical education program quality is maintained and enhanced and that medical students achieve all medical education program objectives and participate in required clinical experiences and settings. STANDARD 8 SUPPORTING DOCUMENTATION Table 8.0-1 | Overall Satisfaction Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of respondents who agree/strongly agree (aggregated) with the statement: “Overall, I am satisfied with the quality of my medical education.” GQ 2012 GQ 2013 GQ 2014 GQ 2015 GQ 2016 GQ 2017 School National School National School National School National School National School National % % % % % % % % % % % %

1. A summary of student feedback for each required course and clerkship for the past two academic years. If a course or clerkship is new or has been significantly revised so that only one year of data are available, provide evaluation data for the new version only. Include in each summary the percentage of students providing feedback. 2. An organizational chart for the management of the curriculum that includes the curriculum committee and its subcommittees, other relevant committees, the chief academic officer, and the individuals or groups with involvement in curriculum design, implementation, and evaluation.

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8.1 CURRICULAR MANAGEMENT A medical school has in place an institutional body (e.g., a faculty committee) that oversees the medical education program as a whole and has responsibility for the overall design, management, integration, evaluation, and enhancement of a coherent and coordinated medical curriculum. 8.1 NARRATIVE RESPONSE a. Provide the name of the faculty committee with primary responsibility for the curriculum. Describe the source of its authority (e.g., medical school faculty bylaws). b. Describe how the members and the chair of the curriculum committee are selected. Note if there are terms for committee members. How often does the curriculum committee meet? c. If there are subcommittees of the curriculum committee, describe the charge/role of each, along with its membership and reporting relationship to the parent committee. How often does each subcommittee meet? d. Describe how the curriculum committee and its subcommittees participate in the following: 1. Developing and reviewing the educational program objectives 2. Ensuring that there is horizontal and vertical curriculum integration (i.e., that curriculum content is coordinated and integrated within and across academic years/phases) 3. Monitoring the overall quality and outcomes of individual courses and clerkships 4. Monitoring the outcomes of the curriculum as a whole e. Provide two recent examples of course or clerkship evaluation data (or other information sources) being used by the curriculum committee to identify problem areas related to course or curriculum structure, delivery, or outcomes. Describe the steps taken by the curriculum committee and its subcommittees to address the identified problems and the results that were achieved.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 8.1 1. The charge to or the terms of reference of the curriculum committee. If the subcommittees of the curriculum committee have formal charges, include those as well. 2. A list of curriculum committee members, including their voting status and membership category (e.g., faculty, student, or administrator) 3. The minutes of four curriculum committee meetings over the past year that illustrate the activities and priorities of the committee. Note: Have available on-site for the survey team three years of curriculum committee minutes.

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8.2 USE OF MEDICAL EDUCATIONAL PROGRAM OBJECTIVES The faculty of a medical school, through the faculty committee responsible for the medical curriculum, ensure that the medical curriculum uses formally adopted medical education program objectives to guide the selection of curriculum content, review and revise the curriculum, and establish the basis for evaluating programmatic effectiveness. The faculty leadership responsible for each required course and clerkship link the learning objectives of that course or clerkship to the medical education program objectives. 8.2 NARRATIVE RESPONSE a. Describe how the medical education program objectives are used to guide the following activities: 1. The selection and appropriate placement of curriculum content within courses/clerkships and curriculum years/phases 2. The evaluation of curriculum outcomes b. Describe the roles and activities of course/clerkship faculty and the curriculum committee and its subcommittees in ensuring that course and clerkship learning objectives are linked to medical education program objectives. Note how the linkage is used in program evaluation and content selection/placement.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 8.2 1. One example from a course and one example from a clerkship illustrating the linkage of the learning objectives of the course and the clerkship to the medical education program objectives.

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8.3 CURRICULAR DESIGN, REVIEW, REVISION/CONTENT MONITORING The faculty of a medical school are responsible for the detailed development, design, and implementation of all components of the medical education program, including the medical education program objectives, the learning objectives for each required curricular segment, instructional and assessment methods appropriate for the achievement of those objectives, content and content sequencing, ongoing review and updating of content, and evaluation of course, clerkship, and teacher quality. These medical education program objectives, learning objectives, content, and instructional and assessment methods are subject to ongoing monitoring, review, and revision by the faculty to ensure that the curriculum functions effectively as a whole to achieve medical education program objectives. 8.3 NARRATIVE RESPONSE a. Describe the roles and activities of the course and clerkship directors and course and clerkship committees, the teaching faculty, the departments, and the chief academic officer/associate dean for the medical education program in the following areas. If other individuals or groups also play a role, include these in the description as well. 1. Developing the objectives for individual courses and clerkships 2. Identifying course and clerkship content, teaching formats, and assessment methods that are appropriate for the course/clerkship learning objectives 3. Evaluating the quality of individual faculty member teaching (e.g., through peer assessment of teaching or review of course content) 4. Monitoring the quality of individual faculty member teaching (e.g., through the review of student evaluations of courses and clerkships) 5. Evaluating the overall quality and outcomes of the course/clerkship b. Describe the process of formal review for each of the following curriculum elements. Include in the description the frequency with which such reviews are conducted, the process by which they are conducted, the administrative support available for the reviews (e.g., through an office of medical education), and the individuals and groups (e.g., the curriculum committee or a subcommittee of the curriculum committee) receiving the results of the evaluation. 1. 2. 3. 4.

Required courses in the pre-clerkship phase of the curriculum Required clerkships Individual years or phases of the curriculum The curriculum as a whole

c. Describe how and how often curriculum content is monitored. Provide examples of how monitoring of curriculum content has been used to identify gaps and unwanted redundancies in topic areas. Describe the tool(s) used for monitoring the content of the curriculum (i.e., the “curriculum database”). d. List the roles and titles of the individuals who have access to the curriculum database. List the roles and titles of the individuals who have responsibility for monitoring and updating its content. Note which individuals, committees, and units (e.g., departments) receive the results of the reviews of curriculum content.

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SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 8.3 1. Copies of any standardized templates used for course and/or clerkship reviews. 2. A sample review of a course and a clerkship. 3. The results of a search of the curriculum database for curriculum content related to the topics of “substance abuse” and “genetics.”

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8.4 PROGRAM EVALUATION A medical school collects and uses a variety of outcome data, including national norms of accomplishment, to demonstrate the extent to which medical students are achieving medical education program objectives and to enhance medical education program quality. These data are collected during program enrollment and after program completion. 8.4 SUPPORTING DATA Table 8.4-1 | USMLE Requirements for Advancement/Graduation Place an “X” in the appropriate columns to indicate if the school’s medical students are required to take and/or pass USMLE Step 1, Step 2 CK, and Step 2 CS for advancement and/or graduation. Take Pass Step 1 Step 2 CK Step 2 CS

Table 8.4-2 | Monitoring of Medical Education Program Outcomes Provide the individuals and/or groups in the medical school that are responsible for reviewing the results of each of the indicators that are used to evaluate medical education program quality and outcomes and how often the results are reviewed. Individuals and Groups How Often These Outcome Indicator Receiving the Data Results are Reviewed Results of USMLE or other national examinations Student scores on internally developed examinations Performance-based assessment of clinical skills (e.g., OSCEs) Student responses on the AAMC GQ Student advancement and graduation rates NRMP match results Specialty choices of graduates Assessment of residency performance of graduates Licensure rates of graduates Practice types of graduates Practice location of graduates

Table 8.4-3 | STEP 1 USMLE Results of First-time Takers Provide the requested Step 1 USMLE results of first-time takers during the three most recently completed years. Percent Passing Mean Total National Mean # Examined School/Nationa Score and SD Total Score and SD Year l Score SD Score SD

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Table 8.4-4 | STEP 2 CK USMLE Results of First-time Takers Provide the requested Step 2 CK USMLE results of first-time takers during the three most recently completed academic years. Mean Total National Mean Percent Passing Score and SD Total Score and SD Academic Year # Examined School/Nationa l Score SD Score SD

Table 8.4-5 | STEP 2 CS USMLE Results of First-time Takers Provide the requested Step 2 CS USMLE results of first-time takers during the three most recently completed academic years. Percent Passing Academic Year # Examined School/National

8.4 NARRATIVE RESPONSE a. Select three current educational program objectives as contained in the response to Element 6.1. Examples should come from the domains of knowledge, skills, and behaviors. For each objective, describe how the attainment of the objective has been evaluated and provide specific data illustrating the extent to which the objective is being met. b. Describe any efforts to address outcome measures that illustrate suboptimal performance by medical students/graduates in one or more of the educational program objectives. Provide two examples of the steps taken to address the gaps between desired and actual outcomes.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 8.4 1. Copies of printouts and graphs provided by the National Board of Medical Examiners that compare the performance of national and medical school first-time takers for USMLE Step 1, Step 2 CS, and Step 2 CK for the past three years/academic years. 2. Feedback from residency program directors and/or graduates on the graduates’ attainment of the school’s competencies/educational program objectives. If available, include data from the six month assessment of the graduate on the ACGME milestones for each specialty.

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8.5 MEDICAL STUDENT FEEDBACK In evaluating medical education program quality, a medical school has formal processes in place to collect and consider medical student evaluations of their courses, clerkships, and teachers, and other relevant information. 8.5 NARRATIVE RESPONSE a. Describe how and by whom evaluation data are collected from medical students on course and clerkship quality. b. Describe whether medical students provide evaluation data on individual faculty, residents, and others who teach and supervise them in required courses and clerkship rotations. c. Provide data from the independent student analysis on students’ satisfaction with the school’s responsiveness to student feedback on courses/clerkships.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 8.5 1. A copy of any standardized forms used by students in the evaluation of courses and/or clerkships. If there are no standardized forms, provide sample forms for individual courses and clerkships. Note if the forms are completed online or on paper. 2. The response rates to questionnaires completed by students during the most recently-completed academic year for each course and clerkship where student evaluation data are collected.

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8.6 MONITORING OF COMPLETION OF REQUIRED CLINICAL EXPERIENCES A medical school has in place a system with central oversight that monitors and ensures completion by all medical students of required clinical experiences in the medical education program and remedies any identified gaps. 8.6 SUPPORTING DATA

Table 8.6-1 | Alternative Clinical Experiences Provide all required clinical encounters/skills for each listed clerkship that were satisfied with alternative methods by 25% or more of students in the most recently-completed academic year, and describe what the alternative methods were (e.g., simulations, computer cases). Add rows as needed. Only schools with regional campuses need to specify the campus for each clerkship. Refer to element 6.2 for the list of required clinical encounters/skills. Clinical Encounters/Skills where Alternative Method(s) Used for Campus Alternative Methods were Used Remedying Clinical Encounter Gaps by 25% or More Students Family medicine Internal medicine Ob-Gyn Pediatrics Psychiatry Surgery

8.6 NARRATIVE RESPONSE a. Describe the process (es) used by students to log their required clinical encounters and skills. Is there a centralized tool used for logging or do individual clerkships use their own systems? b. Summarize when and how each student’s completion of clerkship-specific required clinical encounters and skills is monitored by the following individuals, including whether the results of monitoring are discussed with the students as part of a mid-clerkship review: 1. The student’s attending physician, supervising resident, preceptor 2. The clerkship director c. Summarize when, how, and by whom aggregate data on students’ completion of clerkship-specific required clinical encounters and skills is monitored. Describe how data on completion rates are used by clerkship directors and the curriculum committee and/or a relevant curriculum subcommittee to assess the adequacy of patient volume or case mix.

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8.7 COMPARABILITY OF EDUCATION/ASSESSMENT A medical school ensures that the medical curriculum includes comparable educational experiences and equivalent methods of assessment across all locations within a given course and clerkship to ensure that all medical students achieve the same medical education program objectives. 8.7 NARRATIVE RESPONSE a. Describe the following for each course or clerkship offered at more than one instructional site, including regional campus (es), (also see the response to element 2.6). 1.

The means by which faculty members at each instructional site are informed of and oriented to the core objectives, required clinical encounters and skills, assessment methods, and grading system for the course or clerkship.

2.

How and how often the individuals responsible for the course or clerkship communicate with faculty at each instructional site regarding course or clerkship planning and implementation, student assessment, and course evaluation.

3.

The mechanisms that are used to ensure that leadership/faculty at each site receive and review student evaluations of their educational experience, data regarding students’ completion of required clinical experiences and grades, and any other data reflecting the comparability of learning experiences across instructional sites. Describe the specific types of data reviewed and how the discussions of the data with site leadership and faculty occurs.

b. Describe the individuals (e.g., site director, clerkship director, department chair) and/or groups (curriculum committee or a curriculum committee subcommittee) responsible for reviewing and acting on information related to comparability across instructional sites. c. Provide examples of the mechanisms employed and the individuals involved in addressing inconsistencies across instructional sites in such areas as student satisfaction and student grades.

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8.8 MONITORING STUDENT TIME The medical school faculty committee responsible for the medical curriculum and the program’s administration and leadership ensure the development and implementation of effective policies and procedures regarding the amount of time medical students spend in required activities, including the total number of hours medical students are required to spend in clinical and educational activities during clerkships. 8.8 NARRATIVE RESPONSE a. Describe how policies relating to clerkship duty hours were developed and by what individuals and/or groups they were approved. b. Describe how policies relating to duty hours are disseminated to medical students, residents, and faculty. c. Describe how data on medical student duty hours are collected during the clerkship phase of the curriculum and to whom the data are reported. d. Describe the mechanisms that exist for students to report violations of duty hours policies. How and to whom can students report violations? Describe the steps that can be taken if duty hour limits are exceeded. e. Describe the frequency with which the curriculum committee or its relevant subcommittee(s) monitor the clinical workload of medical students, in the context of formal policies and/or guidelines. How is the effectiveness of policies determined?

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 8.8 1. The formal policy relating to duty hours for medical students during the clerkship phase of the curriculum, including on-call requirements for clinical rotations.

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STANDARD 9: TEACHING, SUPERVISION, ASSESSMENT, AND STUDENT AND PATIENT SAFETY A medical school ensures that its medical education program includes a comprehensive, fair, and uniform system of formative and summative medical student assessment and protects medical students’ and patients’ safety by ensuring that all persons who teach, supervise, and/or assess medical students are adequately prepared for those responsibilities. STANDARD 9 SUPPORTING DOCUMENTATION Table 9.0-1 | Methods of Assessment – Year/Phase One List all courses in the first year/phase of the curriculum, adding rows as needed. Indicate the total number of exams per course. Indicate items that contribute to a grade and whether narrative assessment for formative or summative purposes is provided by placing an “X” in the appropriate column. For faculty/resident ratings, include evaluations provided by faculty members or residents in clinical experiences and small group sessions (e.g., a facilitator evaluation in small group or case-based teaching). Use the row below the table to provide specifics for each occurrence of “Other.” Number each entry in that row (1, 2, etc.) and provide the corresponding number in the “Other” column. Number Included in Grade Lab or NBME Faculty/ Other* Narrative # of Internal OSCE/SP Paper or Course Name Practical Subject Resident (specify Assessment Exams Exam Exam Oral Pres. Exam Exam Rating ) Provided * Other:

Table 9.0-2 | Methods of Assessment – Year/Phase 2 List all courses in the second year/phase of the curriculum, adding rows as needed. Indicate the total number of exams per course. Indicate items that contribute to a grade and whether narrative assessment for formative or summative purposes is provided by placing an “X” in the appropriate column. For faculty/resident ratings, include evaluations provided by faculty members or residents in clinical experiences and small group sessions (e.g., a facilitator evaluation in small group or case-based teaching). Use the row below the table to provide specifics for each occurrence of “Other.” Number each entry in that row (1, 2, etc.) and provide the corresponding number in the “Other” column. Number Included in Grade Other* Narrative Faculty/ Lab or NBME Paper or OSCE/SP # of Internal (specify Assessment Resident Course Name Practical Subject Oral Pres. Exam Exams Exam ) Provided Rating Exam Exam * Other:

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Table 9.0-3 | Methods of Assessment – Year/Phase 3-4 List all required clerkships in the third and fourth years/third and fourth phases of the curriculum, adding rows as needed. Indicate items that contribute to a grade and whether narrative assessment for formative or summative purposes is provided by placing an “X” in the appropriate column. For faculty/resident ratings, include evaluations provided by faculty members or residents in clinical experiences. Use the row below the table to provide specifics for each occurrence of “Other.” Number each entry in that row (1, 2, etc.) and provide the corresponding number in the “Other” column. Included in Grade Narrative NBME Internal Oral Faculty/ OSCE/S Other* Course or Clerkship Assessment Subject Written Exam Resident P Exams (specify) Name Provided Exam Exams or Pres. Rating * Other:

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9.1 PREPARATION OF RESIDENT AND NON-FACULTY INSTRUCTORS In a medical school, residents, graduate students, postdoctoral fellows, and other non-faculty instructors in the medical education program who supervise or teach medical students are familiar with the learning objectives of the course or clerkship and are prepared for their roles in teaching and assessment. The medical school provides resources to enhance residents’ and non-faculty instructors’ teaching and assessment skills, and provides central monitoring of their participation in those opportunities. 9.1 SUPPORTING DATA Table 9.1-1 | Provision of Objectives and Orientation List each course or clerkship where residents, graduate students, postdoctoral fellows, and/or other non-faculty instructors teach medical students. Describe how the relevant department or the central medical school administration ensures that the objectives and orientation to the methods of assessment have been provided and that this information has been received and reviewed. Types of Trainees Who Provide How Objectives Are Provided Course or Clerkship Teaching/Supervision and Teachers Oriented

Table 9.1-2 | Resident Preparation to Teach Briefly summarize the preparation program(s) available to residents to prepare for their roles teaching and assessing medical students in required clinical clerkships. For each program, note whether it is sponsored by the department or the institution (D/I), whether the program is required or optional (R/O), and whether resident participation is centrally monitored (Y/N), and if so, by whom. Add rows as needed. Required/ Centrally Sponsorship Monitored By Program Name/Brief Summary Optional Monitored? (D/I) Whom? (R/O) (Y/N) Family medicine Internal medicine Ob/Gyn Pediatrics Psychiatry Surgery Other (list):

9.1 NARRATIVE RESPONSE a. Describe any institution-level (e.g., curriculum committee, GME office) policies that require the participation of residents and others (e.g., graduate students, postdoctoral fellows) in orientation or faculty development programs related to teaching and/or assessing medical students. b. How does the medical school ensure that all residents who supervise/assess medical students, whether they are from the school’s own residency programs or other programs, receive the objectives and the necessary orientation? c. Describe how data provided by medical students on the quality of resident teaching are used to improve the quality of resident teaching and/or supervision.

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d. Describe any institution-level and department-level programs that prepare graduate students or postdoctoral fellows to teach or assess medical students.

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9.2 FACULTY APPOINTMENTS A medical school ensures that supervision of medical student learning experiences is provided throughout required clerkships by members of the school’s faculty. 9.2 NARRATIVE RESPONSE a. Describe how, by whom, and how often the faculty appointment status of physicians who teach and assess medical students during required clerkships is monitored. b. List any required core clinical clerkships where students are being supervised, assessed, or graded by physicians who are not medical school faculty members (do not include residents/fellows). Describe the steps being taken to provide faculty appointments to these physicians. c. Where teaching of students is carried out by individuals who do not hold faculty appointments at the medical school, describe how the teaching activities of these individuals are supervised by medical school faculty members.

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9.3 CLINICAL SUPERVISION OF MEDICAL STUDENTS A medical school ensures that medical students in clinical learning situations involving patient care are appropriately supervised at all times in order to ensure patient and student safety, that the level of responsibility delegated to the student is appropriate to his or her level of training, and that the activities supervised are within the scope of practice of the supervising health professional. 9.3 NARRATIVE RESPONSE a. Describe how departments and the central medical school administration ensure that medical students are appropriately supervised during required clinical clerkships and other required clinical experiences so as to ensure student and patient safety. b. What mechanisms exist for students to express concern about the adequacy and availability of supervision and how, when, and by whom are these concerns acted upon? c. What mechanisms are used during required clinical experiences to ensure that the level of responsibility delegated to a medical student is appropriate to the student’s level of training and experience? Is there a policy (departmental or institutional) related to the delegation of responsibility to medical students? d. Provide examples of how the clerkship director or the student’s attending physician ensure that health professionals who teach or supervise medical students are acting within their scope of practice.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 9.3 1. Copy of any policies or guidelines related to medical student supervision during required clinical activities that ensure student and patient safety (e.g., policies about timely access to, and in-house availability of, attending physicians and/or residents).

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9.4 ASSESSMENT SYSTEM A medical school ensures that, throughout its medical education program, there is a centralized system in place that employs a variety of measures (including direct observation) for the assessment of student achievement, including students’ acquisition of the knowledge, core clinical skills (e.g., medical historytaking, physical examination), behaviors, and attitudes specified in medical education program objectives, and that ensures that all medical students achieve the same medical education program objectives. 9.4 SUPPORTING DATA Table 9.4-1 | Observation of Clinical Skills Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of respondents who indicated they were observed performing the following clerkship activities. GQ 2015 GQ 2016 GQ 2017 History Physical Exam History Physical Exam History Physical Exam School Nationa School Nationa School Nationa School Nationa School Nationa School Nationa % l% % l% % l% % l% % l% % l% Family Medicine Internal Medicine Ob-Gyn/ Women’s Health Pediatric s Psychiatr y Surgery

Table 9.4-2 Clinical Skills Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of respondents who agree/strongly agree (aggregated) that they are prepared in the following ways to begin a residency program. GQ 2015 GQ 2016 GQ 2017 National National National School % % School % % School % % Acquired the clinical skills required to begin a residency program.

9.4 NARRATIVE RESPONSE a. For each comprehensive clinical assessment (e.g., OSCE or standardized patient assessment) that occurs independent of individual courses or clerkships, describe when in the curriculum it is offered, the general content areas covered by each, and whether the purpose of the assessment is formative (to provide feedback to the student) or summative (to inform decision-making about grades, academic progression, or graduation). b. How has the school assured that all students are assessed performing the essential components of a history LCME® Data Collection Instrument, Full, 2017-18

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and physical examination, as defined by the school, in each required clerkship? Note that the school can decide if students must complete an entire history and physical examination or a modified history and physical that is relevant to the specific clerkship.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 9.4 1. As available, provide data from school-specific sources (e.g., clerkship evaluations) on student perceptions that they were observed performing core clinical skills. 2. Samples of course/clerkship-specific or standardized forms that are used in the assessment of the following clinical skills. Indicate the course or clerkship where each form is used and whether the results are used for formative (feedback) or summative (grading) purposes. a. History taking b. Physical examination

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9.5 NARRATIVE ASSESSMENT A medical school ensures that a narrative description of a medical student’s performance, including his or her non-cognitive achievement, is included as a component of the assessment in each required course and clerkship of the medical education program whenever teacher-student interaction permits this form of assessment. 9.5 NARRATIVE RESPONSE a. Describe any institutional policies that include the requirement for a narrative description of medical student performance. b. List the courses in the preclinical phase of the curriculum that include narrative descriptions as part of a medical student’s final assessment where the narratives are: 1. Provided only to students as formative feedback 2. Used as part of the final grade (summative assessment) in the course c. List the clinical clerkships that include a narrative description as part of a medical student’s final assessment where the narratives are: 1. Provided only to students as formative feedback 2. Used as part of the final grade in the clerkship d. Describe the reasons why a narrative assessment is not provided in a course or clerkship where teacherstudent interaction might permit it to occur (e.g., there is small group learning or laboratory sessions).

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9.6 SETTING STANDARDS OF ACHIEVEMENT A medical school ensures that faculty members with appropriate knowledge and expertise set standards of achievement in each required learning experience in the medical education program. 9.6 NARRATIVE RESPONSE a. Describe the roles, as relevant, of the body with responsibility for central management of the curriculum (i.e., the curriculum committee), other medical school committees, the chief academic officer, and departments, and course/clerkship leadership in setting the standards of achievement for the following: 1. Courses 2. Clerkships 3. The curriculum as a whole (i.e., graduation requirements) b. Describe how the medical school ensures that faculty members with appropriate knowledge and expertise set the standards of achievement for courses and clerkships and for the curriculum as a whole.

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9.7 FORMATIVE ASSESSMENT AND FEEDBACK The medical school’s curricular governance committee ensures that each medical student is assessed and provided with formal formative feedback early enough during each required course or clerkship to allow sufficient time for remediation. Formal feedback occurs at least at the midpoint of the course or clerkship. A course or clerkship less than four weeks in length provides alternate means by which a medical student can measure his or her progress in learning. 9.7 SUPPORTING DATA Table 9.7-1 | Mid-clerkship Feedback Provide school and national data from the AAMC Graduation Questionnaire (GQ) on the percentage of respondents who indicated they received mid-clerkship feedback in the following clerkships. GQ 2016 GQ 2017 School % National % School % National % Family Medicine Internal Medicine Ob-Gyn/Women’s Health Pediatrics Psychiatry Surgery

Table 9.7-2 | Mid-clerkship Feedback As available, provide information from clerkship evaluations for the most recently-completed academic year and/or the independent student analysis on the percentage of respondents who agreed/strongly agreed (aggregated) that they received mid-clerkship feedback for each listed clerkship. Specify the data source. Family Medicine Internal Medicine Ob-Gyn/Women’s Health Pediatrics Psychiatry Surgery Data Source:

Table 9.7-3 | Pre-clerkship Formative Feedback Provide the mechanisms (e.g., quizzes, practice tests, study questions, formative OSCEs) used to provide formative feedback during each course in the pre-clerkship phase of the curriculum (typically years/phases one and two). Length of Course Type(s) of Formative Course Name (in weeks) Feedback Provided

Table 9.7-4 Formative Feedback Provide data from the independent student analysis by curriculum year on student satisfaction (somewhat satisfied/very satisfied) with the following. Add rows for each additional question on the student survey. Survey Question YEAR 1 YEAR 2 YEAR 3 YEAR 4

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Amount and quality of formative feedback in the first/second years Amount and quality of formative feedback in the third year

9.7 NARRATIVE RESPONSE a. Describe how and by whom the provision of mid-course/clerkship feedback is monitored within individual departments and at the curriculum management level. b. For courses and clerkships of less than four weeks duration, describe how students are provided with timely feedback on their knowledge and skills related to the course/clerkship objectives. c. Provide information, as available, regarding medical students’ perceptions of the utility of mid-course/midclerkship feedback and its relationship to the criteria used for summative grading in courses/clerkships.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 9.7 1. Any institutional policy or directive requiring that medical students receive formative feedback by at least the mid-point of courses and clerkships of four weeks (or longer) duration.

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9.8 FAIR AND TIMELY SUMMATIVE ASSESSMENT A medical school has in place a system of fair and timely summative assessment of medical student achievement in each course and clerkship of the medical education program. Final grades are available within six weeks of the end of a course or clerkship. 9.8 SUPPORTING DATA Table 9.8-1 | Availability of Final Grades For each required core clinical clerkship, provide the average and the minimum/maximum number of weeks it took for students to receive grades during the most-recently completed academic year. Also provide the percentage of students who did not receive grades within 6 weeks. Add rows as needed. AY 2014-15 AY 2015-16 AY 2016-17 Core Clerkship Avg. Min Max % Avg. Min Max % Avg. Min Max %

9.8 NARRATIVE RESPONSE a. List any courses in the pre-clerkship phase of the curriculum where all students did not receive their grades within six weeks during the most recently-completed academic year. b. List any specific clerkship sites that are not complying with the school’s guidelines for the timeliness of grade reporting. c. Describe how and by whom the timing of course and clerkship grades is monitored and the steps taken if grades are not submitted in a timely manner. How does the medical school ensure that course and clerkship grades are reported to students on schedule? d. Provide any data from the independent student analysis or course/clerkship evaluations related to students’ opinions about the fairness of summative assessments in courses and clerkships.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 9.8 1. Policy or directive that specifies the time frame for the reporting of grades. 2. If the medical school has regional campus (es) that offer the clinical years of the curriculum, provide the data requested in table 9.8-1 for each campus.

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9.9 STUDENT ADVANCEMENT AND APPEAL PROCESS A medical school ensures that the medical education program has a single standard for the advancement and graduation of medical students across all locations and a fair and formal process for taking any action that may affect the status of a medical student, including timely notice of the impending action, disclosure of the evidence on which the action would be based, an opportunity for the medical student to respond, and an opportunity to appeal any adverse decision related to advancement, graduation, or dismissal. 9.9 NARRATIVE RESPONSE a. Describe the means by which the medical education program ensures that a single set of policies for promotion and graduation is applied across all instructional sites, including regional campuses. b. Summarize the due process protections in place at the medical school when there is the possibility of the school’s taking an adverse action against a medical student for academic or professionalism reasons. Include a description of the process for appeal of an adverse action, including the groups or individuals involved at each step in the process. c. Describe the composition of the medical student promotions committee (or the promotions committees, if more than one). If the promotions committee includes course and/or clerkship directors, describe whether there is a recusal policy in place in the case that an adverse academic action against a student is being proposed. d. Describe the means by which the due process policy and process are made known to medical students.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 9.9 1. The policy that specifies that there is a single standard for promotion and graduation. 2. The policies and procedures for disciplinary action and due process.

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STANDARD 10: MEDICAL STUDENT SELECTION, ASSIGNMENT, AND PROGRESS A medical school establishes and publishes admission requirements for potential applicants to the medical education program, and uses effective policies and procedures for medical student selection, enrollment, and assignment. STANDARD 10 SUPPORTING DOCUMENTATION Table 10.0-1 | Applicants and Matriculants Provide data for the indicated entering classes on the total number of initial applications received in the admissions office, completed applications, applicants interviewed, acceptances issued, and new medical students matriculated for the first year of the medical curriculum. Do not include first year students repeating the year. AY 2012-13 AY 2013-14 AY 2014-15 AY 2015-16 AY 2016-17 Initial applications Completed applications Applicants interviewed Acceptances issued New students matriculated

Table 10.0-2 | Entering Student MCAT Scores If applicable, use the table below to provide mean MCAT scores, for new (not repeating) first-year medical students in the indicated entering classes. AY 2012-13 AY 2013-14 AY 2014-15 AY 2015-16 AY 2016-17 Verbal Reasoning Physical Sciences Biological Sciences

Table 10.0-3 | Entering Student Mean GPA Provide the mean overall premedical GPA for new (not repeating) first-year medical students in the indicated entering classes. If using a weighted GPA, please explain how the weighted GPA is calculated in the last row of the table. AY 2012-13 AY 2013-14 AY 2014-15 AY 2015-16 AY 2016-17 Overall GPA Weighted GPA calculation (if applicable):

Table 10.0-4 | Medical School Enrollment Provide the total number of enrolled first-year medical students (include students repeating the academic year) and the total number of medical students enrolled at the school for the indicated academic years. For students in dual-degree programs, only include those participating in the medical curriculum. AY 2012-13 AY 2013-14 AY 2014-15 AY 2015-16 AY 2016-17

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First-year Total enrollment

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10.1 PREMEDICAL EDUCATION/REQUIRED COURSEWORK Through its requirements for admission, a medical school encourages potential applicants to the medical education program to acquire a broad undergraduate education that includes the study of the humanities, natural sciences, and social sciences, and confines its specific premedical course requirements to those deemed essential preparation for successful completion of its medical curriculum. 10.1 NARRATIVE RESPONSE a. List all the college courses or subjects, including associated laboratories, which are required as prerequisites for admission to the medical school. b. List any courses or subjects that the medical school recommends, but does not require, as prerequisites for admission. c. Describe how the current premedical course requirements were established and by which individuals and/or groups they were approved. d. Describe how often and by whom premedical course requirements are reviewed. Note the data or other information (e.g., about medical student performance) that are used to make decisions about changes to premedical course requirements.

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10.2 FINAL AUTHORITY OF ADMISSION COMMITTEE The final responsibility for accepting students to a medical school rests with a formally constituted admission committee. The authority and composition of the committee and the rules for its operation, including voting privileges and the definition of a quorum, are specified in bylaws or other medical school policies. Faculty members constitute the majority of voting members at all meetings. The selection of individual medical students for admission is not influenced by any political or financial factors. 10.2 NARRATIVE RESPONSE a. Describe the size and composition of the medical school admission committee, including the categories of membership (e.g., faculty, students, medical school administrators, community members) and the specified number of members from each category. If there are subcommittees of the admission committee, describe their composition, role, and authority. b. Describe the process for selection of admission committee members and the length of their initial appointment. Note if members can be reappointed and if there is a maximum term of service. c. Identify the current chair of the admission committee, including his or her faculty and/or administrative title(s). How is the chair selected? Does the chair have a maximum term of service? d. Describe how admission committee members are oriented to the admission committee policies and to the admissions process. e. Describe whether the admission committee as a whole, or a subset of the admission committee, has the final authority for making all or some admission decisions. If a subset of the admission committee makes the final admission decision, describe the source of its authority. Note the circumstances, reasons, and final outcome surrounding any admission committee decision that has been challenged, overruled, or rejected during the past three admission cycles. f.

Describe how the medical school ensures that there are no conflicts of interest in the admission process and that no admission decisions are influenced by political or financial factors.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 10.2 1. An excerpt from the medical school bylaws or other formal document that specifies the authority of, the charge to, and composition of the admission committee and its subcommittees (if any) and the rules for its operation, including voting membership and definition of a quorum at meetings. 2. Provide a list of current admission committee members, including each member’s faculty and/or administrative title, student status, or other status (e.g., graduate of the medical school, community physician) and year of appointment to the committee.

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10.3 POLICIES REGARDING STUDENT SELECTION/PROGRESS AND THEIR DISSEMINATION The faculty of a medical school establish criteria for student selection and develop and implement effective policies and procedures regarding, and make decisions about, medical student application, selection, admission, assessment, promotion, graduation, and any disciplinary action. The medical school makes available to all interested parties its criteria, standards, policies, and procedures regarding these matters. 10.3 NARRATIVE RESPONSE a. Describe how the policies, procedures, and criteria for medical student selection were developed and approved, and how they are disseminated to potential and actual applicants and their advisors. b. Describe the steps in the admissions process, beginning with the receipt of the initial application. For each of the following steps, as applicable, describe the procedures and criteria used to make the relevant decision and the individuals and groups (e.g., admission committee or subcommittee, interview committee) involved in the decision-making process: 1. 2. 3. 4. 5.

Preliminary screening for applicants to receive the secondary/supplementary application Selection for the interview The interview The acceptance decision The offer of admission

c. If there is a joint baccalaureate-MD program(s) or dual degree program(s) (e.g., MD-PhD), describe whether and how the procedures for the selection and admission of students to the MD-granting portion of the program differs from the procedures described in item “b” above. d. Describe how the policies for the assessment, advancement, and graduation of medical students, and the policies for disciplinary action are made available to medical students and to faculty. e. Describe how and by which individual(s) or group(s) the following decisions are made: 1. The advancement of a medical student to the next academic period 2. A medical student’s graduation

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 10.3 1. Policies and procedures for the selection, assessment, advancement, graduation, and dismissal of medical students. 2. The charge to or the terms of reference of the medical student promotions committee(s).

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10.4 CHARACTERISTICS OF ACCEPTED APPLICANTS A medical school selects applicants for admission who possess the intelligence, integrity, and personal and emotional characteristics necessary for them to become competent physicians. 10.4 NARRATIVE RESPONSE a. Describe the personal attributes of applicants considered during the admission process. How was this list of personal attributes developed? By which individuals and groups was the list reviewed and approved? b. Describe the methods used during the admission process to evaluate and document the personal attributes of applicants. Refer to the admission procedures as outlined in element 10.3 to illustrate where, how, and by whom these attributes are assessed. c.

Describe how the members of the admission committee and the individuals who interview applicants (if different than members of the admission committee) are prepared and trained to assess applicants’ personal attributes.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 10.4

1. Copies of any standard form(s) used to guide and/or to evaluate the results of applicant interviews.

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10.5 TECHNICAL STANDARDS A medical school develops and publishes technical standards for the admission, retention, and graduation of applicants or medical students with disabilities, in accordance with legal requirements. 10.5 NARRATIVE RESPONSE a. Describe how often the technical standards are reviewed and approved. b. Describe how the technical standards for admission, retention, and graduation are disseminated to potential and actual applicants, enrolled medical students, faculty, and others. c. Describe how medical school applicants and/or students are expected to document that they are familiar with and capable of meeting the technical standards with or without accommodation (e.g., by formally indicating that they have received and reviewed the standards).

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 10.5 1. The medical school’s technical standards for the admission, retention, and graduation of applicants and students.

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10.6 CONTENT OF INFORMATIONAL MATERIALS A medical school’s catalog and other informational, advertising, and recruitment materials present a balanced and accurate representation of the mission and objectives of the medical education program, state the academic and other (e.g., immunization) requirements for the MD degree and all associated joint degree programs, provide the most recent academic calendar for each curricular option, and describe all required courses and clerkships offered by the medical education program. 10.6 NARRATIVE RESPONSE a. Describe how and how often informational materials about the medical education program are developed. How does the leadership of the medical education program ensure that the materials are accurate and timely? b. Describe how recruitment materials about the medical education program are made available (e.g., online, in the media, in hard-copy) to potential and actual applicants, career advisors, and/or the public. SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 10.6 1. Samples of any recruitment materials related to the medical school. 2. Copy of the current medical school academic bulletin or catalog. Indicate where in the bulletin/catalog, or other informational materials available to the public, the following information can be accessed: a. b. c. d.

Medical education program mission and objectives Requirements (academic and other) for the MD degree and joint degree programs Academic calendar for each curricular option Required course and clerkship descriptions

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10.7 TRANSFER STUDENTS A medical school ensures that any student accepted for transfer or admission with advanced standing demonstrates academic achievements, completion of relevant prior coursework, and other relevant characteristics comparable to those of the medical students in the class that he or she would join. A medical school accepts a transfer medical student into the final year of a medical education program only in rare and extraordinary personal or educational circumstances. 10.7 SUPPORTING DATA Table 10.7-1 | Transfer/Advanced Standing Admissions Provide the number of transfer students and students with advanced standing admitted from the program types listed below into the first, second, third, and fourth-year curriculum during the indicated academic years. YEAR 1 YEAR 2 YEAR 3 YEAR 4 AY AY AY AY AY AY AY AY 2015-16 2016-17 2015-16 2016-17 2015-16 2016-17 2015-16 2016-17 LCME-accredited, MD-granting medical school AOA-accredited, DO-granting medical school Non-LCME or AOA-accredited international medical school Non-MD-granting graduate or professional degree program

10.7 NARRATIVE RESPONSE a. Describe the procedures used for selecting applicants for transfer or for admission with advanced standing, including the procedures by which the medical school determines the comparability of the applicants’ educational experiences and prior academic achievement to those of medical students in the class that they would join. List the criteria (e.g., GPA, USMLE scores, MCAT scores) that are considered in making the determination of comparability. b. Describe the role of the admission committee and members of the medical school administration: (1) in determining if space and resources are available to accept transfers and (2) in making the decision to accept applicants for transfer or for admission with advanced standing. c. Describe how policies and procedures related to transfer/admission with advanced standing are made available to potential applicants for transfer and advanced standing and their advisors. d. If the medical school admitted one or more transfer students to the final year of the curriculum during any year since the previous full survey visit, describe the circumstances surrounding that admission decision.

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SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 10.7 1. Medical school policies and procedures related to transfer and admission with advanced standing.

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10.8 VISITING STUDENTS A medical school does all of the following:       

Verifies the credentials of each visiting medical student Ensures that each visiting medical students demonstrates qualifications comparable to those of the medical students he or she would join in educational experiences Maintains a complete roster of visiting medical students Approves each visiting medical student’s assignments Provides a performance assessment for each visiting medical student Establishes health-related protocols for such visiting medical students Identifies the administrative office that fulfills these responsibilities

10.8 NARRATIVE RESPONSE a. Describe the procedures and criteria used by the medical school to determine if a potential visiting medical student has qualifications comparable to those of the medical students he or she would join in a clinical experience. Qualifications includes comparable educational experiences. Identify the medical school, university, or other office that is responsible. b. Describe the procedures by which the medical school grants approval for medical students from other medical schools to take electives at the institution. Include the following information in the description: 1. How the academic credentials and immunization status of visiting students are verified 2. How the medical school approves the assignments of visiting students to ensure that there are adequate resources (including clinical resources) and appropriate supervision at the site for both the visiting student and any of the medical school’s own students 3. How the medical school ensures that a performance assessment is provided for each visiting student c. Identify the medical school or university staff member(s) who is/are responsible for maintaining an accurate and up-to-date roster of visiting medical students.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 10.8 1. List the types of information included in the roster of visiting medical students (if there is a standardized template for the roster, provide a copy).

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10.9 STUDENT ASSIGNMENT A medical school assumes ultimate responsibility for the selection and assignment of medical students to each location and/or parallel curriculum (i.e., track) and identifies the administrative office that fulfills this responsibility. A process exists whereby a medical student with an appropriate rationale can request an alternative assignment when circumstances allow for it. 10.9 NARRATIVE RESPONSE a. Describe the process for medical student assignment to an instructional site or parallel curriculum in the following circumstances, as relevant. In the description, include when, how, and by whom the final decision about assignment is made. Note the ability of students to select or rank options. 1. 2. 3. 4.

A clinical clerkship site (e.g., a hospital) for an individual clerkship A regional campus that includes only the clerkship (clinical years) phase of the curriculum A regional campus that includes the pre-clerkship phase of the curriculum or all years of the curriculum A parallel curriculum (“track”) located on the central medical school campus or at a regional campus

b. Describe if, in any of the circumstances above, medical students have the opportunity to negotiate with their peers to switch assignment sites or tracks after an initial assignment has been made but before the experience has begun. c. Describe the procedures whereby a student can formally request an alternative assignment through a medical school administrative mechanism either before or during his or her attendance at the site / in the track. Describe the criteria used to evaluate the request for the change and the individual(s) tasked with making the decision. Describe how medical students are informed of the opportunity to request an alternative assignment.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 10.9 1. Medical school policy/procedure allowing a medical student to formally request an alternative educational site or curriculum assignment.

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STANDARD 11: MEDICAL STUDENT ACADEMIC SUPPORT, CAREER ADVISING, AND EDUCATIONAL RECORDS A medical school provides effective academic support and career advising to all medical students to assist them in achieving their career goals and the school’s medical education program objectives. All medical students have the same rights and receive comparable services. STANDARD 11 SUPPORTING DOCUMENTATION Table 11.0-1 | Attrition and Academic Difficulty Provide the number and percentage of first-year medical students and the number and percentage of all medical students who withdrew or were dismissed from the medical school in the indicated academic years. AY 2013-14 AY 2014-15 AY 2015-16 AY 2016-17 First-year students All medical students Table 11.0-2 | Attrition and Academic Difficulty by Curriculum Year Provide the number of medical students who fell into one of the following categories during the listed academic years. Count each student only once. AY 2015-16 AY 2016-17 YEAR YEAR YEAR TOTA YEAR YEAR YEAR YEAR YEAR 2 TOTAL 1 3 4 L 1 2 3 4 Withdrew or were dismissed Transferred to another medical school Were required to repeat the entire academic year Were required to repeat one or more required courses or clerkships Moved to a decelerated curriculum Took a leave of absence as a result of academic problems Took a leave of absence for academic enrichment (including research or a joint degree program) Took a leave of absence for personal reasons

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Table 11.0-3 | Average Graduation Rates Over Five Years Provide the overall graduation rate, and the percentage of medical students that graduated in four years averaged over the past five years. Note: these data should be updated immediately prior to submission of the DCI. Four-Year Graduation Rate Overall Graduation Rate

Table 11.0-4 | Residency Match Rates Provide the number and percentage of participating medical students who initially matched to PGY-1 programs in the National Resident Matching Program without entering the Supplemental Offer and Acceptance Program (SOAP), as well as the percentage of participating students that remained unmatched at the end of the SOAP. AY 2013-14 AY 2014-15 AY 2015-16 AY 2016-17 Percent initially matched (prior to SOAP) Percent unmatched (after SOAP) Table 11.0-5 | Graduates Not Entering Residency Provide the number of medical school graduates who did not enter residency training in the following graduating classes for each of the listed reasons (provide a brief description of the reason for students counted under “other”). Provide the total number of students and the percentage of students who did not enter residency in each graduating class. Count each graduate only once and do not include students who graduated late. Reason Class of 2016 Class of 2017 Family responsibilities/maternity/child care Change of careers Did not gain acceptance to a residency position Preparation for the USMLE Research/pursuing additional degree or training Other: (add rows as required) Describe “Other”: Total number of students in each graduating class who did not enter residency training. Percent of students in each graduating class who did not enter residency training.

Table 11.0-6 | Academic/Career Advising at Geographically Distributed Campuses Indicate how the following services are made available to students at each regional campus by placing an “X” in the appropriate columns(s). Add additional rows for each service/campus. Note: this question only applies to schools with regional campus (es). Available to Students Via E-mail or Services Campus Personnel located Visits from central Student travel Tele/Videoconferen on campus campus personnel to central campus ce Academic counseling Tutoring Career advising

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11.1 ACADEMIC ADVISING A medical school has an effective system of academic advising in place for medical students that integrates the efforts of faculty members, course and clerkship directors, and student affairs staff with its counseling and tutorial services and ensures that medical students can obtain academic counseling from individuals who have no role in making assessment or promotion decisions about them. 11.1 SUPPORTING DATA Table 11.1-1 | Academic Advising/Counseling Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of respondents who were satisfied/very satisfied (aggregated) with academic advising/counseling. GQ 2016 GQ 2017 School % National % School % National %

Table 11.1-2 | Academic Advising/Counseling by Curriculum Year Provide data from the independent student analysis, by curriculum year, on the percentage of respondents who were satisfied/very satisfied (aggregated) with academic advising/counseling and tutoring services. Add rows for each additional question on the student survey. Schools with regional campuses should also specify campus. Survey Question YEAR 1 YEAR 2 YEAR 3 YEAR 4 Availability of academic counseling Availability of tutorial help

11.1 NARRATIVE RESPONSE a. Describe how medical students experiencing academic difficulty are identified. When would be the first time an entering medical student could be identified as being in academic difficulty? b. Describe the types of academic assistance available to medical students (e.g., tutoring, academic advising, study skills/time management workshops). For each type of assistance provided to students, summarize the role and organizational locus (e.g., medical school, university) of the individual(s) who provide this support and how medical students can gain access to each of the resources. c. Describe how the medical school provides an option for medical students to obtain academic counseling from individuals who have no role in assessment or advancement decisions about them.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 11.1 1. Schools with regional campus (es) may provide data from the AAMC Graduation Questionnaire or independent student analysis by campus (as available).

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11.2 CAREER ADVISING A medical school has an effective career advising system in place that integrates the efforts of faculty members, clerkship directors, and student affairs staff to assist medical students in choosing elective courses, evaluating career options, and applying to residency programs. 11.2 SUPPORTING DATA Table 11.2-1 | Career Planning Services Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of respondents who were satisfied/very satisfied (aggregated) in the following areas. GQ 2013 GQ 2014 GQ 2015 GQ 2016 National National National National School % School % School % School % % % % % Overall satisfaction with career planning services Information about specialties

Table 11.2-2 | Career Planning Services by Curriculum Year Provide data from the independent student analysis, by curriculum year, on the percentage of respondents that were satisfied/very satisfied (aggregated) with career advising. Add rows for each additional question on the student survey. Schools with regional campuses should also specify campus. Survey Question YEAR 1 YEAR 2 YEAR 3 YEAR 4 Adequacy of career counseling

Table 11.2-3 | Optional and Required Career Advising Activities Provide a brief description of each career information session and advising activity available to medical students during the most recently completed academic year. Indicate whether the session was optional or required for students in each year of the curriculum. Advising Activity/ Information Session YEAR 1 YEAR 2 YEAR 3 YEAR 4 (Required/Optional)

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11.2 NARRATIVE RESPONSE a. Provide an overview of the personnel from the medical school administration, faculty (e.g., career advisors), and other sites (e.g., a university career office, outside consultants) available to support the medical student career advising system and the role(s) played by each. Provide the title(s) and organizational placement(s) of the individual(s) responsible for the management of the career advising system. b. Provide a description of the print and/or online resources available to medical students to support their career investigations. Note if students are required to use some or all of these materials (e.g., as part of career advising sessions). c. Identify the individual(s) who are primarily responsible for providing guidance to medical students on their choice of intramural and extramural electives during each year of the curriculum. Note the role(s) or title(s) (e.g., student affairs dean, college advisor, departmental faculty advisor) of the individual(s) who are responsible for the formal approval of medical students’ elective choices. Describe any formal (required) sessions where counseling on electives occurs. d. List the individual(s) primarily responsible for the preparation of the Medical Student Performance Evaluation (MSPE). Describe the opportunities for medical students to request another MSPE writer.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 11.2 1. A sample MSPE for a recent graduate with good academic credentials and a sample MSPE for a student who has experienced academic difficulty. Personally identifiable information should be redacted. 2. Schools with regional campus (es) may provide the supporting data requested above for each campus (as available).

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11.3 OVERSIGHT OF EXTRAMURAL ELECTIVES If a medical student at a medical school is permitted to take an elective under the auspices of another medical school, institution, or organization, a centralized system exists in the dean’s office at the home school to review the proposed extramural elective prior to approval and to ensure the return of a performance assessment of the student and an evaluation of the elective by the student. Information about such issues as the following are available, as appropriate, to the student and the medical school in order to inform the student’s and the school’s review of the experience prior to its approval:      

Potential risks to the health and safety of patients, students, and the community The availability of emergency care The possibility of natural disasters, political instability, and exposure to disease The need for additional preparation prior to, support during, and follow-up after the elective The level and quality of supervision Any potential challenges to the code of medical ethics adopted by the home school

11.3 NARRATIVE RESPONSE a. Describe how and by whom extramural electives are reviewed and approved prior to being made available for student enrollment. b. Describe how the medical school evaluates each of the following areas in its review of electives at sites where there is a potential risk to medical student and patient safety: 1. 2. 3. 4. 5. 6.

The availability of emergency care The possibility of natural disasters, political instability, and exposure to disease The need for additional preparation prior to, support during, and follow-up after the elective The level and quality of supervision Potential challenges to the code of medical ethics adopted by the home school Provide an example of how medical students were prepared and supported before and during electives in which there is a risk to student and patient safety.

c. Describe the system for collecting performance assessments of medical students and evaluations of electives from medical students completing extramural electives. d. Describe how the evaluation data on extramural electives provided by medical students is used by the school. For example, how are these data made available to medical students considering their elective options?

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11.4 PROVISION OF MSPE A medical school provides a Medical Student Performance Evaluation required for the residency application of a medical student only on or after October 1 of the student's final year of the medical education program. 11.4 NARRATIVE RESPONSE 1. Provide the earliest date for release by the medical school of the MSPE.

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11.5 CONFIDENTIALITY OF STUDENT EDUCATIONAL RECORDS At a medical school, medical student educational records are confidential and available only to those members of the faculty and administration with a need to know, unless released by the student or as otherwise governed by laws concerning confidentiality. 11.5 NARRATIVE RESPONSE a. Describe the general content of the medical student’s academic file and non-academic file. How does the medical school differentiate between academic records and other relevant records (e.g., health information) so that there is an appropriate separation and assurance of confidentiality? b. Describe how the medical school determines which individuals have permission to review a medical student’s file. Identify the institution officials (i.e., administrators, faculty) who are permitted to review medical student records. How does the medical school ensure that student educational records are available only to those individuals who are permitted to review them? c. Describe the location(s) where medical student academic records are kept.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 11.5 1. Policy and procedure for a member of the faculty/administration to gain access to a medical student’s file.

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11.6 STUDENT ACCESS TO EDUCATIONAL RECORDS A medical school has policies and procedures in place that permit a medical student to review and to challenge his or her educational records, including the Medical Student Performance Evaluation, if he or she considers the information contained therein to be inaccurate, misleading, or inappropriate. 11.6 NARRATIVE RESPONSE a. Describe the procedure that medical students must follow in order to review or challenge their records. Can students gain access to their records in a timely manner? Note if there are any components of students’ records that students are not permitted to review. b. Indicate whether medical students are permitted to review and potentially challenge the following records. If review and challenge are possible, describe the procedures used. 1. Content of the MSPE 2. Course and clerkship data (e.g., examination performance, narrative assessments) 3. Course and clerkship grades c. Describe how the medical school’s policies and procedures related to students’ ability to review and challenge their records are made known to students and faculty.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 11.6 1. Formal medical school policies and procedures related to medical student ability to review and challenge their records, including the length of time it takes for students to gain access to their records.

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STANDARD 12: MEDICAL STUDENT HEALTH SERVICES, PERSONAL COUNSELING, AND FINANCIAL AID SERVICES A medical school provides effective student services to all medical students to assist them in achieving the program’s goals for its students. All medical students have the same rights and receive comparable services. STANDARD 12 SUPPORTING DOCUMENTATION Table 12.0-1 | Tuition and Fees Provide the total tuition and fees assessed to first-year medical students (both for in-state residents and out-of-state nonresidents) for the indicated academic years. Include the medical school’s health insurance fee, even if that fee is waived for a student with proof of existing coverage. AY 2013-14

AY 2014-15

AY 2015-16

AY 2016-17

AY 2017-18

In-state Out-of-state Table 12.0-2 | Average Medical School Educational Debt Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the average reported medical school educational indebtedness of all medical student graduates with medical school debt and the percentage of graduates with indebtedness in excess of $200,000. GQ 2014 GQ 2015 GQ 2016 GQ 2017 School % National % School % National % School % National % School % National % Average medical school debt Percent of graduates with debt greater than $200,000 Table 12.0-3 | Average Overall Educational Debt Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the average overall educational debt (including undergraduate college/university debt) of all medical school graduates with educational debt and the percentage of graduates with debt in excess of $200,000. GQ 2014 GQ 2015 GQ 2016 GQ 2017 School % National % School % National % School % National % School % National % Average overall educational debt Percent of graduates with debt greater than $200,000 Table 12.0-4 | Support Services at Regional Campuses Indicate how the following services are made available to students at each regional campus by placing an “X” in the appropriate columns(s). Add additional rows for each service/campus. Note: this question only applies to schools with regional campus (es). Available to Students via Campus Services

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Personal counseling

Student health services

Student wellbeing programs

Financial aid management

Personnel located on campus Visits from central campus personnel E-mail or Tele/Videoconference Student travel to central campus

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12.1 FINANCIAL AID/DEBT MANAGEMENT COUNSELING/STUDENT EDUCATIONAL DEBT A medical school provides its medical students with effective financial aid and debt management counseling and has mechanisms in place to minimize the impact of direct educational expenses (i.e., tuition, fees, books, supplies) on medical student indebtedness. 12.1 SUPPORTING DATA Table 12.1-1 | Financial Aid and Debt Counseling Services. Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of respondents who were satisfied/very satisfied (aggregated) in the following areas. GQ 2014 GQ 2015 GQ 20165 GQ 2017 School National School National School School National % National % % % % % % % Financial aid administrative services Overall educational debt management counseling Table 12.1-2 | Financial Aid and Debt Counseling Services. Provide data from the independent student analysis, by curriculum year, on the percentage of respondents that were satisfied/very satisfied (aggregated) with financial aid services and debt management counseling. Add rows for each additional question on the student survey. Survey Question Year 1 Year 2 Year 3 Year 4 Quality of financial aid administrative services Overall debt management counseling Table 12.1-3 | Financial Aid/Debt Management Activities Describe financial aid and debt management counseling/advising activities (including one-on-one sessions) that were available for medical students in each year of the curriculum during the most recently completed academic year. Note whether they were required (R) or optional (O). Financial Aid/Debt Management Activities (specify R or O for Required or Optional) YEAR 1 YEAR 2 YEAR 3 YEAR 4

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12.1 NARRATIVE RESPONSE a. Describe the staffing of the financial aid office used by medical students and the reporting relationship(s) of the director of financial aid. 1. Note if the financial aid office resides organizationally within the medical school or at the university level. If the latter, list the other schools/programs supported by financial aid office staff. 2. Indicate the number of financial aid staff who are available to specifically assist medical students. 3. Describe how the medical school determines and evaluates the adequacy of financial aid staffing. b. If the medical school has one or more regional campuses, describe which of the required and optional advising sessions were available at each campus during the most recently completed academic year. c. Provide a description of the types of print and/or online debt management information available to medical students. Note if students are required to use some or all of these materials (e.g., as part of financial aid/debt management sessions). d. Describe current activities at the medical school or university to raise funding for scholarship and grant support for medical students (e.g., a current fund-raising campaign devoted to increasing scholarship resources). Describe the goals of these activities, their current levels of success, and the timeframe for their completion. e. Describe other mechanisms that are being used by the medical school and the university to limit medical student debt, such as limiting tuition increases.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 12.1 1. The most recent LCME Part I-B Financial Aid Questionnaire

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12.2 TUITION REFUND POLICY A medical school has clear, reasonable, and fair policies for the refund of a medical student’s tuition, fees, and other allowable payments (e.g., payments made for health or disability insurance, parking, housing, and other similar services for which a student may no longer be eligible following withdrawal). 12.2 NARRATIVE RESPONSE a. Briefly describe the tuition and fee refund policy. Describe how the policy is disseminated to medical students. b. If not included in the tuition refund policy, describe policies related to the refund of payments made for health and disability insurance and for other fees.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 12.2 1. Policy for refunding tuition and fee payments to medical students who withdraw or are dismissed from the medical education program.

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12.3 PERSONAL COUNSELING/WELL-BEING PROGRAMS A medical school has in place an effective system of personal counseling for its medical students that includes programs to promote their well-being and to facilitate their adjustment to the physical and emotional demands of medical education. 12.3 SUPPORTING DATA Table 12.3-1 | Personal Counseling Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of respondents who were satisfied/very satisfied (aggregated) with personal counseling. GQ 2014 GQ 2015 GQ 2016 GQ 2017 School % National % School % National % School % National % School % National %

Table 12.3-2 | Mental Health Services Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of respondents who were satisfied/very satisfied (aggregated) with student mental health services. GQ 2014 GQ 2015 GQ 2016 GQ 2017 School % National % School % National % School % National % School % National %

Table 12.3-3 | Well-being Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of respondents who were satisfied/very satisfied (aggregated) with programs and activities that promote effective stress management, a balanced lifestyle, and overall well-being. GQ 2014 GQ 2015 GQ 2016 GQ 2017 School % National % School % National % School % National % School % National %

Table 12.3-4 | Student Support Services by Curriculum Year As available, provide data from the independent student analysis, by curriculum year, on the percentage of respondents who were satisfied/very satisfied (aggregated) with the listed student support services. Add rows for additional student survey questions. Survey Question Year 1 Year 2 Year 3 Year 4 Accessibility of personal counseling Confidentiality of personal counseling Availability of mental health services Availability of programs to support student wellbeing

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12.3 NARRATIVE RESPONSE a. Describe the system for personal counseling for medical students, including how, by whom (i.e., roles and titles), and where services are provided. Describe how students are informed about the availability of personal counseling services. b. Comment on how the medical school ensures that personal counseling services are accessible and confidential. c. Summarize medical school programs or other programs designed to facilitate students’ ongoing adjustment to the physical and emotional demands of medical school. Describe how students are informed about the availability of these programs/activities.

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12.4 STUDENT ACCESS TO HEALTH CARE SERVICES A medical school provides its medical students with timely access to needed diagnostic, preventive, and therapeutic health services at sites in reasonable proximity to the locations of their required educational experiences and has policies and procedures in place that permit students to be excused from these experiences to seek needed care. 12.4 SUPPORTING DATA Table 12.4-1 | Student Satisfaction with Health Services Provide school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of respondents who were satisfied/very satisfied (aggregated) with student health services. GQ 2014 GQ 2015 GQ 2016 GQ 2017 School % National % School % National % School % National % School % National %

Table 12.4-2 | Student Satisfaction with Health Services by Curriculum Year As available, provide data from the independent student analysis, by curriculum year, on the percentage of respondents who were satisfied/very satisfied (aggregated) with health care services. Add rows for each additional student survey question. Survey Question Year 1 Year 2 Year 3 Year 4 Accessibility of student health services

12.4 NARRATIVE RESPONSE a. Describe the current system for providing medical students with access to diagnostic, preventive, and therapeutic health services, including where and by whom (i.e., roles and titles) services are provided. For example, if there is a student health center, comment on its location, staffing, and hours of operation. b. Describe how medical students at all instructional sites/campuses with required educational activities are informed about availability and access to health services. c. Describe how medical students, faculty, and residents are informed of policies that allow students to be excused from classes or clinical activities in order to access health services. SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 12.4 1. Policy or guidance document that specifies that medical students may be excused from classes or clinical activities in order to access health services. 2. Schools with regional campuses may provide the supporting data requested above for each campus (as available).

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12.5 NON-INVOLVEMENT OF PROVIDERS OF STUDENT HEALTH SERVICES IN STUDENT ASSESSMENT/ LOCATION OF STUDENT HEALTH RECORDS The health professionals who provide health services, including psychiatric/psychological counseling, to a medical student have no involvement in the academic assessment or promotion of the medical student receiving those services. A medical school ensures that medical student health records are maintained in accordance with legal requirements for security, privacy, confidentiality, and accessibility. 12.5 NARRATIVE RESPONSE a. Describe how the medical school ensures that a provider of health and/or psychiatric/psychological services to a medical student has no current or future involvement in the academic assessment of, or in decisions about, the promotion of that student. Describe how medical students, residents, and faculty are informed of this requirement. b. If health and/or psychiatric/psychological services are provided by university or medical school service providers, describe where these student health records are stored. Note if any medical school personnel have access to these records.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 12.5 1. Policies and/or procedures that specify that providers of health and psychiatric/psychological services to a medical student will have no involvement in the academic assessment of or in decisions about the promotion of that student.

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12.6 STUDENT HEALTH AND DISABILITY INSURANCE A medical school ensures that health insurance and disability insurance are available to each medical student and that health insurance is also available to each medical student’s dependents. 12.6 NARRATIVE RESPONSE a. Indicate whether health insurance is available to all medical students and their dependents. b. Indicate whether and when (e.g., at enrollment, at the beginning of the third year) disability insurance is made available to medical students. Describe when (e.g., during orientation) and by what means medical students are informed of its availability.

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12.7 IMMUNIZATION REQUIREMENTS AND MONITORING A medical school follows accepted guidelines in determining immunization requirements for its medical students and monitors students’ compliance with those requirements. 12.7 NARRATIVE RESPONSE a. Summarize the immunization requirements for medical students and note if the guidelines follow national and regional recommendations (e.g., from the Centers for Disease Control and Prevention, state agencies, etc.). Summarize the rationale for any school requirements that differ from national/regional guidelines. b. Note if immunizations are available on campus (e.g., at the student health center) and how the costs of immunizations are covered. c. Describe how and by whom the immunization status of medical students is monitored.

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12.8 STUDENT EXPOSURE POLICIES/PROCEDURES A medical school has policies in place that effectively address medical student exposure to infectious and environmental hazards, including the following:   

The education of medical students about methods of prevention The procedures for care and treatment after exposure, including a definition of financial responsibility The effects of infectious and environmental disease or disability on medical student learning activities

All registered medical students (including visiting students) are informed of these policies before undertaking any educational activities that would place them at risk. 12.8 NARRATIVE RESPONSE a. Describe institutional policies in the following areas related to medical student exposure to infectious and environmental hazards: 1. The education of medical students about methods of prevention. 2. The procedures for care and treatment after exposure, including definition of financial responsibility. 3. The effects of infectious and/or environmental disease or disability on medical student learning activities. b. Describe when and in what way(s) the school’s own medical students and visiting medical students are informed of the medical school’s policies and procedures related to exposure to infectious and environmental hazards at all instructional sites. c. Briefly summarize any protocols that must be followed by medical students regarding exposure to contaminated body fluids, infectious disease screening and follow-up, hepatitis-B vaccination, and HIV testing. Describe when and how students, including visiting students, learn about the procedures to be followed in the event of exposure to blood-borne or air-borne pathogens (e.g., a needle-stick injury). d. Describe when in the course of their education medical students learn how to prevent exposure to infectious diseases, especially from contaminated body fluids. e. Provide data on the percentage of medical students who report being familiar with the protocol following exposure to infectious and environmental hazards. For programs with regional campuses, provide data by campus. f.

Provide data from the Independent Student Analysis on student satisfaction with the adequacy of education about prevention and exposure to infectious and environmental hazards.

SUPPORTING DOCUMENTATION REQUIRED FOR ELEMENT 12.8 1. Relevant policies on medical student exposure to infectious and environmental hazards. 2. Policies related to the implications of infectious and/or environmental disease or disability on medical student educational activities.

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GLOSSARY OF TERMS FOR LCME ACCREDITATION STANDARDS AND ELEMENTS Adequate types and numbers of patients (e.g., acuity, case mix, age, gender): Medical student access, in both ambulatory and inpatient settings, to a sufficient mix of patients with a range of severity of illness and diagnoses, ages, and both genders to meet medical educational program objectives and the learning objectives of specific courses, modules, and clerkships. (Element 5.5) Admission requirements: A comprehensive listing of both objective and subjective criteria used for screening, selection, and admission of applicants to a medical education program. (Standard 10) Admission with advanced standing: The acceptance by a medical school and enrollment in the medical curriculum of an applicant (e.g., a doctoral student), typically as a second or third-year medical student, when that applicant had not previously been enrolled in a medical education program. (Element 10.7) Any related enterprises: Any additional medical school-sponsored activities or entities. (Element 1.2) Assessment: The systematic use of a variety of methods to collect, analyze, and use information to determine whether a medical student has acquired the competencies (e.g., knowledge, skills, behaviors, and attitudes) that the profession and the public expect of a physician. (Element 1.4) Benefits of diversity: In a medical education program, the facts that having medical students and faculty members from a variety of socioeconomic backgrounds, racial and ethnic groups, and other life experiences can 1) enhance the quality and content of interactions and discussions for all students throughout the preclinical and clinical curricula and 2) result in the preparation of a physician workforce that is more culturally aware and competent and better prepared to improve access to healthcare and address current and future health care disparities. (Standard 3) Central [or centralized] monitoring: Tracking by institutional (e.g., decanal) level offices and/or committees (e.g., the curriculum committee) of desired and expected learning outcomes by students and their completion of required learning experiences. (Element 8.6) Clinical affiliates: Those institutions providing ambulatory and/or inpatient medical care that have formal agreements with a medical school to provide clinical experiences for the education of its medical students. (Element 1.4) Clinical and translational research: The conduct of medical studies involving human subjects, the data from which are intended to facilitate the translation and application of the studies’ findings to medical practice in order to enhance the prevention, diagnosis, and treatment of medical conditions. (Element 7.3) Comparable educational experiences: Learning experiences that are sufficiently similar so as to ensure that medical students are achieving the same learning objectives at all educational sites at which those experiences occur. (Element 8.7) Competency: Statements of defined skills or behavioral outcomes (i.e., that a physician should be able to do) in areas including, but not limited to, patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism and ethics, and systems-based practice for which a medical student is required to demonstrate mastery prior to completion of his or her medical education program and receipt of the MD degree. (Element 8.7) Core curriculum: The required components of a medical curriculum, including all required courses/modules and clinical clerkships/rotations. (Element 7.9)

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Clinical reasoning: The integration, organization, and interpretation of information gathered as a part of medical problem-solving. (Elements 7.4 and 9.4) Coherent and coordinated curriculum: The design of a complete medical education program, including its content and modes of presentation, to achieve its overall educational objectives. Coherence and coordination include the following characteristics: 1) the logical sequencing of curricular segments, 2) coordinated and integrated content within and across academic periods of study (i.e., horizontal and vertical integration), and 3) methods of instruction and student assessment appropriate to the achievement of the program's educational objectives. (Element 8.1) Critical judgment/critical thinking: The consideration, evaluation, and organization of evidence derived from appropriate sources and related rationales during the process of decision-making. The demonstration of critical thinking requires the following steps: 1) the collection of relevant evidence, 2) the evaluation of that evidence, 3) the organization of that evidence, 4) the presentation of appropriate evidence to support any conclusions, and 5) the coherent, logical, and organized presentation of any response. (Elements 7.4 and 9.4) Curriculum management: Involves the following activities: leading, directing, coordinating, controlling, planning, evaluating, and reporting. An effective system of curriculum management exhibits the following characteristics: 1) evaluation of program effectiveness by outcomes analysis, using national norms of accomplishment as a frame of reference, 2) monitoring of content and workload in each discipline, including the identification of omissions and unplanned redundancies, and 3) review of the stated objectives of each individual curricular component and of methods of instruction and student assessment to ensure their linkage to and congruence with programmatic educational objectives. (Element 8.1) Direct educational expenses: The following educational expenses of an enrolled medical student: tuition, mandatory fees, books and supplies, and a computer, if one is required by the medical school. (Element 12.1) Direct faculty participation in decision-making: Faculty involvement in institutional governance wherein faculty input to decisions is made by the faculty members themselves or by representatives chosen by faculty members (e.g., versus appointed by administrators). (Element 1.3) Diverse sources [of financial revenues]: Multiple sources of predictable revenues that include, but are not unduly dependent upon any one of, the following: tuition, gifts, clinical revenue, governmental support, research grants, endowment, etc. (Element 5.1) Effective: Supported by evidence that the policy, practice, and/or process has produced the intended or expected result(s). (Standard 1) Eligibility requirements‌for initial and continuing accreditation: Receipt and maintenance of authority to grant the MD degree from the appropriate governmental agency and initial and continuing accreditation by one of the six regional accrediting bodies. (Element 1.6) Equivalent methods of assessment: The use of methods of medical student assessment that are as close to identical as possible across all educational sites at which core curricular activities take place. (Element 8.7) Evaluation: The systematic use of a variety of methods to collect, analyze, and use information to determine whether a program is fulfilling its mission(s) and achieving its goal(s). (Element 3.3) Fair and formal process for taking any action that may affect the status of a medical student: The use of policies and procedures by any institutional body (e.g., student promotions committee) with responsibility for making decisions about the academic progress, continued enrollment, and/or graduation of a medical student that ensure: 1) that the student will be assessed by individuals who have not previously formed an opinion of the student’s abilities, professionalism, and/or suitability to become a physician and 2) that the student has received timely notice of the

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proceedings, information about the purpose of the proceedings, and any evidence to be presented at the proceedings; his or her right to participate in and provide information or otherwise respond to participants in the proceedings; and any opportunity to appeal any adverse decision resulting from the proceedings. (Element 9.9) Fair and timely summative assessment: A criterion-based determination, made as soon as possible after the conclusion of a curricular component (e.g., course/module, clinical clerkship/rotation) by individuals familiar with a medical student’s performance, regarding the extent to which he or she has achieved the learning objective(s) for that component such that the student can use the information provided to improve future performance in the medical curriculum. (Element 9.8) Final responsibility for accepting students rests with a formally constituted admission committee: Ensuring that the sole basis for selecting applicants for admission to the medical education program are the decisions made by the faculty committee charged with medical student selection in accordance with appropriately approved selection criteria. (Element 10.2) Formative feedback: Information communicated to a medical student in a timely manner that is intended to modify the student’s thinking or behavior in order to improve his or her subsequent learning and performance in the medical curriculum. (Element 9.7) Functionally integrated: Coordination of the various components of the medical school and medical education program by means of policies, procedures, and practices that define and inform the relationships among them. (Element 2.6) Health care disparities: Differences between groups of people, based on a variety of factors including, but not limited to, race, ethnicity, residential location, sex, age, and socioeconomic, educational, and disability status, that affect their access to health care, the quality of the health care they receive, and the outcomes of their medical conditions. (Element 7.6) Independent study: Opportunities either for medical student-directed learning in one or more components of the core medical curriculum, based on structured learning objectives to be achieved by students with minimal faculty supervision, or for student-directed learning on elective topics of specific interest to the student. (Element 6.3) Integrated institutional responsibility: Oversight by an appropriate central institutional body (commonly a curriculum committee) of the medical education program as a whole. An effective central curriculum authority exhibits the following characteristics: 1) participation by faculty, students, and administrators, 2) the availability of expertise in curricular design and methods of instruction, student assessment, and program evaluation, and 3) empowerment, through bylaws or decanal mandate, to work in the best interests of the medical education program without regard for parochial or political influences or departmental pressures. (Element 8.1) Learning objectives: A statement of the specific, observable, and measurable expected outcomes (i.e., what the medical students will be able to do) of each specific component (e.g., course, module, clinical clerkship, rotation) of a medical education program that defines the content of the component and the assessment methodology and that is linked back to one or more of the medical education program objectives. (Element 6.1) Major location for required clinical learning experiences: A clinical affiliate of the medical school that is the site of one or more required clinical experiences for its medical students. (Element 5.6) Medical education program objectives: Broad statements, in measurable terms, of the knowledge, skills, behaviors, and attitudes (typically linked to a statement of expected competencies) that a medical student is expected to exhibit as evidence of his or her achievement of all programmatic requirements by the time of medical education program completion. (Standard 6 and Element 6.1)

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Medical education track: A parallel program of study for a subset of the medical student body that requires participating students to complete specific programmatic learning objectives (e.g., in research, primary care, leadership) in addition to the medical educational program objectives required of all medical students. (Element 5.12) Medical problem-solving: The initial generation of hypotheses that influence the subsequent gathering of information. (Elements 7.4 and 9.4) Mission-appropriate diversity: The inclusion, in a medical education program’s student body and among its faculty and staff and based on the program’s mission, goals, and policies, of persons from different racial, ethnic, economic, and/or social backgrounds and with differing life experiences to enhance the educational environment for all medical students. (Element 3.3) Narrative assessment: Written comments from faculty that assess student performance and achievement in meeting the objectives of a course or clerkship. (Element 9.5) National norms of accomplishment: Those data sources that would permit comparison of relevant medical schoolspecific medical student performance data to national data for all medical schools and medical students (e.g., USMLE scores, AAMC GQ data, specialty certification rates). (Element 8.4) Need to know: The requirement that information in a medical student’s educational record be provided only to those members of the medical school’s faculty or administration who have a legitimate reason to access that information in order to fulfill the responsibilities of their faculty or administrative position. (Element 11.5) Outcome-based terms: Descriptions of observable and measurable desired and expected outcomes of learning experiences in a medical curriculum (e.g., knowledge, skills, attitudes, and behavior). (Element 6.1) Primacy of the medical education program’s authority over academic affairs and the education/assessment of medical students: The affirmation and acknowledgement that all decisions regarding the creation and implementation of educational policy and the teaching and assessment of medical students are, first and foremost, the prerogative of the medical education program. (Element 1.4) Principal academic officer at each campus is administratively responsible to the dean: The administrator identified by the dean or the dean’s designee (e.g., associate or assistant dean, site director) as having primary responsibility for implementation and evaluation of the components of the medical education program that occur at that campus. (Element 2.5) Program objectives: See definition for Medical education program objectives above. Publishes: Communicates in hard-copy and/or on-line in a manner that is easily available to and accessible by the public. (Standard 10) Regional accrediting body: The six bodies recognized by the US Department of Education that accredit institutions of higher education located in their regions of the US: 1) Higher Education Commission, 2) Middle States Commission on Higher Education, 3) New England Association of Schools and Colleges Commission on Institutions of Higher Education, 4) Northwest Commission on Colleges and Universities, 5) Southern Association of Colleges and Schools Commission on Colleges, and 6) Western Association of Schools and Colleges Senior Colleges and University Commission. (Element 1.6) Regional campus: A medical school with a regional campus is a school that has two or more campuses, with each campus offering one or more complete years of the medical education program. (Element 2.5)

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Regularly scheduled and timely feedback: Information communicated periodically and sufficiently often (based on institutional policy, procedure, or practice) to a faculty member to ensure that the faculty member is aware of the extent to which he or she is (or is not) meeting institutional expectations regarding future promotion and/or tenure. (Element 4.4) Self-directed learning: Includes medical students’ self-assessment of their learning needs; their independent identification, analysis, and synthesis of relevant information; and their appraisal of the credibility of information sources. (Element 6.3) Senior administrative staff: People in academic leadership roles, to include but not limited to, associate/assistant deans, directors, academic department chairs, and people who oversee the operation of affiliated clinical facilities and other educational sites. Many, if not most, of these people also have faculty appointments, and for tracking purposes should only be counted in one category when completing tables such as those listed in the DCI under Element 3.3. (Standard 2 and Elements 2.1, 2.4, and 3.3) Service-learning: Educational experiences that involve: 1) medical students’ service to the community in activities that respond to community-identified concerns, 2) student preparation, and 3) student reflection on the relationships among their participation in the activity, their medical school curriculum, and their roles as citizens and medical professionals. (Element 6.6) Single standard for the promotion and graduation of medical students across all locations: The academic and non-academic criteria and levels of performance defined by a medical education program and published in programmatic policies that must be met by all medical students on all medical school campuses at the conclusion of each academic year for promotion to the next academic year and at the conclusion of the medical education program for receipt of the MD degree and graduation. (Element 9.9) Standards of achievement: Criteria by which to measure a medical student’s attainment of relevant learning objectives and that contribute to a summative grade. (Element 9.6) Technical standards for admission, retention, and graduation of medical students with disabilities: A statement by a medical school of the: 1) essential academic and non-academic abilities, attributes, and characteristics in the areas of intellectual-conceptual, integrative, and quantitative abilities; 2) observational skills; 3) physical abilities; 4) motor functioning; 5) emotional stability; 6) behavioral and social skills; and 7) ethics and professionalism that a medical school applicant or enrolled medical student must possess or be able to acquire, with or without reasonable accommodation, in order to be admitted to, be retained in, and graduate from that school’s medical educational program. (Element 10.5) Transfer: The permanent withdrawal by a medical student from one medical school followed by his or her enrollment (typically in the second or third year of the medical curriculum) in another medical school. (Element 5.10) Visiting students: Students enrolled at one medical school who participate in clinical (typically elective) learning experiences for a grade sponsored by another medical school without transferring their enrollment from one school to the other. (Element 5.10)

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LCME Standards (Effective July 1, 2017) Standard 1: Mission, Planning, Organization, and  Integrity 1.1 Strategic Planning and Continuous Quality  Improvement (A. Filak) 1.2 Conflict of Interest Policies (A. Filak/H. Bante) 1.3 Mechanisms for Faculty Participation (A. Filak/P.  Baker) 1.4 Affiliation Agreements (A. Filak) 1.5 Bylaws (A. Filak) 1.6 Eligibility Requirements (A. Filak)

Standard 4: Faculty Preparation, Productivity,  Participation, and Policies 4.1 Sufficiency of Faculty (A. Lentsch) 4.2 Scholarly Productivity (A. Lentsch/M. Cushion) 4.3 Faculty Appointment Policies (A. Lentsch) 4.4 Feedback to Faculty (A. Lentsch) 4.5 Faculty Professional Development (A. Lentsch/P.  Baker) 4.6 Responsibility for Educational Program Policies (A.  Lentsch/A. Filak)

Standard 7: Curricular Content (All OME) 7.1 Biomedical, Behavioral, Social Sciences 7.2 Organ Systems/Life Cycle/Primary Care/Prevention  /Wellness/Symptoms/Signs/Differential Diagnosis,  Treatment Planning, Impact of Behavioral and Social  Factors 7.3 Scientific Method/Clinical/Translational Research 7.4 Critical Judgment/Problem‐Solving Skills 7.5 Societal Problems 7.6 Cultural Competence and Health Care Disparities 7.7 Medical Ethics 7.8 Communication Skills 7.9 Interprofessional Collaborative Skills

Standard 10: Medical Student Selection, Assignment,  and Progress (All OME) 10.1 Premedical Education/Required Coursework 10.2 Final Authority of Admission Committee 10.3 Policies Regarding Student Selection/Progress and  Their Dissemination 10.4 Characteristics of Accepted Applicants 10.5 Technical Standards 10.6 Content of Informational Materials 10.7 Transfer Students 10.8 Visiting Students  10.9 Student Assignment

Standard 2: Leadership and Administration

Standard 3: Academic and Learning Environments

2.1 Administrative Officer and Faculty Appointments (A.  Filak) 2.2 Dean’s Qualifications (A. Filak) 2.3 Access and Authority of the Dean (A. Filak) 2.4 Sufficiency of Administrative Staff (A. Filak) 2.5 Responsibility of and to the Dean (A. Filak) 2.6 Functional Integration of the Faculty (A. Filak)

3.1 Resident Participation in Medical Student Education  (A. Bennett/P. Baker/R Neel) 3.2 Community of Scholars/Research Opportunities (A.  Bennett/Amy Thompson/Andy Thompson) 3.3 Diversity/Pipeline Programs and Partnerships (A.  Bennett/M. Mallory) 3.4 Anti‐Discrimination Policy (A. Bennett/M. Mallory) 3.5 Learning Environment/Professionalism (A. Bennett/ A. Filak) 3.6 Student Mistreatment (A. Bennett)

Standard 5: Educational Resources and Infrastructure

Standard 6: Competencies, Curricular Objectives, and  Curricular Design

5.1 Adequacy of Financial Resources (A. Filak) 5.2 Dean’s Authority/Resources (A. Filak) 5.3 Pressures for Self‐Financing (A. Filak) 5.4 Sufficiency of Buildings and Equipment (A. Filak) 5.5 Resources for Clinical Instruction (A. Filak) 5.6 Clinical Instructional Facilities/Information Resources (A. Filak/P. Baker/R. Neel) 5.7 Security, Student Safety, and Disaster Preparedness  (A. Filak/P. Baker/R. Neel) 5.8 Library Resources/Staff (A. Filak/L. Schick) 5.9 Information Technology Resources/Staff (A. Filak/ N.  Holsing) 5.10 Resources Used By Transfer/Visiting Students (A.  Filak/A. Bennett) 5.11 Study/Lounge/Storage Space/Call Rooms (A.  Filak/A. Bennett) 5.12 Required Notifications to the LCME (A. Filak/A.  Bennett)

Standard 8: Curricular Management, Evaluation, and  Enhancement (All OME) 8.1 Curricular Management 8.2 Use of Medical Educational Program Objectives 8.3 Curricular Design, Review, Revision/Content Monitoring 8.4 Program Evaluation  8.5 Medical Student Feedback 8.6 Monitoring of Completion of Required Clinical  Experiences 8.7 Comparability of Education/Assessment 8.8 Monitoring Student Time

Standard 11: Medical Student Academic Support,  Career Advising, and Educational Records (All OSA) 11.1 Academic Advising 11.2 Career Advising 11.3 Oversight of Extramural Electives (OME) 11.4 Provision of MSPE 11.5 Confidentiality of Student Educational Records 11.6 Student Access to Educational Records

6.1 Program and Learning Objectives (P. Baker) 6.2 Required Clinical Experiences (P. Baker) 6.3 Self‐Directed and Life‐Long Learning (P. Baker) 6.4 Inpatient/Outpatient Experiences (P. Baker/R. Neel) 6.5 Elective Opportunities (P. Baker) 6.6 Service‐Learning (P. Baker) 6.7 Academic Environments (P. Baker) 6.8 Education Program Duration (P. Baker)

Standard 9: Teaching, Supervision, Assessment, and  Student and Patient Safety (All OME) 9.1 Preparation of Resident and Non‐Faculty Instructors  9.2 Faculty Appointments  9.3 Clinical Supervision of Medical Students  9.4 Assessment System 9.5 Narrative Assessment  9.6 Setting Standards of Achievement  9.7 Formative Assessment and Feedback  9.8 Fair and Timely Summative Assessment  9.9 Student Advancement and Appeal Process

Standard 12: Medical Student Health Services, Personal  Counseling, and Financial Aid Services (All OME) 12.1 Financial Aid/Debt Management Counseling/  Student Educational Debt 12.2 Tuition Refund Policy 12.3 Personal Counseling/Well‐Being Programs 12.4 Student Access to Health Care Services 12.5 Non‐Involvement of Providers of Student Health Services in Student Assessment/ Location of  Student Health Records 12.6 Student Health and Disability Insurance 12.7 Immunization Requirements and Monitoring 12.8 Student Exposure Policies/Procedures


Medical Education Senior Associate Dean Andrew T. Filak, MD

Clinical Programs Associate Dean

Foundational Sciences Associate Dean

Pamela L. Baker, PhD

Bruce F. Giffin, PhD

Course Directors

Co-Course Directors

Blood & Cardiovascular D. J. Lowrie, PhD

Laura Wexler, MD

Brain, Mind and Behavior Bruce F. Giffin, PhD

John G. Quinlan, MD

Fundamentals of Cellular Medicine Edmund M. Choi, PhD

Keith Stringer, MD

Fundamentals of Molecular Medicine John J. Monaco, PhD

Keith Stringer, MD

Assistant Dean Laurah Lukin, PhD Graduate Research Assistant Cijy Elizabeth Sunny

Clinical Skills and SIM Michael A. Sostok, MD

Staff

Human Growth Development Kathi Makoroff, MD

Assoc. Dean Support, Medical Spanish & Nutrition Electives Catherine Smith

IPEX Tiffiny L. Diers, MD

IPEX, LCs, P&S Gina M. Burg

MSK Andrew R. Thompson, PhD

Mark J. Goddard, MD

LCMS+ Becky L. Trippel

Multi Systems D. J. Lowrie, PhD

George Deepe, MD

M3/M4 Janet Rosing

GI/Endo/Repro Aaron M. Marshall, PhD

Mercedes Falciglia, MD

Renal & Pulmonary D. J. Lowrie, PhD Heather R. Christensen, PhD

PAC, Testing, Student Handbook John E. (Ned) Donnelly, EdD

Max C. Reif, MD Kathryn A. WikenheiserBrokamp, MD

Program Directors

LPCC Sarah R. Pickle, MD Roohi Kharofa, MD, MPH Learning Communities, M1/M2 Facilitator M. Stephen Baxter, MD

M3/M4 Robert W. Neel, MD

P&S H. Joseph Kiesler, MD Lisa Kelly, MD

Spanish Elective Christine J. O’Dea, MD Student Evaluations and LCMS+ LoRain C. Drais

Intersession Director Amy Guiot, MD

Content Experts Microbiology Edmund M. Choi, PhD Keith Stringer, MD

Pharmacology Terry Kirley, MD

Curriculum and Faculty Development Emily A. Wagner

ACEPA Sarah Ronan-Bentle, MD HCEM Kay Vonderschmidt, PA, MS-EM

Student Worker Physiology John Lorenz, MD LPCC Nancy Jamison*

* Currently resides and reports to Family Medicine.

Content Expert

Nutrition Bonnie Brehm, PhD


Learning Communities S. Baxter, MD M1/M2 and LCs

G. Burg OME support

M1 Learning Community Facilitators

M2 Learning Community Facilitators

S. Baxter, MD Emergency Medicine

R. Luke, MD Internal Medicine

S. Baxter, MD Emergency Medicine

J. Lawrence, MD Anesthesiology

N. Elder, MD Family Medicine

K. Lee, MD Psychiatry

M. Brandi, MD Neurology

S. Wright, MD Emergency Medicine

J. Friemoth, MD Family Medicine

S. Riegler, MD Internal Medicine

J. McCutcheon, MD Psychiatry

E. Powell, MD Internal Medicine

C. Buttarazzi, MD Psychiatry

A. Kumar, MD Pediatrics

J. Ellison, MD Psychiatry

J. Quinlan, MD Neurology

C. Jones, MD Anesthesiology

C. Richardson, MD  Emergency  Medicine  

B. Evans, DO Psychiatry

D. Sall, MD & M. Kelleher, MD Internal Medicine

P. Toth, MD Emergency Medicine

H. Varghai, MD Internal Medicine

D. Freiberg, MD Orthopaedic Surgery

L. Saxena, MD Family medicine

O. Zmora, MD Family Medicine

M. Mallory, MD Pediatrics/S. Ronan‐Bentle, MD Emergency Medicine

M. Munoz, MD Psychiatry

K. Stringer, MD Peds‐Pathology


Third Year Clerkships

R. Neel, MD M3/M4 Chair J. Rosing, OME Support

Specialty Clerkship Coordinators

Specialty Clerkship Directors

S. Foote, Anesthesia

T. James, MD Anesthesia

P. Jordan Dermatology

B. Adams, MD Dermatology

M. Murphy, Emergency Medicine

J. Campbell, MD Emergency Medicine

M. Bosse, Family Medicine

J. Schlaudecker, MD Geriatric Medicine

J. Lefebvre, Internal Medicine

L. Coberly, MD IM‐ CV ICU

J. Lefebvre, Internal Medicine

L. Coberly, MD IM –Med ICU

M. Wyan, Ophthalmology

L. Kelly, MD Ophthalmology

K. Reising, Orthopedic Surgery

B. Grawe, MD Orthopedic Surgery

A. Terhar Otolaryngology

R. Dhanda‐Patil, MD Otolaryngology

J. Sloniker, Pathology

S. Kahn, MD Pathology

K. Coleman, Radiation Oncology

J. Kharofa MD Radiation Oncology

T. Feldkamp Radiology

L. Wang MD Radiology

P. Wright, Urology

N. Patil, MD Urology

Core Clerkship Directors

Core Clerkship Coordinators

K. Athota, MD Surgery

B. Patrick, Surgery

L. Coberly, MD Internal Medicine

J. Lefebvre, Internal Medicine

R. Ellis, MD Family Medicine

N. Jamison, Family Medicine

P. Johnston, MD Psychiatry

C. Gibson, Psychiatry

C. Lehmann, MD Pediatrics

M. Pence, Pediatrics

J. Quinlan, MD Neuroscience

M. Sathe, Neuroscience

A. Thompson, MD, Obstetrics/ Gynecology

D. Brown, Obstetrics/ Gynecology


Fourth Year Electives

R. Neel, MD M3/M4 Chair

J. Rosing, OME Support

Elective Acting Internship

Research Electives

Sub Specialty Medical Clinical Experiences

Primary Care Clinical Experiences

Sub Specialty Surgical Clinical Experiences

Self�Directed Educational


M4 Sub Specialty Medical Clinical Elective Elective Stroke Epilepsy Child Neurology* Consultation Liaison Psychiatry* Emergency Psychiatry* Introduction to Addiction Psychiatry/Medicine PRIM Care Psychiatry* Forensic Psychiatry* Adolescent Inpatient Psychiatry* Child Psychiatry Inpatient & ER Consult* Adolescent Inpatient Psychiatry‐ Triple Board GERO Psychiatry General Practitioner Radiation Oncology Clinical Diagnostic Radiology Diagnostic Radiology JH Introduction to Nuclear Medicine Dermatology Special Cincinnati Special Elective Clinical Dermatology Community Hospital Medicine IM * Inpatient Hospitalist Experience* Clinical Cardiology UH* Clinical Cardiology VAMC* ECG Reading VAMC GEN Cardiology JH* Intensive Care Medicine GSH* Cardiac Care Unit UH* Clinical Clerkship in Gastroenterology UH* Clerkship in Hepto UH* Med Intensive Care Unit TCH * Clinical Gastro/Hepto VAMC* Clinical Gastroenterology JH* Gastroenterology Private Practice TCH Clerkship in Endocrine/ Metabolism* Hematology‐ Oncology Clinical Elective UH* Hematology‐ Oncology Elective VAMC* Ambulatory Hematology‐ Oncology * Clinical Infectious Disease and HIV Care* Hospital Infectious Diseases WCH & Drake Medical Consequences Opioid Misuse & Dependence OP Arthritis/Allergy* Clinical Nephrology GSH* Nephrology & Hypertension UH&VAMC* Transplant Nephrology UH * Clinical Pulmonary Medicine UH* Clerkship in Pulmonary Medicine VAMC* Pulmonary Medicine TCH*

Director Matthew Flaherty MD David Ficker MD Shannon Standridge DO MPH Cheryl McCullum‐Smith MD/PhD Bryan Griffin DO Shannon Miller MD Lawson Wulsin MD Douglas Lehrer, MD Sergio Delgado MD Brian Kurtz MD Jenifer Bowden MD Muhammad Aslam MD Jordan Kharofa MD Lily Wang MBBS Brian Weaver MD Jennifer Scheler MD Brian Adams MD MPH Brian Adams MD MPH Greg Kennebeck MD Justin Held MD PhD James Wilkin MD Robin Vandivier‐Pletsch MD Karen Ohlbaum MD Stephen Goldberg MD Shahla Mallick MD Timothy Smith MD Donald Schoch MD Donald Schoch MD Steven Mueller MD Kris Ramprasad MD Stephen Goldberg MD Michael Kreines MD Robert Cohen MD Tahir Latif MD Jayapandian Bhaskaran MD David Drosick MD Jaime Robertson MD Peter Grubbs MD Judith Feinberg MD J. Lawrence Houk MD Amir Izhar MD Satwant Singh MD Amit Govil MD Peter Lenz MD Ralph Panos MD Steve Mueller MD

Coordinator Mahima Sathe Christine Gates Mahima Sathe Christina Gibson Christina Gibson Christina Gibson Christina Gibson Christina Gibson Christina Gibson Christina Gibson Christina Gibson Christina Gibson Karen Coleman Tosha Feldkamp Tosha Feldkamp Tosha Feldkamp Jordan Perry Jordan Perry Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre Julie Lefebvre


M4 Sub Specialty Medical Clinical Elective con’t Pediatric Critical Care Medicine Pediatric Cardiology* Pediatric Endocrinology* Pediatric Gastro, Hepato & Nutrition* Pediatric Hematology‐Oncology Consult Elective* Pediatric Hematology‐Oncology Inpatient* Pediatric Infectious Diseases * Pediatric Nephrology* Clinical Clerkship In Neonatal Pediatrics* Pediatric Pathology Pediatric Radiology Pediatric Rheumatology* Pediatric Pulmonology* Forensic Pathology Laboratory Medicine Neuropathology Surgical Pathology Diagnostic Hematopathology Perinatal Pathology Clin Clkshp in PM& R

Rajit Basu MD Ivan Wilmot MD Nancy Crimmins MD Scott Pentiuk MD Michael Absalon MD PhD Michael Absalon MD PhD Rebecca Brady MD Elif Erkan MD Henry Akinbi MD Rachel Sheridan MD Steven Kraus MD Jennifer Huggins MD Gary McPhail MD Karen Looman DO Paul Steele MD Ady Kendler MD PhD Jiang Wang MD PhD Julianne Qualtieri MD Jerzy Stanek MD PhD Ashlee Bolger MD

Mimi Pence Mimi Pence Mimi Pence Mimi Pence Mimi Pence Mimi Pence Mimi Pence Mimi Pence Mimi Pence Mimi Pence Mimi Pence Mimi Pence Mimi Pence Jessica Sloniker Jessica Sloniker Jessica Sloniker Jessica Sloniker Jessica Sloniker Jessica Sloniker Mary Duke

* Also considered an ICE

M4 Elective Acting Internships

Elective Family Medicine* Internal Medicine* Emergency Medicine* Neurology* Neurological Surgery Acting Internship Child Psychiatry * Obstetrics* Gynecology* Surgery *

Director Robert Ellis MD Leann Coberly MD Robbie Paulsen MD John Quinlan MD Kerry Crone MD David Nelson MD Amy Thompson, MD Amy Thompson, MD Krishna Athota, MD

Coordinator Nancy Jamison Julie Lefebvre Melissa Murphy Mahima Sathe Penny Schwab Christina Gibson Deana Brown Deana Brown Bennie Patrick

* Also considered an ICE

M4 Research Electives

Elective Advanced Mentor in Clinical and Basic Research Basic and Clinical Research for Medical Students Neuroanatomy/Neurosurgery Research Ophthalmic Research Research Elective in Children’s Orthopedic Research Otolaryngology Head Neck Surgery Research in Family Medicine Special Elective Investigative Dermatology Ped & Adolescent Gyn‐Intro to Research & Clinical Care

Director George Deepe MD James Heubi MD Jeffrey Keller PhD Winston Kao PhD James McCarthy MD Reena Dhanda‐Patil MD Christopher White MD Raymond Boissy PhD Gylynthia Trotman, MD PhD

Coordinator Kristin Barnes Sandra Geideman Jennifer West Michele Wyan Janis Messer Alex Terhar Nancy Jamison Jordan Perry Deana Brown


M4 Sub Specialty Surgical Clinical Elective Elective Pediatric Ophthalmology General Ophthalmology Elective* Clinical Ophthalmology* Otolaryngology surgery Clinical Clerkship In Orthopedics* Clin elect Children’s Orth Neurological Surgery* Neurocritical Care (NCC)* Female Pelvic Med Reconstructive Surgery* Gynecologic Oncology Jr Internship Gen Surgery* Cardiothoracic Surgery GSH* Cardiothoracic Surgery UH* Elective In Urology * Reconstructive Care Of Burned Child* Pediatric Surgery* Plastic Surgery* Organ Transplant & Transplant Immunology* Surgical Intensive Care UH* Vascular Surgery GSH* Vascular Surgery Rotation* Anesthesia*

Director Eniolami Dosunmu MD Lisa Kelly MD Zelia Correa MD PhD Reena Dhanda‐Patil MD Brian Grawe MD Charles Mehlman DO Sudhakar Vadivelu DO Krishna Mohan MD James Whiteside MD Eric Eisenhauer MD Krishna Athota MD Kevin Grannan MD Sandra Starnes MD Nilesh Patil MD Petra Warner MD A. Roshni Dasgupta MD MPH William Kitzmiller MD Tayyab Diwan MD Krishna Athota MD Alistair Phillips MD George Meier III MD Thomas James, MD

Coordinator Michele Wyan Michele Wyan Michele Wyan Alex Terhar Kim Reising Janis Messer Jennifer West Karen Burk Deana Brown Deana Brown Bennie Patrick Bennie Patrick Bennie Patrick Perri Wright Mary Pelley Julie Ludwig Kathy Hoh Bennie Patrick Bennie Patrick Bennie Patrick Bennie Patrick Shannon Foote

* Also Considered an ICE

Primary Care Clinical Elective Elective Primary Car Emergency Medicine* Geriatric Medicine Multidisciplinary* Preceptor in Family Medicine* Global Health Care* Global Health Care Tanzania * Palliative Care* Homeless Health Elective OP PC for Patients with Intellectual & Develpmt Disabilities OP Adolescent Medicine* Ambulatory Pediatric Preceptorship* Child Abuse Pediatric Emergency Medicine* Introduction to Advocacy and Injury Prevention Care NORM & High Risk Newborn GSH* Transition Medicine Developmental Disorders Clinical Genetics* OB Laborist* Family Planning/Contraception Maternal‐Fetal Med Clksp Reproduction Endocrinology & Infertility Community Women’s Health Global And International Medical Education * Also Considered an ICE

Director Robbie Paulsen MD Jeffrey Schlaudecker MD Robert Ellis MD Robert Ellis MD Robert Ellis MD Robert Ellis MD Robert Ellis MD Lauren Wang MD Corrine Lehmann MD Corrine Lehmann MD Kathi Makoroff MD Eunice Blackmon MD Lisa Vaughn PhD Kurt Schibler MD Abigail Nye MD Karen Mason MD Robert Hopkins MD Amy Thompson MD Amy Thompson MD Emily DeFranco DO Michael Thomas MD Rocco Rossi MD Jason Blackard PhD

Coordinator Murphy, Melissa Melissa Bosse Nancy Jamison Nancy Jamison Nancy Jamison Nancy Jamison Nancy Jamison Nancy Jamison Mimi Pence Mimi Pence Mimi Pence Mimi Pence Mimi Pence Mimi Pence Mimi Pence Mimi Pence Mimi Pence Deana Brown Deana Brown Deana Brown Deana Brown Deana Brown


Self Directed Education and Interdisciplinary Elective Dissection Of The Human Body Gross Anatomy Prosection & Teaching Clinical Capstone: Get Ready For Residency Integrative Medicine Clinical Transfusion Medicine Clinical Nutrition Interprofessional Collaboration In Health Care Military Med: Basic Offcer Leadership Refining Communication techniques for future physicians

Director DJ Lowrie PhD DJ Lowrie PhD Sarah Ronan�Bentle MD Mary Barnes MD Patricia Carey MD Bonnie Brehm PhD Bonnie Brehm PhD Rob Neel MD Amy Thompson MD

Coordinator Laura Garrison Laura Garrison Melissa Murphy Margaret Simon Catherine Smith Catherine Smith J. Rosing Deana Brown


Pilot Goals - Core EPAs - Initiatives - AAMC

1 of 1

Core EPAs Home (https://www.aamc.org/initiatives /coreepas/)

https://www.aamc.org/initiatives/coreepas/goals/

Goals of the Core EPAs Pilot Primary Goal: To demonstrate the feasibility of implementing the Core EPAs for Entering Residency framework in the path to graduation of M.D. candidates.

Pilot Goals (https://www.aamc.org /initiatives/coreepas /goals/)

Specifically, we hope to answer questions in four main areas: 1. Curriculum development:

Guiding Principles (https://www.aamc.org/initiatives /coreepas/guiding-principles/) Pilot Participants (https://www.aamc.org/initiatives /coreepas/pilotparticipants/) News and Updates (https://www.aamc.org/initiatives /coreepas/newsandupdates/)

How do we teach students the knowledge, skills, and attitudes needed for each of the EPAs? What do we teach students in order for them to be able to independently perform the skills needed for each EPA? When do we teach each of these skills? In what order do we teach each skill? What components are best taught in a classroom? In a small group? In a simulated environment? In a clinical setting? 2. Assessment of competency using the EPA framework:

Publications and Presentations (https://www.aamc.org/initiatives /coreepas /publicationsandpresentations/)

How many observations are needed for each of the EPAs? What contexts (e.g., children versus adult, acute versus ambulatory setting, simple versus complex disease) are essential to observe for each EPA?

Listserve To subscribe to the Core EPAs listserve, send a blank email to subscribecoreepas@lists.aamc.org (mailto:subscribecoreepas@lists.aamc.org). Contact coreepas@aamc.org (mailto:coreepas@aamc.org)

How consistent must the performance of the students be to be entrusted to perform the activity without direct supervision? Are they assessed as a bundle or does the assessment of each component add up to a complete EPA assessment? 3. The path to entrustment: Who makes the entrustment decision? When is the decision made? How is the decision documented? How and when is developmental information about entrustment conveyed to residency program directors? How do residency program directors view the credibility of entrustment decisions? 4. Faculty development: How do we teach faculty about CBME and EPAs? Can this be scaled (webinar or online? Small group?) What are the faculty development needs for helping faculty to assess competence through this EPA framework? How do we reach community based faculty? What data do we need to track faculty assessment decisions? What forms, videos, and other learning materials need to be produced? Secondary goal: To demonstrate improvement in the gap between performance and expectations for students entering residency who have been entrusted on the Core EPAs.

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Guiding Principles - Core EPAs - Initiatives - AAMC

1 of 1

Core EPAs Home (https://www.aamc.org/initiatives /coreepas/) Pilot Goals (https://www.aamc.org/initiatives /coreepas/goals/) Guiding Principles (https://www.aamc.org /initiatives/coreepas /guiding-principles/) Pilot Participants (https://www.aamc.org/initiatives /coreepas/pilotparticipants/) News and Updates (https://www.aamc.org/initiatives /coreepas/newsandupdates/) Publications and Presentations (https://www.aamc.org/initiatives /coreepas /publicationsandpresentations/)

https://www.aamc.org/initiatives/coreepas/guiding-principles/

Core EPAs Guiding Principles The pilot group recommends that institutions intending to design and implement educational systems utilizing the framework of Core Entrustable Professional Activities for Entering Residency should: Employ a systematic approach to map educational opportunities and assessments for each EPA Explicitly measure the attribute of trustworthiness in addition to the specific knowledge, skills and attitudes required for each EPA Create a longitudinal view of each learner’s performance via, at minimum, aggregated performance evidence; and consider the added value of longitudinal relationships and formal coaching structures in informing entrustment decisions

Listserve To subscribe to the Core EPAs listserve, send a blank email to subscribecoreepas@lists.aamc.org (mailto:subscribecoreepas@lists.aamc.org).

Gather multi-modal performance evidence from multiple assessors about each learner for each EPA

Contact

Include global professional judgments about entrustment of each learner in the body of evidence

coreepas@aamc.org (mailto:coreepas@aamc.org)

that supports entrustment decisions Ensure a process for formative feedback along the trajectory to entrustment to provide opportunities for both remediation and potential acceleration of responsibilities Create a process to render and maintain formal entrustment decisions by a trained group (entrustment committee) that reviews performance evidence for each student Ensure that each learner is an active participant in the entrustment process: aware of expectations, engaged in gathering and review of performance evidence, and generating individualized learning plans to attain entrustment Align formal entrustment decisions regarding individual students with nationally established performance expectations, as currently described in the Core EPAs for Entering Residency Curriculum Developer’s Guide (https://members.aamc.org/eweb/upload /Core%20EPA%20Curriculum%20Dev%20Guide.pdf)

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Core Entrustable Professional Activities for Entering Residency Faculty and Learners’ Guide Learn Serve Lead

Association of American Medical Colleges


Š2014 Association of American Medical Colleges. May not be reproduced or distributed without prior permission. To request permission, please visit: www.aamc.org/91514/reproductions.html This is a publication of the Association of American Medical Colleges. The AAMC serves and leads the academic medicine community to improve the health of all. www.aamc.org.


Core Entrustable Professional Activities for Entering Residency Faculty and Learners’ Guide


Core Entrustable Professional Activities for Entering Residency

Preface We are excited to provide you with the final “version 1.0” of the Core Entrustable Professional Activities (EPAs) for Entering Residency. This work has been the product of a great deal of effort over the past year and a half. Many of you have been engaged through the Reactor Panel or through one of the Association of American Medical College’s groups that provided essential and actionable feedback. We are grateful for your input and hope you see the fruits of your efforts in this version. We see the publication of this version as a beginning rather than an end—an open invitation to an ongoing conversation about how to assure that students are well prepared for residency training. While we used the literature and the “wisdom of the crowd” to inform our work, we are certain that the current version will change as the work of our community begins now with all of you. We hope you will receive the publication of the Core EPAs for Entering Residency as a call to action to think differently about the desired outcomes for your learners and the learning experiences and assessment opportunities they will encounter during their time with you. Perhaps most importantly, we are asking that you continue to share feedback throughout the testing and implementation ahead. We need to understand from you what works, in what contexts, and for whom. We hope that as you begin to answer these questions at your sites, you will share lessons learned through posting to the Association of American Medical College’s iCollaborative website: www.mededportal.com/icollaborative/resource/887 On the basis of your feedback, we created two separate manuals. One is for curriculum developers with details about how we mapped the EPAs to domains of competence, competencies, and their respective milestones, and the other is for frontline faculty and learners with just a description of the EPA, narrative and bulleted descriptions of learner behaviors, and clinical vignettes describing pre-entrustable and entrustable learners. We hope you will find this a practical way to reframe your thinking about what we should expect from our medical school graduates. From the beginning, we have been guided by a focus on patient safety, so we are anxious to see this “bench” work translated into real differences “at the bedside.” We look forward to learning from you as we now move from the learning phase to the testing and implementation phases of the Core Entrustable Professional Activities for Entering Residency.

The Core Entrustable Professional Activities for Entering Residency Drafting Panel

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Core Entrustable Professional Activities for Entering Residency

Acknowledgments We would like to acknowledge our Advisory Panel, which met September 19, 2012, to help us set the course for this project: Robert G. Carroll, Ph.D. Assistant Dean for Academic Affairs in the Basic Sciences Brody School of Medicine East Carolina University Jason R. Frank, M.D., M.A. (Ed.), FRCPC Director, Specialty Education Strategy, and Standards Royal College of Physicians and Surgeons of Canada Tracy B. Fulton, Ph.D. Professor, Biochemistry and Biophysics Competency Director, Medical Knowledge University of California at San Francisco Heather Hageman Director of Educational Planning and Program Assessment Director, Standardized Patient Program Washington University School of Medicine

Janet E. Lindsley, Ph.D. Associate Professor of Biochemistry Assistant Dean of Curriculum University of Utah Deborah Simpson, Ph.D., M.A. Medical Education Program Director, Aurora Health Care Clinical Adjunct Professor of Family Medicine, University of Wisconsin School of Medicine and Public Health Mark C. Wilson, M.D., M.P.H. Associate Dean, Graduate Medical Education University of Iowa, Carver College of Medicine DIO, University of Iowa Hospitals and Clinics

We wish to thank the many individuals who were part of our Reactor Panel for their invaluable feedback throughout the process of developing the Core Entrustable Professional Activities for Entering Residency. Special thanks also to Jan Bull, Lead Specialist for Competency-based Learning and Assessment at the AAMC, for her efforts at developing the background material for the Drafting Panel and for putting together this document. We wish to thank Olle ten Cate for his vision in developing the concept of Entrustable Professional Activities (EPAs) and for his valuable feedback.

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Core Entrustable Professional Activities for Entering Residency

Drafting Panel for Core Entrustable Professional Activities for Entering Residency Timothy Flynn, M.D., Chair Senior Associate Dean for Clinical Affairs University of Florida

Stephanie Call, M.D., MSPH Program Director, Internal Medicine Virginia Commonwealth University Carol Carraccio, M.D., M.A. Vice President, Competency-based Assessment American Board of Pediatrics Lynn Cleary, M.D. Vice President for Academic Affairs State University of New York, Upstate Tracy B. Fulton, Ph.D. Professor, Biochemistry and Biophysics Competency Director, Medical Knowledge University of California at San Francisco Maureen Garrity, Ph.D. Dean for Student Affairs University of Colorado, Denver Steven Lieberman, M.D. Senior Dean for Administration University of Texas Medical Branch, Galveston Brenessa Lindeman, M.D. Resident Physician, General Surgery Member, AAMC Board of Directors Johns Hopkins University

Rebecca Minter, M.D. Associate Chair of Education, Department of Surgery; and Associate Program Director, General Surgery University of Michigan Jay Rosenfield, M.D., M.Ed. Vice Dean, Undergraduate Medical Professions Education University of Toronto Joe Thomas, M.D. Intern, Emergency Medicine Mayo Clinic Mark C. Wilson, M.D., M.P.H. Associate Dean, Graduate Medical Education University of Iowa, Carver College of Medicine DIO, University of Iowa Hospitals and Clinics AAMC Staff Carol A. Aschenbrener, M.D. Chief Medical Education Officer Robert Englander, M.D., M.P.H. Senior Director, Competency-based Learning and Assessment For inquiries and correspondence, contact Dr. Robert Englander at renglander@aamc.org.

Monica L. Lypson, M.D., MHPE Professor of Internal Medicine and Medical Education Assistant Dean for Graduate Medical Education University of Michigan Medical School

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Core Entrustable Professional Activities for Entering Residency

Table of Contents Background and Context for the Core EPAs for Entering Residency . . . . . . . . . . . . . . . . . . . . . . . . 2 How to Use this Document . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 EPA 1: Gather a history and perform a physical examination . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 (Primary authors: Stephanie Call, Tracy Fulton) EPA 2: Prioritize a differential diagnosis following a clinical encounter . . . . . . . . . . . . . . . . . . . . . . 10 (Primary authors: Maureen Garrity, Brenessa Lindeman) EPA 3: Recommend and interpret common diagnostic and screening tests . . . . . . . . . . . . . . . . . . . 13 (Primary authors: Steven Lieberman, Monica Lypson) EPA 4: Enter and discuss orders and prescriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 (Primary authors: Rebecca Minter, Jay Rosenfield) EPA 5: Document a clinical encounter in the patient record . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 (Primary authors: Carol Carraccio, Lynn Cleary) EPA 6: Provide an oral presentation of a clinical encounter . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 (Primary authors: Rebecca Minter, Jay Rosenfield) EPA 7: Form clinical questions and retrieve evidence to advance patient care . . . . . . . . . . . . . . . . . . 26 (Primary authors: Stephanie Call, Tracy Fulton) EPA 8: Give or receive a patient handover to transition care responsibility . . . . . . . . . . . . . . . . . . . . 29 (Primary authors: Joe Thomas, Mark Wilson) EPA 9: Collaborate as a member of an interprofessional team . . . . . . . . . . . . . . . . . . . . . . . . . . 32 (Primary authors: Carol Carraccio, Lynn Cleary) EPA 10: Recognize a patient requiring urgent or emergent care and initiate evaluation and management . . . . 34 (Primary authors: Joe Thomas, Mark Wilson) EPA 11: Obtain informed consent for tests and/or procedures . . . . . . . . . . . . . . . . . . . . . . . . . . 38 (Primary authors: Robert Englander, Timothy Flynn) EPA 12: Perform general procedures of a physician . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 (Primary authors: Maureen Garrity, Brenessa Lindeman) EPA 13: Identify system failures and contribute to a culture of safety and improvement . . . . . . . . . . . . . 43 (Primary author: Robert Englander) Appendix: Bulleted list of expected behaviors for pre-entrustable and entrustable learners . . . . . . . . . . . 46 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 For a complete version of the Core Entrustable Professional Activities for Entering Residency Drafting Panel Report, please go to: www.mededportal.org/icollaborative/resource/887

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Association of American Medical Colleges


Core Entrustable Professional Activities for Entering Residency

Background and Context for the Core EPAs for Entering Residency Over the past several years, program directors have increasingly expressed concern that some medical school graduates are not prepared for residency.1-3 Efforts are under way in both the United States and Canada4,5 to better define the requirements at key transition points in the formation of physicians (college to medical school, medical school to residency, and residency to practice or fellowship). Liaison Committee for Medical Education (LCME) standards require all accredited schools to have educational objectives that are grounded in outcomes valued by the profession and the public. Most schools have “graduation competencies” or “graduation objectives” that are linked to foundational competencies and to the unique mission of the school. However, as of yet there has been no agreement in the undergraduate medical education (UME) community about a common core set of behaviors that could/ should be expected of all graduates. In 2013, the Accreditation Council for Graduate Medical Education (ACGME) in partnership with the American Board of Medical Specialties (ABMS) initiated the Milestone Project6 to define progressive levels of performance for each competency, with the expectation that residents achieve specific milestones before graduating from training and taking their specialty certification examination. The time is right to identify a short list of integrated activities to be expected of all M.D. graduates making the transition from medical school to residency: the Core Entrustable Professional Activities for Entering Residency. The AAMC convened an experienced Drafting Panel to engage in this important effort. The Drafting Panel had a student, a resident, and a basic scientist as well as distinguished medical educators who represented the continuum from undergraduate medical education through practice. The work of the Drafting Panel builds on previous work, including the AAMC Project on the Clinical Education of Medical Students4, the Milestones Project6, published studies of the UME-GME transition,7-9 and the recently published “Reference List of General Physician Competencies.”10

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Conceptual Framework Chosen for This Work To develop a conceptual framework, the members of the Drafting Panel first agreed on the following shared definitions: 1.  Competency: An observable ability of a health professional, integrating multiple components such as knowledge, skills, values, and attitudes. Since competencies are observable, they can be measured and assessed to ensure their acquisition.11 2. E ntrustable Professional Activity (EPA): EPAs are units of professional practice, defined as tasks or responsibilities that trainees are entrusted to perform unsupervised once they have attained sufficient specific competence. EPAs are independently executable, observable, and measurable in their process and outcome, and, therefore, suitable for entrustment decisions.12 3. Milestone: A milestone is a behavioral descriptor that marks a level of performance for a given competency (derived from the ACGME Milestones project6). After considering the benefits and disadvantages of the two prevailing conceptual frameworks in the literature, competencies and Entrustable Professional Activities (EPAs),13 the Drafting Panel decided to proceed with EPAs (see Table 1). The reader should note that EPAs and competencies are not mutually exclusive. To the contrary, EPAs by definition require the integration of competencies, and competencies are best assessed in the context of performance (as can be provided by the EPA framework). The relationship between EPAs, competencies, and milestones is further explored in Figure 2.

Association of American Medical Colleges


Core Entrustable Professional Activities for Entering Residency

Table 1. Comparison of the Benefits and Disadvantages of the Two Conceptual Frameworks Considered: Competencies and EPAs

Benefits

EPAs

Competencies

 PAs are “activities,” which make sense E to faculty, trainees, and the public

 epresent the day-to-day work of the R professional

 ompetencies have been the basis for C assessment in the GME space for a decade

 ituate competencies and milestones in S the clinical context in which we live

In the aggregate, define the “good physician”

 ave a reasonable body of evidence H around assessment of the “traditional” domains (medical knowledge and patient care)

 ave been used for establishing or H developing milestones of performance for at least the GME years

Disadvantages

 ake assessment more practical by M clustering milestones into meaningful activities

 xplicitly add the notions of trust and E supervision into the assessment equation

 ere relatively recently introduced in the • W literature • Have had little operationalization worldwide

• •

Are abstract  re granular and therefore often not the A way we think about or observe learners

 ere designed originally for the W residency-to-practice transition

Charge to the Core EPAs for Entering Residency Drafting Panel As a result of the chosen conceptual framework, the Drafting Panel was charged with the following: To delineate those activities that all entering residents should be expected to perform on day 1 of residency without direct supervision, regardless of specialty. We used the ACGME definitions for direct and indirect supervision14: 1) Direct Supervision: The supervising physician is physically present with the resident and the patient. 2) Indirect Supervision is broken down into two levels: a. Direct Supervision Immediately Available: The supervising physician is physically within the hospital or other site of patient care and is immediately available to provide direct supervision. b. Direct Supervision Available: The supervising physician is not physically present within the hospital or other site of patient care, but is immediately available by means of telephonic and/or electronic modalities, and is available to provide direct supervision.

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Association of American Medical Colleges


Core Entrustable Professional Activities for Entering Residency

Guiding Principles Before delineating the Core EPAs for Entering Residency, the Drafting Panel defined the following principles to guide our work: A. General • The primary motivation for this work is patient safety. We focused on aligning the professional development at the UME-GME transition with safe, effective, and compassionate care. • A secondary motivation is to enhance the confidence of new residents, program directors, and patients with respect to the residents’ abilities to perform the activities they will be expected to do without direct supervision when they enter residency. • The activities will represent a necessary but not sufficient set of competencies for entering residents, a “core,” not a ceiling. • These activities are intended to supplement, not replace, the mission- and specialty-specific graduation competencies of the individual medical schools and specialties.

• Critical competencies and their milestones should be linked to the EPAs to provide a shared mental model of expected behavior for new residents that will help faculty and students in assessment. • The ideal implementation and assessment system will give students many opportunities to practice with repeated, low-stakes formative assessments, culminating in entrustment decisions for each of the 13 EPAs by the time they graduate.

Relationship between the Core EPAs for Entering Residency and School or Specialty-Specific EPAs The Core EPAs for Entering Residency are designed to be a subset of all of the graduation requirements of a medical school. Individual schools may have additional mission-specific graduation requirements, and specialties may have specific EPAs that would be required after the student has made the specialty decision but before residency matriculation. The Core EPAs may also be foundational to an EPA for any practicing physician or for specialty-specific EPAs. The relationships among Core EPAs for Entering Residency, medical school graduation requirements, EPAs for all physicians, and specialtyspecific EPAs are depicted in Figure 1.

B. Implementation Principles • The success of this work will require faculty development in teaching the EPAs, direct observation, using tools for workplace assessment, and delivering feedback. C. Assessment Principles

Expectations for the Medical School Graduate

Core EPAs

For Entering Residency

EPAs

For any Practicing Physician

EPAs

For Specialties

• Assessment must be considered through every step of this process. • Assessment of these activities must embrace qualitative feedback based on direct observation. • Cost, feasibility and educational impact should be added to the validity and reliability considerations of new or existing assessment tools.15

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Figure 1. The relationships among the Core EPAs for Entering Residency to a medical school’s graduation requirements, the EPAs for any physician, and specialty-specific EPAs

Association of American Medical Colleges


Core Entrustable Professional Activities for Entering Residency

The Relationships among EPAs, Competencies, and Milestones Before discussing the relationships among EPAs, competencies, and milestones, we want to emphasize that two competencies are foundational to all of the EPAs because they are required for any entrustment decision: 1) trustworthiness and 2) self-awareness of limitations that leads to appropriate help-seeking behavior.16 Therefore, both of these competencies should be documented in a learner’s portfolio before any entrustment decision is made. The relationship between EPAs and competencies has been elucidated in the literature.12,17 EPAs are units of work, while competencies are abilities of individuals. One of the defining markers of an EPA is that its performance requires integration of competencies, usually across domains. To apply that concept to this work, the Drafting Panel did a mapping exercise to determine the five to eight competencies most critical to making an entrustment decision for each of the 13 EPAs. We chose the competencies from the “Reference List for General Physician Competencies.”10 Furthermore, we wanted to underscore that Interpersonal and Communication Skills (ICS) and Professionalism competencies are integrated throughout the Core EPAs for Entering Residency. Appendix D is a table that displays the number of times each competency was linked to one of the EPAs as a critical component of a supervisor’s entrustment decision. Readers can see in that appendix that ICS and Professionalism competencies are among the most frequently cited as critical to performing the EPAs. In fact, ICS competencies 1 and 2, which refer to effective communication with patients and families (ICS 1) and with intra- and interprofessional colleagues (ICS 2), respectively, have the highest number of links to the EPAs. While the relationship between EPAs and competencies is relatively well-defined in the literature, the relationship between EPAs and milestones is not. The EPAs provide the clinical context for the competencies. As such, each EPA can be mapped to the competencies that are critical to making an entrustment decision. Each competency, then, has milestones associated with it that represent behavioral markers of increasing levels of performance. Thus, an EPA is directly related to the milestones for those competencies that are critical to entrustment decisions for that EPA.

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Once we determined the critical competencies for each EPA, we sought to develop milestones for each of the competencies. We used the pool of milestones from Pediatrics (PEDS)18, Surgery (SURG)19, Emergency Medicine (EM)20, Internal Medicine (IM)21, and Psychiatry (PSYCH)22 and the Core Competencies for Interprofessional Collaboration (IPEC)23 that were published when the EPAs were written. We developed two milestones for each competency: 1) the milestone at which a learner would be considered “preentrustable” (i.e., not yet worthy of entrustment to perform the activity without direct supervision) and 2) the milestone at which a learner would be considered “entrustable” (i.e., worthy of entrustment to perform the activity without direct supervision). We then synthesized the combined milestones for the preentrustable learner to create both a narrative and a bulleted description of the learner at this level, and we did the same using the milestones for the entrustable learner. Once we had created these behavioral descriptions, we translated them into clinical vignettes that can be used as the basis for faculty development and for assessment via vignette matching.24 As conceived for the Core EPAs for Entering Residency, the relationships among EPAs, competencies, and milestones are illustrated in Figure 2.

DOC

EPA

DOC

DOC

C2 C3 C1 C4 C2 C5

M1 M2 M1 M2 M1 M2 M1 M2 M1 M2 M1 M2

EPA: Entrustable Professional Activity

C: Competency

DOC: Domain of Competence

M: Milestone

Narrative Description of a pre-entrusted learner

Narrative Description of a entrusted learner

Figure 2. EPAs require the integration of competencies, usually from two or more domains. For each competency, then, milestones can be devised and then synthesized into descriptive narratives of expected behaviors for learners at pre-entrustable and entrustable levels of performance.

Association of American Medical Colleges


Core Entrustable Professional Activities for Entering Residency

How to Use This Document Contents

Using the Guide for Developing Faculty

This document delineates 13 EPAs that all entering residents should be expected to perform on day 1 of residency without direct supervision regardless of specialty choice.

The EPA descriptions, the expected behaviors, and the vignettes are expected to serve as the foundation for faculty development. Faculty can use this guide as a reference for both feedback and assessment in pre-clinical and clinical settings. We have created this version of the document for frontline faculty and learners by retaining only the detail essential for observing and assessing the EPAs and making entrustment decisions. This document is available online and is titled Core Entrustable Professional Activities for Entering Residency: Faculty and Learners’ Guide.

Each EPA has the following sections: •

Description of the EPA with associated critical functions

A narrative for each EPA of the expected behaviors for pre-entrustable and entrustable learners based on the milestones

Vignettes for each EPA that illustrate what the preentrustable and entrustable learners might look like in a clinical setting

The Appendix lists the behaviors expected of a preentrustable and entrustable learner in bulleted form.

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Using the Guide for Developing Learners Learners can also use this document to understand the core of what is expected of them by the time they graduate. The EPA descriptions themselves delineate the expectations, while the developmental progression laid out from pre-entrustable to entrustable behaviors can serve as the roadmap for achieving them.

Association of American Medical Colleges


Core Entrustable Professional Activities for Entering Residency

EPA 1: Gather a history and perform a physical examination Description of the activity

Day 1 residents should be able to perform an accurate complete or focused history and physical exam in a prioritized, organized manner without supervision and with respect for the patient. The history and physical examination should be tailored to the clinical situation and specific patient encounter. This data gathering and patient interaction activity serves as the basis for clinical work and as the building block for patient evaluation and management. Learners need to integrate the scientific foundations of medicine with clinical reasoning skills to guide their information gathering. Functions History • •

• • • • • •

 btain a complete and accurate history in an organized fashion. O Demonstrate patient-centered interview skills (attentive to patient verbal and nonverbal cues, patient/family culture, social determinants of health, need for interpretive or adaptive services; seeks conceptual context of illness; approaches the patient holistically and demonstrates active listening skills). Identify pertinent history elements in common presenting situations, symptoms, complaints, and disease states (acute and chronic). Obtain focused, pertinent histories in urgent, emergent, and consultative settings. Consider cultural and other factors that may influence the patient’s description of symptoms. Identify and use alternate sources of information to obtain history when needed, including but not limited to family members, primary care physicians, living facility, and pharmacy staff. Demonstrate clinical reasoning in gathering focused information relevant to a patient’s care. Demonstrate cultural awareness and humility (for example, by recognizing that one’s own cultural models may be different from others) and awareness of potential for bias (conscious and unconscious) in interactions with patients.

Physical Exam • • • •

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Perform a complete and accurate physical exam in logical and fluid sequence. Perform a clinically relevant, focused physical exam pertinent to the setting and purpose of the patient visit. Identify, describe, and document abnormal physical exam findings. Demonstrate patient-centered examination techniques that reflect respect for patient privacy, comfort, and safety (e.g., explaining physical exam maneuvers, telling the patient what one is doing at each step, keeping patients covered during the examination).

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Core Entrustable Professional Activities for Entering Residency

Pre-Entrustable Learners Expected behaviors for a pre-entrustable learner The learner at this level demonstrates underdeveloped skill in history gathering, manifested as errors of omission or commission in gathering information. This learner may also incorrectly perform physical exam maneuvers and may miss key physical exam findings. These gaps in demonstrated skill may be due to a limited ability to filter, prioritize, and connect pieces of information to each other; to prior clinical encounters; or to existing factual knowledge. The pre-entrustable learner may make decisions based on intuition or a limited ability to develop relevant mental models rather than on appropriate information. The learner inconsistently demonstrates use of patient-centered information gathering and physical exam skills and may either generalize based on a patient’s background or pay inadequate attention to the patient’s individual background. Vignette for a pre-entrustable learner Zhongshu is seeing patients in the free clinic as part of a primary care team. Her first patient of the day is Mr. Rodriguez, for whom the nursing triage sheet documents a chief complaint of cough. Mr. Rodriguez is new to the clinic. He is fully clothed and sitting on the examination table when Zhongshu walks into the room. Zhongshu closes the door and stands, leaning against the wall, with a tablet in hand to take notes and document in the chart. Zhongshu starts her history-taking by saying, “The nurses said you have a cough. How long has it been going on?” She follows this with a series of questions regarding the description and progression of the cough. She finds that the patient has a chronic cough that seems to have gotten acutely worse. She asks about associated symptoms and inciting or relieving factors. She asks pertinent questions about history such as smoking, exposure to sick contacts, and known lung disease. She takes a full medical history, including medications, and details a family tree in the chart. Social history points include marital status, current living situation, and substance use history. She does not include occupational or travel history. She does not demonstrate curiosity about Mr. Rodriquez’ cultural context or elicit his health beliefs. After she is done taking the history, Zhongshu says, “OK, Mr. Rodriguez, I am going to take a look at you.” She starts by auscultating the lungs in six areas, first

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under the shirt then moving to over the shirt for the upper lung zones. During the lung exams, she asks the patient to “take some deep breaths.” She then listens to the heart in four areas. Next, she grabs the otoscope on the wall and uses it to check pupillary reaction to light and eye movements (asking the patient to look up, to the side, and down), looks inside the oropharynx, and then grabs the ear piece to look at the ear. She does a brief but appropriate examination of the abdomen and checks the skin for rashes and feet for pulses. She does not note the temporal muscle wasting or the bilateral cervical adenopathy that is present. After the examination, Zhongshu tells the patient that she will be discussing him with the primary care team and will return. As she is leaving the room, Mr. Rodriguez asks timidly, “What do you think is causing my cough?” Zhongshu turns and answers, “I am sure that it is nothing serious, probably an upper respiratory infection or bronchitis. There are some medications that cause coughs, but you are not on them. We will probably get a chest X-ray.” She then walks out of the room.

Entrustable Learners Expected behaviors for an entrustable learner The learner at this level is routinely able to gather an accurate complete history and can also gather a focused history in an urgent, emergent, or consultation setting. When necessary, the learner identifies and uses alternative sources of information beyond the patients themselves and ensures appropriate communication by using interpreter services when necessary. The entrustable learner can perform an accurate complete physical exam or a focused physical exam pertinent to the patient visit, identify and document abnormal findings, and describe such findings to team members. For the entrustable learner, analytic reasoning and the abilities to activate prior foundational knowledge and prior clinical experience underlie the choice of either a complete or a focused history and physical exam and guide the gathering of information relevant to the patient’s care. The learner at this level consistently uses patient-centered interview skills and physical exam techniques that, even under conditions of stress or fatigue, demonstrate respect for patients, insight about patients’ emotional responses, sensitivity toward each patient’s unique background and needs, and the ability to communicate bidirectionally.

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Vignette for an entrustable learner Zhongshu is seeing patients in the free clinic as part of a primary care team. Her first patient of the day is Mr. Rodriguez, for whom the nursing triage sheet documents a chief complaint of cough. Mr. Rodriguez is new to the clinic. Before entering the room, Zhongshu asks the nurse if an interpreter is needed; she clarifies that the patient’s first language is Spanish but that he has full ability to communicate in English. Mr. Rodriquez is fully clothed and sitting on the examination table when Zhongshu walks into the room. Zhongshu closes the door and invites the patient to sit in the chair while they review his history. Zhongshu grabs the stool and wheels it over so that she can sit facing the patient. She asks Mr. Rodriguez if he minds if she jots down a few notes while they are talking. Zhongshu starts her history-taking with: “Mr. Rodriguez, it is great to meet you. My name is Zhongshu Tang. You can call me Dr. Tang. I am working with the primary care team today. What brings you to the clinic today?” Upon eliciting the complaint of a cough, she says, “Tell me a bit more about the cough,” and uses several techniques such as repeating back what she has heard, providing summary statements, and asking follow-up questions to elicit the pertinent details of the history. She finds that the patient has a chronic cough that seems to have gotten acutely worse. She asks about associated symptoms and symptoms related to potential diagnoses such as gastroesophageal reflux disease, allergic rhinitis, asthma and malignancy. She also identifies important risk factors for different diagnoses such as occupational history, travel history, and alcohol use. She takes detailed medical history, including the use of prescription, over-thecounter, and other medications and drugs; pertinent family history; social history; and information about allergies (including reactions). She specifically asks Mr. Rodriguez what he believes is causing the cough and if he has seen any healers or other providers. She identifies that he has seen a lay healer and tried some folk remedies including ajo (garlic) and gordolobo (mullein) tea. She concludes by asking, “Mr. Rodriguez, do you think that I have missed anything important in your medical history or about your cough?” After she is done taking the history, Zhongshu says, “OK, Mr. Rodriguez, I would like to do a full examination at this point. I will step out and let you change into a gown, which is located in this drawer. I will be back in a minute. Is there anything else that you

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need right now?” Zhongshu steps into the hall briefly, closing the door behind her. She returns to the room and states, “Mr. Rodriguez, I would like to do a full examination from head to toe. I am going to explain to you what I am doing at each point, but please let me know if you have questions.” She starts by examining the head, eyes, ears, nose, and throat, telling the patient what she is doing before she touches the patient at each step. She notes that there is temporal wasting and inquires about recent weight loss and a bit about diet. She also notes cervical adenopathy and asks the patient about tenderness and duration. She does a thorough lung examination, removing or moving the gown so that she can auscultate directly at each point. She auscultates, then performs more detailed maneuvers such as listening for egophony and percussion. She moves through the rest of the exam, performing each part thoroughly and continuing to tell the patient what she is doing. Throughout the exam, she pays careful attention to draping and patient modesty and comfort. After the examination, Zhongshu tells the patient that she will be discussing him with the primary care team and will return. She asks if there is anything else that Mr. Rodriguez has thought of during the exam and if Mr. Rodriguez has any further questions. As she is leaving the room, Mr. Rodriguez asks timidly, “What do you think is causing my cough?” Zhongshu turns, closes the door again, and sits down on the stool to answer the question. She first asks, “Is there something that you are worried about?” Mr. Rodriguez admits that he is worried about cancer. Zhongshu reviews that there are several causes of chronic cough, including upper airway cough syndrome, gastroesophageal reflux disease, asthma, allergies, chronic bronchitis, primary pulmonary diseases, and chronic infections. She explains that that is why she was asking so many questions, looking for clues to the underlying cause. She states that lung cancer can present as a chronic cough. She reassures the patient that she will discuss the symptoms and physical examination with the team and that they will pursue a work-up to find the cause. She asks again if the patient has any further questions and explains that she will be right back. She then walks out of the room.

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EPA 2: Prioritize a differential diagnosis following a clinical encounter Description of the activity

To be prepared for the first day of residency, all physicians need to be able to integrate patient data to formulate an assessment, developing a list of potential diagnoses that can be prioritized and lead to selection of a working diagnosis. Developing a differential diagnosis is a dynamic and reflective process that requires continuous adaptation to avoid common errors of clinical reasoning such as premature closure. Functions • • • • • •

Synthesize essential information from the previous records, history, physical exam, and initial diagnostic evaluations. Integrate information as it emerges to continuously update differential diagnosis. Integrate the scientific foundations of medicine with clinical reasoning skills to develop a differential diagnosis and a working diagnosis. Engage with supervisors and team members for endorsement and verification of the working diagnosis in developing a management plan. Explain and document the clinical reasoning that led to the working diagnosis in a manner that is transparent to all members of the health care team. Manage ambiguity in a differential diagnosis for self and patient and respond openly to questions and challenges from patients and other members of the health care team.

Pre-Entrustable Learners Expected behaviors for a pre-entrustable learner The learner at this level approaches assessment of a patient problem largely from a rigid template based on associations made between symptoms or physical exam findings and diagnoses. This learner may not gather all pertinent information from the patient’s history or physical exam findings, leading to a differential diagnosis that is too narrow or contains inaccuracies. The learner at this level has a limited ability to filter, prioritize, and make connections between information gathered from primary and secondary sources, including the patient’s history, physical exam, and diagnostic evaluations such as laboratory and radiographic studies. Additionally, this learner has a limited ability to identify and reflect on pertinent information as it emerges in order to continuously update the differential diagnosis and avoid errors of clinical reasoning, such as premature closure.

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The pre-entrustable learner may overly rely on supervisors and team members for development of the differential diagnosis and selection of a working diagnosis and may not be able to articulate a cohesive management plan. When this learner does offer a management plan, it may not be sufficiently inclusive of all items in the differential, thereby missing confirmation or disconfirmation of important diagnoses. The pre-entrustable learner may also create and carry out a management plan without the required prior endorsement and/or verification of the working and differential diagnosis from supervisors. The management plans developed by the learner may, thus, include a broad range of diagnostic evaluations that are not tailored to the prioritized differential diagnosis; plans may disregard pre-test probability or relevant system factors. The pre-entrustable learner has little insight into his limitations and may not be aware when his knowledge is insufficient for the situation at hand, leading to overor underestimation of abilities and uneasiness when questioned by the patient or supervisor. This learner may come to premature closure. He or she may not be comfortable acknowledging ambiguity and may not

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ask other health care providers on the team, including supervising physicians, nursing, or other staff, for help. The pre-entrustable learner may fail to document or may incompletely document the reasoning that led to the assessment and plan, which have errors that would be apparent to other team members. Vignette for a pre-entrustable learner Tom is working at a general pediatrics clinic. He is asked to see Ben, a 3-year-old boy whose mother brought him in with a fever last night. Tom proceeds to gather a history from Ben’s mom, who states that he was in his usual state of health until last night, when she noticed he felt warm. His temperature was 102.4, and she gave him Tylenol, which brought the fever down. Upon Tom’s questioning, she notes that he has been drinking plenty of fluids. During the physical examination, Tom tells the mother that Ben has an erythematous pharynx and an erythematous, nonmobile right tympanic membrane. Tom tells Ben’s mother that he isn’t sure exactly what is causing the fever, but he would like to obtain a strep test and a chest X-ray to be certain of what is going on. Ben’s mother asks why a chest X-ray will be necessary, stating she is concerned about the radiation exposure for her son. Tom states he isn’t sure, but the baby has a fever and might have pneumonia. He states he will discuss the case with his supervisor, Dr. Miller, and the two of them will return. Tom gives a presentation about his encounter with Ben to Dr. Miller and lists his differential diagnosis as 1) strep throat, 2) ear infection, and 3) pneumonia. Dr. Miller asks Tom additional information about Ben’s history, including hydration status and presence or absence of a productive cough. When Tom cannot provide the additional details, Dr. Miller also asks if he obtained Ben’s past medical history. Tom says that he did not, and Dr. Miller informs him that Ben has a history of two prior ear infections and that because of the erythematous, non-mobile right tympanic membrane, ear infection is the most likely diagnosis. Dr. Miller and Tom return to the exam room, and Dr. Miller confirms with Ben’s mother that he has been making adequate urine and has not been suffering from a cough. Dr. Miller repeats Tom’s physical exam and verifies the reported findings. He tells Ben’s mom that a right ear infection is the working diagnosis

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because of the red eardrum. He suggests a prescription for amoxicillin and a follow-up visit in 2 weeks to check the ears and make sure the infection has cleared. Mom asks about the strep test Tom mentioned, and Dr. Miller responds that because the plan is for a course of amoxicillin and the treatment for strep is the same, he thinks the test would not help and is therefore not worth the cost.

Entrustable Learners Expected Behaviors for an entrustable learner The individual at this level approaches development of the differential and working diagnosis of a patient problem with the ability to link current findings to prior clinical encounters. He gathers pertinent information not only from the patient but also from the patient’s record and past history, using all the available data to propose a relevant set of differential diagnoses, neither too broad nor too narrow. This learner can usually understand how to relate current and emerging information to continuously update the differential diagnosis and is able to avoid most errors of clinical reasoning, such as premature closure. The learner at this level has an understanding of his knowledge, strengths, and weaknesses. Entrustable learners know when to consult supervisors and team members in the development of their differential diagnosis and selection of a working diagnosis and can usually articulate a cohesive management plan that takes into account the items in the differential diagnosis. This learner engages with supervisors and team members for endorsement and verification of the working diagnosis in developing a management plan tailored to the prioritized differential diagnosis. The entrustable learner is comfortable with some ambiguity, manifested as an ability to respond to questions or challenges from the patient, family, or supervisor in a professional manner even when uncertain about the answer. This learner feels comfortable seeking assistance from other members of the health care team. His documentation demonstrates evidence of clinical reasoning so that other providers will be able to ensure continuity of care for the patient.

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Vignette for an entrustable learner Tom is working at a general pediatrics clinic. He is asked to see Ben, a 3 year-old boy whose mother brought him in with a fever last night. Before gathering the history from Ben’s mom, he checks the medical record and finds that Ben has had two prior ear infections. As Tom gathers the history from Ben’s mom, he learns that Ben was well until last night, when she noted a temperature of 102.4, and that Tylenol brought the fever down. He continues to be interested in play and is making adequate urine. When questioned, she denies productive cough. Tom tells Ben’s mom that he sees a red throat and a red and non-moving eardrum on physical exam and that Ben’s lung fields are clear. Tom tells Ben’s mother that he suspects an ear infection is the cause of the fever but that he is also considering a strep throat, given Ben’s red throat. Tom tells Ben’s mom that he will report his findings and plan to his supervisor, Dr. Miller. Tom presents this encounter to Dr. Miller in a thorough yet focused manner and lists the differential diagnoses as ear infection, strep throat, or other pharyngitis, noting that because of the symptoms, physical exam findings, and past history, he believes that the most likely cause of the fever is an ear infection. Dr. Miller concurs with Tom’s assessment and suggests that they return to the exam room to discuss the plan with Ben’s mom. They enter the examination room and tell Mom the most likely diagnosis is an ear infection because of the red, non-moving eardrum. Tom states that since amoxicillin was effective for Ben’s last infection, he will write a prescription for it. Mom asks about the strep test Tom mentioned, and Tom responds that because the plan is for a course of amoxicillin and the treatment for strep is the same, he thinks the test would not help and is therefore not worth the cost. He suggests that she return with Ben to see Dr. Miller in two weeks for a follow-up.

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EPA 3: Recommend and interpret common diagnostic and screening tests Description of the activity

This EPA describes the essential ability of the day 1 resident to select and interpret common diagnostic and screening tests* using evidence-based and cost-effective principles as one approaches a patient in any setting. Functions • • • • • •

Recommend first-line, cost-effective diagnostic evaluation for a patient with an acute or chronic common disorder or as part of routine health maintenance. Provide a rationale for the decision to order the test. Incorporate cost awareness and principles of cost-effectiveness and pre-test/posttest probability in developing diagnostic plans. Interpret the results of basic diagnostic studies (both lab and imaging); know common lab values (e.g., electrolytes). Understand the implications and urgency of an abnormal result and seek assistance for interpretation as needed. Elicit and take into account patient preferences in making recommendations.

*Common diagnostic and screening tests include the following: Plasma/serum/blood studies: Arterial blood gases Bilirubin Cardiac enzymes Coagulation studies CBC Urine studies: Chlamydia Culture and sensitivity Gonorrhea Microscopic analysis U/A dipstick

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Culture and sensitivity Electrolytes Glucose Hepatic proteins HgbA1c

HIV antibodies HIV viral load Lipoproteins Renal function tests RPR

Body fluids (CSF, pleural, peritoneal): Cell counts Culture and sensitivity Protein(s)

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Pre-Entrustable Learners* Expected behaviors for a pre-entrustable learner The pre-entrustable learner can recommend a standard set of studies for the patient and can provide a list of additional labs and imaging examinations thought to be useful for that particular patient. However, this learner is limited in her ability to discuss which panel(s) or individual lab value(s) or imaging studies are most important for specific patients. Additionally, she has difficulty justifying each recommendation and does not appear to have considered the impact a false-positive or false-negative test might have on the patient’s workup. At this level, the learner may not always provide the rationale for the recommended evaluation, and when she does, the rationale often does not include 1) considerations of pertinent risk factors identified from the history and physical examination, 2) other determinants of health that may modify the patient’s risk profile, 3) considerations of pre-test and post-test probabilities, or 4) considerations of costs, either overall or out-of-pocket. Additionally, there is limited evidence that patient preferences have been factored into the recommendations. When test results are received, the pre-entrustable learner may misinterpret common insignificant or explainable abnormalities as important or may fail to recognize important abnormalities and their urgency. Vignette #1 for a pre-entrustable learner Terry has just taken a history and performed a physical examination on an 18-year-old woman who presented to the Emergency Department with a 2-week history of sharp chest pain. The patient was diagnosed with type 1 diabetes mellitus four weeks ago and is being treated with insulin. The chest pain is atypical for cardiac ischemia, and the patient has no known cardiovascular disease risk factors except diabetes. The patient does report polyuria. The previous medical records are not available for review. Physical exam findings—including vital signs—are normal. Following the presentation of the history and physical exam, Terry indicates that her working diagnosis is “rule out myocardial infarction.” Her supervisor asks her to recommend a diagnostic evaluation with a rationale for each test. She recommends a basic chemistry panel to rule out

Diabetic Ketoacidosis (DKA), a CBC because the patient may need to be admitted, a urinalysis to help exclude DKA and urinary tract infection, a hemoglobin A1c to assess diabetic control, a lipid panel for risk factor identification, serum troponin I and creatine kinase levels, an ECG to rule out myocardial infarction, and a chest radiograph to exclude “other chest pathology.” She reports having discussed these plans with the patient. The supervisor points out that given the presentation, a myocardial infarction is unlikely. He therefore suggests they forego the creatine kinase test given the almost zero pre-test probability, especially if the troponin comes back negative. Additionally, he asks Terry to review the chart to see when the hemoglobin A1c was last measured before ordering the test. Serum studies show hyperglycemia and hyponatremia, and the urinalysis shows glycosuria, numerous squamous epithelial cells, 3 to 4 WBC/HPF, and a negative leukocyte esterase. ECG is normal. Troponin level is normal. Terry recommends admission to rule out myocardial infarction. She recommends a urine culture and sensitivity followed by broad-spectrum oral antibiotics for a urinary tract infection. She fails to recognize the hyponatremia as pseudo-hyponatremia due to hyperglycemia. The supervisor reiterates that this is unlikely to represent cardiac origin of the chest pain and explains the pseudo-hyponatremia to her. The supervisor also notes that while the squamous cells suggest the urinalysis was not “clean,” the absence of significant WBC or leukocyte esterase make further evaluation unnecessary due to a low-to-absent pre-test probability. The supervisor also indicates that this is likely musculoskeletal pain and recommends discharge home from the Emergency Department with a nonsteroidal anti-inflammatory drug (NSAID). Vignette #2 for a pre-entrustable learner Margaret has been called down to the Emergency Room to see Ms. Smith, a 36-year-old who presented with severe abdominal pain of several hours duration. She has been unable to eat or find a comfortable position. The Emergency Room is busy, and Margaret begins her evaluation. The nurse notes that it is time for Ms. Smith to be admitted, so the supervising physician asks Margaret to report her initial thoughts and provide suggestions about next steps in the evaluation. Margaret presents the history of present

*Note: For this EPA, two vignettes have been provided for the pre-entrustable and the entrustable learner.

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illness and examination findings. When reviewing the labs, Margaret overlooks the positive beta-HCG and elevated alkaline phosphatase but states that the patient’s white blood cell count is a little high but within normal limits. Finally, she provides detailed information on the picnic the patient attended that day and concern that she must immediately get a stool sample from Ms. Smith to rule out food poisoning.

The entrustable learner methodically reviews each test and imaging result, interpreting the cause and urgency of abnormal values and seeking help for interpretation of tests that are beyond her scope of knowledge. She notes and attempts to interpret results that are unexpectedly normal.

In order to get a jump-start on things and help her team out, Margaret orders a comprehensive metabolic panel, lipase, amylase, CA-125, and a CT scan with contrast. Margaret volunteers to take the patient down to radiology for a CT scan as well to help make the diagnosis. Her supervisor thanks Margaret for her willingness to assist the team, but he cautions her about the possible implications of radiation in women of childbearing age until pregnancy is excluded. In addition, the supervisor discusses with Margaret the current lack of clear recommendations for screening for ovarian cancer.

Terry has just taken a history and performed a physical examination on an 18-year-old woman who presented to the Emergency Department with a two-week history of sharp chest pain. The patient was diagnosed with type 1 diabetes mellitus four weeks ago and is being treated with insulin. The chest pain is atypical for cardiac ischemia, and the patient has no known cardiovascular risk factors except diabetes. The patient does report polyuria. The previous medical records are not available for review. Physical exam findings, including vital signs, are normal. Following the presentation of the history and physical exam, Terry indicates that her working diagnosis is “musculoskeletal chest pain.” Her supervisor asks her to recommend a diagnostic evaluation with a rationale for each test. She recommends a basic chemistry panel to assess glucose and to exclude electrolyte imbalances that may accompany polyuria or the presumed hyperglycemia. She also recommends a urinalysis to assess polyuria. Despite the added expense, she recommends an ECG as baseline and a troponin 1 level to be sure that “we’re not missing any pericarditis or something unusual.” Terry defers a hemoglobin A1c as being too soon after initiation of therapy for diabetes, and she also defers a lipid panel until she can review the chart to see if it has already been done.

Entrustable Learners Expected behaviors for an entrustable learner The entrustable learner provides an initial plan for laboratory tests and imaging studies that are targeted to the most important working diagnoses when discussing the next steps in a patient’s care after a thorough history and physical exam. This learner is able to provide a rationale for each test. She provides information to the supervisor and other members of the health care team that attempts to place the patient’s risk factors and clinical presentation in context and considers the patient’s resources and preferences in making recommendations. The learner demonstrates cost awareness and attempts to apply cost-benefit considerations that are specific to the patient’s condition, demographics, and ability to pay. For common diagnostic tests, the learner at this level can cite relevant information on the likelihood and interpretation of a positive test. This learner also incorporates the patient’s demographics and health behaviors into her recommendations for screening and diagnostic evaluations. At this level, the learner provides clear rationales for her diagnostic recommendations.

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Vignette #1 for an entrustable learner

Terry discusses these recommendations with the patient and learns that she is insured under her parents’ plan. Terry discusses with her the low likelihood of myocardial infarction and the caution needed in interpreting the ECG. The patient appreciates the attention to cost and is agreeable to the cardiac evaluation because she knew already that diabetic patients are at increased risk for heart disease. Serum studies show hyperglycemia and hyponatremia. Urinalysis shows glycosuria, numerous squamous epithelial cells, 3 to 4 WBC/HPF, and a negative leukocyte esterase. ECG and troponin I tests are normal. Terry correctly interprets the urine collection

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as a “dirty catch� but notes the lack of WBC and leukocyte esterase, telling her supervisor that she does not believe further testing is indicated. She correctly interprets the low sodium level as pseudohyponatremia due to hyperglycemia. She recommends an NSAID as needed for chest pain, suggests that the patient be reassured about the cause of her pain, and volunteers to explore further any concerns she may have about her pain and new diagnosis of diabetes. Vignette #2 for an entrustable learner Margaret has been called down to the Emergency Room to see Ms. Smith, a 36-year-old who presented with severe abdominal pain of several hours duration. She has been unable to eat or find a comfortable position. The Emergency Room is busy, and Margaret begins her evaluation. The nurse notes that it is time for Ms. Smith to be admitted, so the supervising physician asks Margaret to share her initial thoughts and provide suggestions about next steps in the evaluation. Margaret presents the history of present illness and examination findings. She reports that while obtaining the history, she asked Ms. Smith what she thought was going on, and Ms. Smith mentioned that she might be pregnant. When reviewing the labs, Margaret notes first that Ms. Smith’s urine pregnancy test is positive and that not only must they consider abdominal causes of her pain, but a betaHCG might be needed as ectopic pregnancy is in the differential as well. Margaret identifies the elevated alkaline phosphatase as an acute concern and notes that her white count that is higher than normal. She recommends an ultrasound, both to rule out gall bladder disease and to look for an ectopic pregnancy as the cause of pain. She chooses ultrasound out of concern for radiation exposure to the fetus and notes that if further testing is needed, the risk to the fetus must be considered.

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EPA 4: Enter and discuss orders and prescriptions Description of the activity

Writing safe and indicated orders is fundamental to the physician’s ability to prescribe therapies or interventions beneficial to patients. It is expected that physicians will be able to do this without direct supervision when they matriculate to residency. Entering residents will have a comprehensive understanding of some but not necessarily all of the patient’s clinical problems for which they must provide orders. They must also recognize their limitations and seek review for any orders and prescriptions they are expected to provide but for which they do not understand the rationale. The expectation is that learners will be able to enter safe orders and prescriptions in a variety of settings (e.g., inpatient, ambulatory, urgent, or emergent care). Functions • • • • • • •

Demonstrate an understanding of the patient’s current condition and preferences that will underpin the orders being provided. Demonstrate working knowledge of the protocol by which orders will be processed in the environment in which they are placing the orders. Compose orders efficiently and effectively, such as by identifying the correct admission order set, selecting the correct fluid and electrolyte replacement orders, and recognizing the needs for deviations from standard order sets. Compose prescriptions in verbal, written, and electronic formats. Recognize and avoid errors by using safety alerts (e.g., drug-drug interactions) and information resources to place the correct order and maximize therapeutic benefit and safety for patients. Attend to patient-specific factors such as age, weight, allergies, pharmacogenetics, and co-morbid conditions when writing or entering prescriptions or orders. Discuss the planned orders and prescriptions (e.g., indications, risks) with patients and families and use a nonjudgmental approach to elicit health beliefs that may influence the patient’s comfort with orders and prescriptions.

Pre-Entrustable Learners Expected behaviors for a pre-entrustable learner The pre-entrustable learner has difficulty filtering and synthesizing key information from a patient’s history and physical examination to inform an understanding of a patient’s condition in a manner that enables safe and effective prioritization in ordering tests and therapies. This learner adopts a “shotgun” approach to orders, casting a wide, unfocused net that may, nonetheless, miss key tests needed and minimally considers costs of orders. The pre-entrustable learner acts impulsively in placing orders rather than pausing to consider the big picture and waiting for cause and effect to play out from earlier orders. She feels compelled to act and can be impatient and nonreflective. The learner does not take into account

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patient preferences when placing orders and is often focused on her own needs and desire for information. She does not recognize when to tailor or deviate from a standard order set. The pre-entrustable learner can be defensive when questioned about orders and may be unable to clearly articulate the rationale behind the orders. She may be overly confident in her plans and may not seek sufficient review of orders despite her limited experience. This learner may place orders without communicating with the rest of the team and/or patients and families regarding plans. The learner, although technologically facile, has little ability to navigate the order-entry system and does not understand alerts or other system features that can aid the selection of order sets. The pre-entrustable learner may not follow established protocols for placing and carrying out orders within the system in which they are being placed. Common errors in prescription writing

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and entry are made, with limited double-checking or knowledge of how to verify drug dosages, names, and interactions. Vignette for a pre-entrustable learner Sheila is doing a rotation in pediatric orthopedic surgery, when she is called to the Emergency Department to assess an eight-year-old boy who was brought in after a motor vehicle accident. The paramedics tell Sheila that the child was initially transported to a community hospital close by. He was transferred to the tertiary children’s hospital because it appeared that he had a femur fracture, and there was concern for significant blood loss. Sheila does not gather any other details about the accident or subsequent vital signs before the paramedics leave the Emergency Department. The patient’s mother then arrives, and Sheila obtains a superficial history, identifying only that the boy is on medication for asthma without asking any details about the family background. She performs a quick physical, focused on the child’s legs. Sheila proceeds to the bedside computer, looks quickly for the order set labeled “trauma,” and selects everything from that list. She orders 23 blood tests, with no thought about their indication. She orders three units of blood in case a transfusion is needed, requests X-rays of the lower limbs, and orders drugs for asthma. Sheila ignores the red triangle that appears on the computer screen beside the units of blood requested. She goes to meet with the mother and proceeds to list the tests being done, without asking the mom if this is OK or if she understands. Sheila then goes to the attending physician to present a straightforward case of a traumatic leg injury in an otherwise well child. She is questioned about the mechanism of injury but is unable to give details, perseverating instead on the probable need for blood transfusion. In the meantime, the mother goes to the nursing station, politely tells the charge nurse that her English is not that strong, and asks the nurse to explain what is being done. The charge nurse gets an interpreter and discovers that the mother is a Jehovah’s Witness and will not consent to any blood products. The mother also hands the charge nurse a CD that contains X-rays of the child’s legs done at the community hospital before transfer. Mom indicates she is very nervous about her son getting any more radiation from X-rays. At this time, a note from the hospital pharmacy comes

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back to the ED indicating that the dose of the asthma drug ordered is too high for the patient’s age.

Entrustable Learners Expected behaviors for an entrustable learner The entrustable learner is able to synthesize the information at hand from the patient’s history, physical exam, and review of existing studies to reach an understanding of the patient’s current condition. This includes considering patient preferences and desires with respect to expectations for diagnostic and therapeutic next steps. With this big picture perspective, the entrustable learner is able to parsimoniously place orders in a thoughtful, stepwise process, awaiting results from one set of studies before making a decision to order additional tests. She is flexible in her thinking, and when faced with an unexpected result from a study, is able to interpret the result and adjust her plans for next steps. She communicates with patients as results become available and engages with patients when considering starting new medications or other treatments. When a patient asks about other options, she is able to articulate the risks and benefits of a given approach and to consider alternatives. The entrustable learner considers special patient demographics that may dictate a particular care pathway. This learner is able to effectively use care pathways and algorithms, yet can recognize when deviation is needed. She is also able to recognize and effectively use the safety alerts within the electronic medical record. When this learner is faced with a diagnostic or therapeutic need that is unfamiliar or that she is not comfortable with, she seeks the help of more experienced health care providers or other resources for guidance. Vignette for an entrustable learner Sheila is doing a rotation in pediatric orthopedic surgery, when she is called to the Emergency Department to assess an eight-year-old boy who was brought in after a motor vehicle accident. Immediately upon the boy’s arrival, Sheila assesses his vital signs and intravenous access and asks the paramedics for more information about the mechanism of injury and for details about the child’s course since the accident. The paramedics tell Sheila that the child was initially transported to a community hospital close by. He was transferred to the larger tertiary children’s hospital

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because it appeared that he had a femur fracture, and there was concern for significant blood loss. Sheila verifies that the child has appropriate IV access and necessary monitoring in place and appears to be stable. She further queries the paramedics about the concerns about bleeding and reviews the outside hospital records to determine what work-up was completed there with respect to delineation of the femur fracture and evaluation for other injuries. She then performs her own complete physical exam. The boy’s mother arrives, and it appears that English is not her first language, so Sheila requests an interpreter. After assuring the boy’s mother that he is currently stable and while awaiting the arrival of the interpreter, Sheila proceeds to the bedside computer to enter some orders. Because the boy had already undergone a full set of X-rays and a full panel of labs at the outside hospital, she elects to order only a CBC, type and screen, and basic metabolic panel at this time. The interpreter then arrives, and Sheila is able to obtain further history from the child’s mother, learning that he has a history of asthma and that the family are Jehovah’s Witnesses and refuse all blood products. Sheila returned to the computer to order the boy’s asthma medication, and a safety alert pops up indicating an inappropriate dose. Sheila verifies the dose of his medication on the inhaler from the mother and re-enters the correct dose. She also enters an alert in the system regarding the parent’s refusal of blood products for her son. Sheila then presents the boy’s case to the attending physician, noting her concern about the boy’s anemia, which was just verified on repeat CBC, and the mother’s refusal of blood products for her son. The attending physician asks Sheila if there are any alternatives to packed red blood cells for acute blood loss anemia and whether the mother might consider those alternatives. Sheila states she does not know but will investigate other options, report back, and discuss her findings with the mother. Pending this discussion, she will seek her attending’s guidance before placing the order for alternative therapies that are not familiar to her. She also reports that she is seeking interpretation of the outside films to verify that no additional imaging is needed.

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EPA 5: Document a clinical encounter in the patient record Description of the activity

Entering residents should be able to provide accurate, focused, and context-specific documentation of a clinical encounter in either written or electronic formats. Performance of this EPA is predicated on the ability to obtain information through history, using both primary and secondary sources, and physical exam in a variety of settings (e.g., office visit, admission, discharge summary, telephone call, email). Documentation is a critical form of communication that supports the ability to provide continuity of care to patients and allows all health care team members and consultants to 1. Understand the evolution of the patient’s problems, diagnostic work-up, and impact of therapeutic interventions. 2. Identify the social and cultural determinants that affect the health of the patient. 3. View the illness through the lens of the patients and family. 4. Incorporate the patient’s preferences into clinical decision making. The patient record is a legal document that provides a record of the transactions in the patient-physician contract. Functions • • • • • • • • •

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Filter, organize, and prioritize information. Synthesize information into a cogent narrative. Record a problem list, working and differential diagnosis and plan. Choose the information that requires emphasis in the documentation based on its purpose (e.g., Emergency Department visit, clinic visit, admission History and Physical Examination). Comply with requirements and regulations regarding documentation in the medical record. Verify the authenticity and origin of the information recorded in the documentation (e.g., avoids blind copying and pasting). Record documentation so that it is timely and legible. Accurately document the reasoning supporting the decision making in the clinical encounter for any reader (e.g., consultants, other health care professionals, patients and families, auditors). Document patient preferences to allow their incorporation into clinical decision making.

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Pre-Entrustable Learners Expected behaviors for a pre-entrustable learner Documentation follows a standard template regardless of the intended audience or purpose of the communication. Availability of documentation may be delayed and may be missing necessary elements but may also include unnecessary or redundant information, inaccurate information from cutting and pasting pieces of the electronic health record (EHR), as well as prohibited abbreviations. The note may not include date, time, and signature as well as other institutionally required information. Written forms are not always legible. Documentation of the history does not demonstrate pursuit of primary or secondary sources to fill gaps. Documentation of part of the physical examination and/ or laboratory values may not be verifiable by others. The note reflects lack of time or skill or both or frustration in navigating the system to piece together various sources of information required for accuracy (e.g., medication reconciliation is not accurate and complete) and does not identify gaps in care when they occur. Clinical reasoning is not reflected in the note, and laboratory values may be interpreted literally or inaccurately. Thus, management plans are based on directives from others and limited help-seeking behaviors often leave gaps in understanding. Communication may be unidirectional or may not consider the patient’s cultural context or health beliefs, resulting in plans that may not address patient preferences. Vignette for a pre-entrustable learner As the attending on service, you review the admission note of the learner, Meena, assigned to your team. Meena was asked to evaluate Griffin, a three-yearold boy with cystic fibrosis being readmitted after a recent admission for pneumonia and failure to thrive, who now presents with persistent cough, listlessness, and poor oral intake. When you round at 8 a.m. the morning after admission, there is no recorded history and physical, so you return in late morning to review it. The admission note has a date but no time or signature. Meena’s admission history documents that Griffin was doing well for the first couple of days after his last discharge and then his cough worsened. She wrote

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that he hasn’t been eating or drinking much and spends the day lying on the couch watching TV. The note indicates poor oral intake, but there is no mention of urine output or the pattern of bowel movements. Several other pertinent negative aspects of the history are not mentioned (e.g., color or amount of sputum, history of abdominal pain or urinary symptoms, fever, sweating). She gives the dates of the recent admission but does not mention results of sputum cultures or chest radiograph. She lists the medications from his discharge summary as his current medication list, but the list is not accurate. It does not include the increase in dose, which you prescribed yesterday when the mother called to ask for a new prescription because she left his medicine at the grandmother’s house. During this call, Mom also told you that Griffin wouldn’t take the nutritional supplement and that no one ever called her about the home care services she was supposed to receive. This information is not noted in the history. The recorded physical examination includes vital signs and oral and ear, lung, heart, and abdominal exams. There is no mention of overall appearance and no mention of skin turgor. The recorded lung exam does not address degree of distress and says, “Difficult to examine due to patient crying.” The laboratory data include a CBC, electrolytes, and renal function tests noted as “within normal limits.” The note does not clarify the date of those tests, and you are left wondering if they were done on this admission. Chest radiograph is noted as “pending.” In the assessment and plan, Meena includes a problem list and the specific diagnostic tests and orders for each problem, but there is no text explaining the differential diagnosis or thought process behind the cause for the worsened cough or listlessness and poor oral intake. Her plan includes the same nutritional supplement that the mother complained to you about on the phone. There is no mention in the plan of social service consultation or home health services referral.

Entrustable Learners Expected behaviors for an entrustable learner The learner at this level provides documentation that is adapted to the intended audience or purpose of the communication. The documentation is timely and comprehensive and tells a cogent patient story without excessive detail. The notes include only acceptable

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abbreviations and date, time, and signature, as well as other institutionally required information. The written forms are always legible. The entrustable learner’s documentation of the history demonstrates accurate use of primary or secondary sources to fill in any gaps. The documentation of the physical examination and laboratory values is verifiable by others. The notes demonstrate successful navigation of the medical system by identifying problems when they arise and documenting engagement of those who can help resolve them. Clinical reasoning is documented and reflects a combination of thought processes as well as discussions with other providers; the latter are accurately noted as such. The entrustable learner interprets basic laboratory values accurately and uses them to inform the management plan. The communication with patients occurs in a bidirectional manner, highlights patient preferences in the documentation, and integrates those preferences into the plan. Vignette for an entrustable learner As the attending on service, you review the admission note of the learner, Meena, assigned to your team. Meena was asked to admit Griffin, a three-year-old boy with cystic fibrosis being readmitted after a recent admission for pneumonia and failure to thrive, who now presents with persistent cough, listlessness, and poor oral intake. When you round at 8 a.m. the morning after the patient has been admitted, the history and physical have been recorded and with date, time, and signature. Meena’s note about Griffin’s admission history and physical document that he was doing well for the first couple of days after his last discharge and then his cough worsened. She wrote that he hasn’t been eating or drinking much and spends the day lying on the couch watching TV. She gives the dates of the recent admission and includes pertinent information from that encounter, including the results of the chest X-ray showing bilateral infiltrates and a sputum culture showing Pseudomonas sensitive to the antibiotic regimen prescribed. In the medication list she notes the change in antibiotic dosage you made recently when you learned that the original antibiotics were left at the grandmother’s house. She also notes that he was prescribed a nutritional supplement at the last admission but that Mom hasn’t been giving him much

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of it because he doesn’t like it. The note indicates poor oral intake and a slight decrease in urination over the past couple of days and mentions that the last bowel movement was three days ago. The note describes yellow-to-green-colored sputum that has increased in volume and perhaps a half dozen coughing episodes resulting in sputum. The note says that Mom thought Griffin felt warm but doesn’t have a thermometer at home to check his temperature. The recorded physical examination includes vital signs; the general appearance of a quiet, listless, sleepy child with an intermittent cough; an observation of decreased skin turgor and dry mucous membranes; and a normal oral and ear exam, as well as a normal heart and abdominal exam and no clubbing. The recorded lung exam describes mild tachypnea but no retractions and scattered crackles in both lungs. The laboratory data are dated and include a CBC, electrolytes, and renal function tests with values documented. Chest radiograph is noted as ordered stat. A follow-up addendum describes the X-ray results. In the assessment and plan, Meena includes a problem list and the specific diagnostic tests and orders for each problem. She includes a discussion of the potential for inadequately treated pneumonia as well as the potential for emergence of antibiotic resistance. Under the problem of “possible dehydration,” she notes her initial plan for IV fluids and indicates that she will check with the senior resident about this. Under the discussion of nutritional status, she indicates the need for nutrition consultation and talking to Mom about the preferred type of nutritional supplement for her son. She also notes the need for social service evaluation and support as well as a second referral for visiting nurse services since no one ever called Mom about the home care services she was to receive. Meena notes that she has encountered a similar problem with a referral on another patient and plans to take this up with her senior resident and attending.

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EPA 6: Provide an oral presentation of a clinical encounter Description of the activity

The day 1 resident should be able to concisely present a summary of a clinical encounter to one or more members of the health care team (including patients and families) in order to achieve a shared understanding of the patient’s current condition. A prerequisite for the ability to provide an oral presentation is synthesis of the information, gathered into an accurate assessment of the patient’s current condition. Functions • • • •

Present information that has been personally gathered or verified, acknowledging any areas of uncertainty. Provide an accurate, concise, and well-organized oral presentation. Adjust the oral presentation to meet the needs of the receiver of the information. Assure closed-loop communication between the presenter and receiver of the information to ensure that both parties have a shared understanding of the patient’s condition and needs.

Pre-Entrustable Learners Expected behaviors for a pre-entrustable learner The pre-entrustable learner follows a rigid template when presenting, failing to take cues from the receiver of information to ensure that there is a shared understanding of the information being conveyed. He often rushes ahead and fails to pause in the presentation at appropriate inflexion points to allow for input or discussion. The presentation is often not concise or well organized around the chief complaint or primary patient care issue being presented. The presentation wanders to include extraneous information that is not immediately relevant. The pre-entrustable learner does not tailor the presentation to meet the needs of the receiver of the information, often using many acronyms and medical jargon, nor is he able to adjust the presentation appropriately for varying contexts of patient care (e.g., emergent versus ambulatory settings). When queried about information presented about which he is unsure, the learner can become defensive or can sometimes even confabulate information in order to cover his uncertainty. The learner may also fail to retrieve some piece of evidence that is being requested. The learner at this level tends to accept information contained in the medical record and include it in the presentation without personally verifying it. The pre-entrustable learner can be either overconfident or underconfident in presentations, leading to a lack of comfort with the recommendations

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from other members of the health care team and/or patients and their family members. At the conclusion of the presentation, the learner does not ensure that there is closed-loop communication, with verbal expression by all parties verifying the agreed-upon next steps and plan. Vignette for a pre-entrustable learner Nick is rotating on the General Surgery service at the Veterans Affairs hospital. He is on call to receive the next patient admitted. His resident, Janelle, pages him to come to the Emergency Department to evaluate a new patient. On arrival in the Emergency Room, Nick notices that the patient he is going to evaluate is an elderly gentleman in obvious distress who is accompanied by a young woman identified as his daughter. Nick jumps right in and begins assessing the gentleman, learning that he is 88 years old and has developed the acute onset of severe abdominal pain with vomiting in the past 24 hours and has had minimal urine output. Nick finishes the history and physical, sees that labs are pending, and rushes off to find Janelle to present his findings and plan. As he is leaving, the patient’s daughter stops him and asks what is wrong with her father, and Nick replies that he appears to be in acute renal failure secondary to severe dehydration and possible bowel obstruction. The daughter looks confused and very worried, but Nick states he has to leave to find his resident.

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Nick runs into Janelle in the elevator and begins his presentation in front of several other people. Janelle asks him to wait until they exit the elevator. He then launches into the patient’s past medical history, current medications, and extensive review of systems including the patient’s past history of onychomycosis, for which he sees a podiatrist, rather than succinctly framing the discussion around the patient’s current acute complaint. When Janelle tries to redirect Nick to define the chief complaint, he becomes very flustered and says he is getting to that next. He ultimately completes his presentation, which is quite prolonged and not well organized, and Janelle asks for his recommendations. He states with certainty that he feels the patient has a bowel obstruction, based on the vomiting and a history of past abdominal surgery, which has led to renal failure. When queried about the evidence to support this diagnosis Nick, is unable to provide any supporting evidence and becomes a bit defensive, stating that the ER resident hadn’t yet ordered all the correct tests to confirm his suspicions, but labs were pending. Nick and Janelle proceed to the Emergency Department to evaluate the patient together and run into their attending, who is in the Emergency Room to see the new patient consult with them. Nick immediately jumps in and again presents the patient in essentially the same manner as he had to Janelle, without incorporating her feedback about the organization and focus of his presentation. In addition, he fails to notice that the daughter is listening to his presentation and appears both confused and distraught. When she tries to interrupt, he briefly pauses and says he will be with her in a minute, when he is finished presenting her father’s case to his attending.

Entrustable Learners Expected behaviors for an entrustable learner The entrustable learner is a skilled communicator who understands that the oral presentation serves an important function in medical care and is able to adjust his presentation appropriately for the receiver of information (e.g., faculty, patient/family, team members), for the context of the presentation (e.g., emergent versus ambulatory), and for the emotional intensity of the presentation. He actively engages the patient, family, and other team members in the presentation and does not shy away from difficult or

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stressful issues. This learner tells the patient’s story accurately and efficiently and can make a cogent argument to support the proposed management plan. He usually feels comfortable with uncertainty and readily acknowledges gaps in the knowledge and skills needed to manage a given patient. The learner reflects on areas of uncertainty and seeks additional information and assistance as needed. The entrustable learner engages consistently in bidirectional communication that ensures a shared understanding of information and avoids unnecessary medical jargon. He filters, synthesizes, and prioritizes information into broad categories and can recognize patterns while presenting findings, resulting in a concise, wellorganized presentation. He is sensitive to issues of privacy and confidentiality when discussing patients. Vignette for an entrustable learner Nick is rotating on the General Surgery service at the Veterans Affairs hospital. He is on call to receive the next patient admitted. His resident, Janelle, pages him to go to the Emergency Room to evaluate a new patient. On arrival in the Emergency Room, Nick notices that the patient he is going to evaluate is an elderly gentleman named Mr. Jones who is in obvious distress. Nick gently asks Mr. Jones who is accompanying him and is told it is his daughter. Mr. Jones then gives his daughter permission to tell Nick the details of his current condition. Nick learns from the daughter that her father is 88 years old and has developed the acute onset of severe abdominal pain with vomiting in the past 24 hours and has not urinated in a long time. Nick does a careful and focused history, gathering information as appropriate directly from the patient and also from his daughter, performs a physical examination, and then orders a number of laboratory tests, which he describes to Mr. Jones and his daughter. He tells them that he is going to speak to Janelle, his supervising resident, and will be back to discuss their next steps and recommendations. As he is leaving, the patient’s daughter stops him and asks what is wrong with her father, and Nick replies that his kidneys appear to be shutting down and he is concerned it may be due to dehydration from a blockage in his bowels. The daughter looks confused and very worried. Nick sits down with the daughter to further explain his tentative diagnosis and reasoning, until she is able to verbalize that she understands his concerns and the plan.

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Nick finds Mr. Jones’ nurse and Janelle, and takes them to a private location to begin the presentation. Nick starts by ascertaining what Janelle already knows about Mr. Jones. He then focuses on the most emergent issues first and asks the nurse to contribute her initial history and sequential pattern of vital signs noted. Nick presents the chief complaint and relevant past medical history clearly, using the patient’s own description and words for clarification. The presentation is concise and efficient, and Nick notes some of the gaps in the history that he will need to look for in Mr. Jones’ chart, including the fact that neither the patient nor his daughter can recall the medication history fully. He states with confidence, but not certainty, that the patient likely has a bowel obstruction, based on the vomiting, his physical exam findings, and the history of past abdominal surgery. He states his concern that the obstruction has produced dehydration and consequent acute renal failure. He also considers a number of other possibilities in the differential diagnosis and notes that they will have to be ruled out by the various laboratory tests recommended. Nick states his plan to ask the nurse to start an IV and begin a fluid bolus, as well as some intravenous antibiotics, while they are waiting for the results of the blood tests and imaging studies. He states that he thinks the patient needs to be admitted but asks Janelle for her input on whether Mr. Jones should go to the OR urgently and whether he should anticipate the need for an ICU bed. Once the presentation is completed, Nick asks Janelle and the nurse if they have any questions. He asks the nurse to repeat the plan to ensure they are all “on the same page.” Once they have all agreed on the immediate plan, he tells Janelle that he needs to return to the daughter to more fully explain the results of the pending tests once they are available. When Nick returns to the Emergency Room, the on-call attending surgeon is at the patient’s bedside and asks Nick to update him on Mr. Jones’ condition. Nick refines his presentation, incorporating Janelle’s feedback about his presentation style and plan. Nick also notices that the patient’s daughter is listening intently, and he maintains eye contact with her to ensure that his presentation is delivered in a way that is understandable for her as well as appropriate for his attending, pausing to allow her to interject when she has questions or when his presentation points require clarification.

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Core Entrustable Professional Activities for Entering Residency

EPA 7: Form clinical questions and retrieve evidence to advance patient care Description of the activity

On day 1 of residency, it is crucial that residents be able to identify key clinical questions in caring for patients, identify information resources, and retrieve information and evidence that will be used to address those questions. Day 1 residents should have basic skill in critiquing the quality of the evidence and assessing applicability to their patients and the clinical context. Underlying the skill set of practicing evidence-based medicine is the foundational knowledge an individual has and the self-awareness to identify gaps and fill them. Functions • • • • • • • •

Develop a well-formed, focused, pertinent clinical question based on clinical scenarios or real-time patient care. Demonstrate basic awareness and early skills in appraisal of both the sources and content of medical information using accepted criteria. Identify and demonstrate the use of information technology to access accurate and reliable online medical information. Demonstrate basic awareness and early skills in assessing applicability/ generalizability of evidence and published studies to specific patients. Demonstrate curiosity, objectivity, and the use of scientific reasoning in acquisition of knowledge and application to patient care. Apply the primary findings of one’s information search to an individual patient or panel of patients. Communicate one’s findings to the health care team (including the patient/family). Close the loop through reflection on the process and the outcome for the patient.

Pre-Entrustable Learners Expected behaviors for a pre-entrustable learner The learner at this level often relies more on linear thinking than does a more advanced learner, has less experience to draw on, and is less aware of her own knowledge limitations. The pre-entrustable learner may be overly focused on the individual patient, less aware of or attentive to trends or understanding about populations and communities of patients, and may in general jump to conclusions or generalizations without fully understanding the complexity of the situation or the types of information or evidence needed. This learner may have an underdeveloped mental model of the problem even after multiple iterations of the problem-solving cycle, and, even with sufficient prior knowledge in place, may not be able to activate it to their advantage in problem solving. This learner needs improvement in the ability to both retrieve and assess relevant evidence. Finally, this learner is not always able

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to translate new findings into the care of the patient or a panel of patients. Vignette for a pre-entrustable learner Sierra is on the transfusion medicine service and is asked to consult on a patient for whom the diagnosis of thrombotic thrombocytopenic purpura (TTP) is being considered and the initiation of plasmapheresis is being requested. Sierra reviews the chart quickly and notes that the patient was admitted with thrombocytopenia 24 hours ago. She notes a lack of agreement between the primary team and the consulting hematology service on the diagnosis. She continues to collect the data that she feels are pertinent and then notifies the transfusion medicine fellow that she has a new consult and is ready to present. Upon hearing the presentation of Sierra’s chart review on the patient, the fellow asks Sierra what she thinks is the etiology of the thrombocytopenia. Sierra states that

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the chart suggests TTP. When the fellow prompts for other causes of thrombocytopenia, Sierra is able to list several other diagnoses that should be considered. The fellow then asks Sierra what she thinks the next steps should be. Sierra states that they should go see the patient and talk to the hematology experts to figure out what the diagnosis is. The fellow prompts Sierra to review some background literature on the differential diagnosis of thrombocytopenia, the diagnosis of TTP, and its treatment. Sierra consults her pocket medicine book and also searches online using a generic web browser. She returns stating that they need to review the blood smear, collect more laboratory data, and get some more historical facts from the patient. She states that she suspects TTP and thinks that, if they confirm by looking at the smear, they should initiate plasmapheresis as soon as possible. The attending physician now joins the discussion and asks if Sierra and the fellow have reviewed the most recent evidence regarding the use of plasmapheresis in TTP. Sierra states that she has reviewed the literature and that plasmapheresis is useful. The attending physician asks her if she ran across any new evidence in this area and prompts Sierra to think about where she might find that evidence. Sierra states that she searched the Internet but that she could also use a summary updated source very quickly. She leaves, reviews a summary source, and returns again, suggesting that plasmapheresis should be started. At this point, the attending physician prompts Sierra to review the case one more time to identify any patientspecific issues that might suggest that the general evidence is not applicable to this patient, noting that the patient is on several specific medications that may be associated with TTP.

Entrustable Learners Expected behaviors for an entrustable learner The learner at this level routinely identifies situations in patient care in which additional information is needed based on assessment of her own knowledge gaps and patient needs. She formulates focused, pertinent clinical questions based on clinical scenarios, or real-time care of a patient or panel of patients and is willing and able to take the time to identify appropriate evidence to answer those questions. This

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learner is able to focus her cognitive processes on discerning relevant factors, identifying the unknowns, and developing knowledge for generating a solution via just-in-time learning. When gaps in personal knowledge are identified, she takes steps to address those gaps in order to maintain a sufficient biophysical, clinical, epidemiological, and social-behavioral scientific knowledge base that can be applied to patient care activities. This learner demonstrates skill in appraising sources, using information technology appropriately, and generating a manageable volume of information. The learner is able to assess the applicability and generalizability of the information. When gaps in the evidence are identified, she takes steps to “close the loop� to determine ways to improve care. Vignette for an entrustable learner Sierra is on the transfusion medicine service and is asked to consult on a patient for whom the diagnosis of TTP is being considered and the initiation of plasmapheresis is being requested. Sierra reviews the chart quickly, preparing to present to her fellow and attending physician, and notes a lack of agreement between the primary team and the consulting hematology service about the diagnosis. She is not familiar with the specific diagnostic criteria for TTP, so she goes to an online evidence summary source for a quick review. While reviewing the diagnostic criteria, she finds that there are several different causes of TTP and TTP-like syndromes, including medications. She notes several key references for later reading. Sierra reviews the electronic medical record in more detail, paying particular attention to the data she has read that will help differentiate the diagnosis of TTP from other disease states. Seeing that some of the necessary information is not included in the chart notes, she tells the fellow that she will go talk to the patient and then meet the fellow in the laboratory to review the peripheral smear. On interviewing the patient, she identifies one medication known to be associated with a TTP-like syndrome and also notes that the patient has had a gastric bypass in the past, which puts the patient at risk for nutritional deficiencies such as vitamin B12. Sierra reviews the peripheral smear with the hematopathology and transfusion fellows and then feels that she is ready to present the patient to the fellow and attending physician. When prompted by

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the fellow to outline her assessment, Sierra outlines a differential diagnosis that considers the patient-specific key features. She includes medication-associated TTP. She states that she came across an association with one of the patient’s medications in a review article, but that she is not aware of the actual incidence, reporting that she has a reference for an original article that she would like to pull because it will give her a more accurate sense of the association. She also includes several other disease states in her differential diagnosis, including B12 deficiency, noting that there are several case reports in the literature describing B12 deficiency and TTP presenting in similar ways. At this point, the fellow asks Sierra what she thinks they should do next for the patient. Sierra states that based on her reading, plasmapheresis should not be initiated while there is still doubt about the diagnosis. She suggests that they need a few more laboratory studies and wonders aloud if there is evidence to support the use of empiric plasmapheresis in this type of a presentation. She also asks if there is harm in doing plasmapheresis if the diagnosis is actually B12 deficiency or medication-associated TTP. She confirms with the fellow that she should take a few minutes to search PubMed for any controlled-trial evidence in this area. The attending physician now joins the discussion. Sierra reports from her literature search that there is strong and consistent evidence from randomized controlled trials for using plasmapheresis in TTP, but that this is less strong if the TTP is associated with a medication or if an alternative diagnosis is being considered. The attending physician agrees and confirms Sierra’s recommendations to check several more lab values, including B12, and to postpone plasmapheresis for now. As a team, they go to discuss their recommendations with the primary team and the hematology consulting team. As they leave, Sierra suggests that they bring several of the articles with them for the team.

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EPA 8: Give or receive a patient handover to transition care responsibility Description of the activity

Effective and efficient handover communication is critical for patient care. Handover communication ensures that patients continue to receive high-quality and safe care through transitions of responsibility from one health care team or practitioner to another. Handovers are also foundational to the success of many other types of interprofessional communication, including discharge from one provider to another and from one setting to another. Handovers may occur between settings (e.g., hospitalist to PCP; pediatric to adult caregiver; discharges to lower-acuity settings) or within settings (e.g., shift changes). Functions for transmitter of information • • • • • •

Conduct handover communication that minimizes known threats to transitions of care (e.g., by ensuring you engage the listener, avoiding distractions). Document—and update—an electronic handover tool. Follow a structured handover template for verbal communication. Provide succinct verbal communication that conveys, at a minimum, illness severity, situation awareness, action planning, and contingency planning. Elicit feedback about the most recent handover communication when assuming primary responsibility of the patients. Demonstrate respect for patient privacy and confidentiality.

Functions for receiver of information • • • • • •

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Provide feedback to transmitter to ensure informational needs are met. Ask clarifying questions. Repeat back to ensure closed-loop communication. Ensure that the health care team (including patient/family) knows that the transition of responsibility has occurred. Assume full responsibility for required care during one’s entire care encounter. Demonstrate respect for patient privacy and confidentiality.

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Pre-Entrustable Learners Expected behaviors for a pre-entrustable learner When giving handover communication, this learner is inconsistent in the application of a standardized format, leading to errors of omission and/or commission in the verbal and written versions of the handover. Because the learner at this level may not be able to prioritize the information to be communicated, he often presents data in an unfiltered manner, resulting in a low “signalto-noise” ratio. The pre-entrustable learner’s choice of setting in which to conduct the handover does not reflect awareness of established characteristics of high-quality handover communication (e.g., finding a setting that minimizes interruptions and distractions). This learner also focuses on his own tasks to the exclusion of the big picture, demonstrating minimal “situation awareness” about the overall team workload or other factors that may influence the receiver of the information. When functioning as a receiver of handovers, the preentrustable learner does not ask clarifying questions, anticipate patient events, or verbalize understanding. Vignette for a pre-entrustable learner Bob is rotating on a urology inpatient service. He is frantically working at the computer trying to update his sign-out when he glances at the clock and realizes he is running late. He runs to meet Jim, the incoming overnight intern, in the workroom where all the other team members are hanging out and talking. Another team member is already signing out and tells Bob that he must leave in order to make it to one of his children’s events. Bob wonders aloud why he doesn’t have kids, as an excuse to sign out early. He waits and begins to text on his cell phone until his colleague completes his sign-out. He begins sign-out by apologizing to Jim because he did not have time to write down all the test results or completely update the electronic handover tool for all the patients because he had been “hammered” all afternoon. Using the hospital template format for his handover, Bob begins talking about his patients by reading from notes scribbled on his patient list. He starts with his most concerning patient, someone he thinks should be watched more closely. During the patient summary, he gives Jim the patient’s complete

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past medical history of GERD, type 2 diabetes mellitus, coronary artery disease status post three vessel CABG, migraine headaches, COPD, peripheral vascular disease, and bladder cancer status post-ileal-conduit surgery 2 weeks ago. He continues by describing all the past hospitalizations, treatments, entire medication list, all normal and abnormal labs, and all medication changes and reasons for the changes. He states his concern that the patient may be developing an abscess. A page asking for potassium replacement for one of his patients interrupts him. He goes to put in the order. When he comes back, he recognizes that the first patient sign-out has taken too long. He quickly finishes the first patient, failing to mention that Jim will need to follow up on the CT abdomen and pelvis that is part of the action plan. He also fails to give Jim the opportunity to ask for feedback. The rest of his sign-out continues to be fraught with errors of omission as well as inclusion of extraneous information. During the fourth day on service, Jim tells Bob about a patient of Bob’s who developed a fever the previous night and was supposed to be placed on MRSA coverage in the event of a fever because of prior history. Bob becomes defensive, stating that Jim knows how crazy it was the day before with all the admissions and the nurses interrupting them during sign-out. He says he’s amazed he got any information right given how busy it was and how loud it was during sign-out!

Entrustable Learners Expected behaviors for an entrustable learner When giving handover communication, the entrustable learner is able to consistently follow a standardized format, providing, at a minimum, for each patient: 1) illness severity, 2) action planning, and 3) contingency planning. This learner can modify the template to suit specific patient, team, and contextual variables. He is able to update and effectively use the computerized handoff tool to complement handover communication. He can organize the content of verbal communication about each patient to prioritize the information for the recipient of the handover. The entrustable learner conducts patient handovers in settings and in manners that reflect awareness of established characteristics of high-quality handover communication (e.g., in an appropriate environment for handovers, minimizing distractions and interruptions, using closed-loop

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communication, and taking into account the workload of the other team members and the oncoming provider). When functioning as a receiver of handovers, the entrustable learner demonstrates active listening and asks clarifying questions. Further, he uses summarizing and repeat-back techniques to ensure closed-loop communication. Vignette for an entrustable learner Bob is rotating on a urology inpatient service. He is getting ready for the handover to the night team and completes his update of the electronic handover and prints out two copies, one for himself and one for the on-call person. He then stops by the nursing station to let the resource nurse know they are beginning signout and to ask if there is anything the nurses need or any patients that he should see before rounds. One of Bob’s co-workers passes by and asks if he can sign out first because his child has an event that night that he has to attend. Bob agrees readily and asks if there is anything he can do to help ensure that his co-worker gets to his child’s event on time. The co-worker asks Bob to just check the input/output on one of his patients; Bob does so and pages him with the results. After his colleague completes his sign-out with Jim, the incoming on-call team member, Bob meets Jim in the workroom where team members from several health care teams are hanging out and talking. Recognizing the potential for distractions and HIPAA violations, Bob asks Jim to relocate to an adjacent room. Bob hands Jim the printout of the electronic handover communication tool that he copied for him. Using the hospital template format for his handover, he starts with his most concerning patient, someone who should be watched more closely. During the patient summary, Bob tells Jim that the patient is a 67-year-old male with a history of bladder cancer status post-ileal-conduit surgery two weeks ago, who presented with two days of fevers, abdominal pain, and tachycardia, suggesting sepsis. The patient’s blood pressure has been within normal limits. He has received broad-spectrum antibiotics and fluids. He has a CT of the abdomen and pelvis that will require follow-up. The scan was ordered to look for an intra-abdominal abscess. A page asking for potassium replacement for one of his patients interrupts him. Bob confirms with the nurse that the patient is doing well and the potassium is not critically low. He lets the nurse

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know he will put in the order as soon as he is finished with sign-out. When he comes back from speaking with the nurse, he finishes reporting to Jim about the first patient by discussing the action items for the night (including checking temperatures, blood pressures, urine output, and pain scores every four hours and following up on the CT of the abdomen and pelvis). He tells Jim the plan for recurrent fever, hypotension, poor urine output, or worsening pain. Bob also tells Jim that the patient may need escalation of care to the ICU, if he decompensates further. Jim reiterates the action and contingency plans. Bob asks Jim if he has any questions, and Jim replies, “What is the team’s plan if the scan reveals an abscess?” Bob tells him the patient should be notified of the new information, since the current plan would be operative intervention. Importantly, Bob adds that Jim should be attentive to the fact that the patient is deaf in his left ear and is very hard of hearing in his right. They then proceed through the rest of the sign-out. The following morning, Bob returns to obtain the handover from Jim. Bob asks Jim how the night went, and Jim states that overall it went well but that Bob had forgotten to tell him to check the post-bolus potassium on the patient they were interrupted for during rounds. Jim tells Bob he came across it this morning and noted it was low but above the threshold level for IV replacement that Bob had told him. Bob states that he is sorry and will develop a place on his sign-out sheet to note changes that occur during the sign-out process to try to avoid a similar error in the future.

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EPA 9: Collaborate as a member of an interprofessional team Description of the activity

Effective teamwork is necessary to achieve the Institute of Medicine competencies for care that is safe, timely, effective, efficient, and equitable. Introduction to the roles, responsibilities, and contributions of individual team members early in professional development is critical to fully embracing the value that teamwork adds to patient care outcomes. Functions • • • • • • • •

Identify team members’ roles and the responsibilities associated with each role. Establish and maintain a climate of mutual respect, dignity, integrity, and trust. Communicate with respect for and appreciation of team members and include them in all relevant information exchange. Use attentive listening skills when communicating with team members. Adjust communication content and style to align with team-member communication needs. Understand one’s own roles and personal limits as an individual provider and seek help from the other members of the team to optimize health care delivery. Help team members in need. Prioritize team needs over personal needs in order to optimize delivery of care.

Pre-Entrustable Learners Expected behaviors for a pre-entrustable earner The pre-entrustable learner is at a stage of identity development where he is concerned about and focused on his own performance, making it difficult for him to recognize and prioritize team goals over his own. He identifies the roles of other team members but only fully understands and appreciates the contributions of other physicians. Therefore, the pre-entrustable learner usually seeks answers from physicians and adheres only to their recommendations and directives. The preentrustable learner has a limited ability to appreciate the importance of other team members and the role of diversity and inclusion in team-based care. His communication is largely unidirectional, in response to a prompt, and is template driven, with limited ability to modify content based on audience, venue, receiver preference, or type of message. The learner at this level has difficulty reading his own emotions and struggles with anticipating or reading others’ emotions. He is thus unable to manage strong emotions in himself or others. He may demonstrate lapses in professionalism such as disrespectful interactions, particularly in times of stress and fatigue.

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The pre-entrustable learner functions as a passive member of the team and acts independently of input from team members, patients, and families. As a result, he is unaware of resources available to and needed by patients, which limits his ability to help coordinate their care with other members of the interprofessional team. Vignette for a pre-entrustable learner Karl is assigned to an inpatient general medicine service for four weeks. He is five minutes late for work rounds one morning. When he joins the team, he apologizes for being late and says that the telemetry tech wouldn’t let him look at the overnight tracings for one of his patients who is hospitalized for evaluation of syncope. He is obviously flustered and says, “I can’t believe she wouldn’t let me see those tracings! She was talking to the night tech, and they said to come back in a half hour. I have no control over her, but someone should really talk to her about unprofessional behavior.” Later during rounds with the team, they go in to see Mrs. Gardner, another of his patients, an elderly woman who was hospitalized for urosepsis. The resident asks the patient how physical therapy is going. The patient says that she hasn’t had therapy for the

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past three days. Karl rolls his eyes and when they leave the room, he says, “I spoke to that therapist two days ago. He said the patient had declined therapy on the first day, and on the second day she wasn’t in the room when he stopped by. No wonder this hospital has a bad reputation! No one is doing their job to take care of the patient.” The next day, the case manager on the team approaches Karl’s supervisor to say that when the liaison from the nursing home arrived to evaluate Mrs. Gardner, Karl wouldn’t give up the patient’s chart to let her review it for almost a half hour. The liaison had waited patiently, then inquired about when he would be done. Karl told her impatiently that he had had to wait for the chart, and so would she. The case manager described him as being dismissive and rude. When the supervisor asked Karl about it, he responded with frustration: “I can’t believe she complained about that! She should know we have to get our notes in the chart as soon as possible, and I had to get to lecture at 1:00 p.m.”

Entrustable Learners Expected behaviors for an entrustable learner The entrustable learner actively strives to integrate himself into the team. He recognizes the value and contributions of all team members and seeks their input and help as needed. This learner keeps other team members to stay informed. He enjoys good interactions with team members based on his ability to adapt his communication strategies to the needs of the recipient in content, style, and venue. The learner at this level listens actively and elicits ideas and opinions from all team members. He anticipates and responds to emotions in typical situations. Other team members perceive his style of interaction as professional, and he rarely shows lapses in professional conduct. These lapses tend to occur only in unanticipated situations that evoke strong emotions, when even entrustable learners may have some difficulty managing the situation. When the occasional lapse occurs, however, he has the insight to grow from the experience by using what he learns to anticipate and manage future triggers.

and care plan development. He shares his knowledge of community resources with patients and is actively involved in care coordination. Vignette for an entrustable learner Karl is assigned to an inpatient general medicine service for four weeks. He is five minutes late for work rounds one morning. When he joins the team, he apologizes for being late and says that he wanted to look at the overnight tracings for one of his patients who is hospitalized for evaluation of syncope so they could make a decision about discharge during rounds. He says he had to wait a few minutes for the overnight tech and the day tech to finish their handoff conversation. Later during rounds with the other doctors, they go in to see Mrs. Gardner, another of his patients, an elderly woman who was hospitalized for urosepsis. One of the team members asks her how physical therapy is going. Mrs. Gardner says that she hasn’t had therapy for the past three days. Karl responds by saying, “I know you didn’t feel like therapy a couple of days ago. Since then, you’ve had so many tests that it might have been hard for the therapist to find you in the room. I know he really wants to get you going; I’ll give him another call and see what we can work out.” The next day, the case manager on the team approaches Karl’s supervisor to say that Karl was particularly helpful with Mrs. Gardner. He happened to be writing his note in her chart when the case manager came to review it and he explained his concerns about Mrs. Gardner’s daughters’ opposition to any suggestion of a temporary nursing home placement. He asked the case manager to help him work with them. With the help of Karl’s preparation of the daughters, the case manager was successful in getting them to understand the rationale for the temporary placement as being in their mother’s best interest.

The entrustable learner generally works toward achieving team goals, though this is sometimes more difficult when personal goals compete with team goals. He usually involves patients, families, and other members of the interprofessional team in goal setting

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EPA 10: Recognize a patient requiring urgent or emergent care and initiate evaluation and management Description of the activity

The ability to promptly recognize a patient who requires urgent or emergent care, initiate evaluation and management, and seek help is essential for all physicians. New residents in particular are often among the first responders in an acute care setting, or the first to receive notification of an abnormal lab or deterioration in a patient’s status. Early recognition and intervention provides the greatest chance for optimal outcomes in patient care. This EPA often calls for simultaneously recognizing need and initiating a call for assistance. Examples of conditions for which first-day interns might be expected to recognize, initiate evaluation and management, and seek help include the following: 1. chest pain 2. mental status changes 3. shortness of breath and hypoxemia 4. fever 5. hypotension and hypertension 6. tachycardia and arrhythmias (e.g., SVT, Afib, heart block) 7. oliguria, anuria, urinary retention 8. electrolyte abnormalities (e.g., hyponatremia, hyperkalemia) 9. hypoglycemia and hyperglycemia Functions • • • • • • • • • • •

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Recognize normal vital signs and variations that might be expected based on patient- and disease-specific factors. Recognize severity of a patient’s illness and indications for escalating care. Identify potential underlying etiologies of the patient’s decompensation. Apply basic and advanced life support as indicated. Start initial care plan for the decompensating patient. Engage team members required for immediate response, continued decision making, and necessary follow-up to optimize patient outcomes. Understand how to initiate a code response and participate as a team member. Communicate the situation to responding team members. Document patient assessments and necessary interventions in the medical record. Update family members to explain patient’s status and escalation-of-care plans. Clarify patient’s goals of care upon recognition of deterioration (e.g., DNR, DNI, comfort care).

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Pre-Entrustable Learners

I don’t think there is any reason to call anyone.”

Expected behaviors for a pre-entrustable learner

Thirty minutes later, Jorge receives a call that Mr. Gold’s mental status has changed. Jorge goes to the room and sees Mr. Gold wearing a non-rebreather facemask, sleepy but arousable. Jorge tells the nurse, “You did not tell me he was requiring this much oxygen.” Jorge talks with Mr. Gold, who expresses concern about his shortness of breath. Mr. Gold also asks Jorge to call his wife to give her an update. Jorge does not discuss goals of care with Mr. Gold. Jorge does a head-to-toe physical exam over the next several minutes. He finds decreased breath sounds on the right lower lung, with no wheezing or crackles. Peripheral pulses are diminished. The rest of the exam is unremarkable, with no focal neurologic deficits. Jorge decides to call his senior resident and discuss the case.

The pre-entrustable learner has an incomplete understanding of personal limitations. This may result in an overestimation of personal ability, dismissal of concerns that other health care team members express about a deteriorating patient, and delay in responding to or asking for help for a patient in need of urgent or emergent care. The pre-entrustable learner has difficulty gathering, filtering, and prioritizing the critical data for a patient. Consequently, this learner has difficulty communicating clinical encounters in a concise and efficient manner. This learner has gaps in his medical knowledge and inconsistently applies the knowledge he does have. Consequently, he fails to recognize variations of vital signs that may occur with age or various disease states. He may also inconsistently order and interpret test results, delaying reassessment and further testing or therapeutic interventions. Gaps in medical knowledge make it challenging for him to anticipate next steps for patients requiring urgent or emergent care. Additionally, this learner does not understand the health care system and, therefore, may have difficulty mobilizing the skills and abilities of team members or using escalation in care policies and procedures. The pre-entrustable learner communicates in a unidirectional manner without seeking input from the patient, family members, or health care team members. Following the urgent or emergent interventions, the pre-entrustable learner may demonstrate a defensive and/or argumentative attitude in debriefing sessions. Vignette for a pre-entrustable learner Jorge is the overnight provider on the hospital internal medicine team. He is called from the nursing station about Mr. Gold, who is complaining of shortness of breath. Jorge looks at his handoff notes and says, “He is just here with a COPD exacerbation. I am sure that is all it is. He should be fine.” Ten minutes later, Mr. Gold’s nurse comes to the call room and tells Jorge, “I am worried about Mr. Gold. He does not look well.” Jorge inquires about the patient’s oxygen saturation and is told that it is 87%. He responds, “This is fine for his condition.” The nurse suggests that Jorge call his senior resident to discuss Mr. Gold. Jorge responds, “The patient is at baseline. I saw him a little while ago.

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On the way to call his senior resident, he is called about another patient, who has not had a bowel movement for three days, and is asked to place an order for a bowel regimen. Before calling his senior resident, he places the order for the bowel regimen. He then calls his senior resident and first discusses the bowel regimen order. Jorge next expresses his displeasure at working with Mr. Gold’s nurse because he felt he was able to handle the situation himself. When asked about vital signs, past medical history, hospital course, and initial interventions, Jorge states he had not reviewed this information or initiated tests or interventions because he wanted to discuss the case first. Jorge suggests a “shotgun” approach to diagnostic tests to cover all possible causes of altered mental status, tachycardia, and hypoxia. After seeing Mr. Gold with the resident, Jorge realizes he failed to notice a trend of worsening hypotension and tachycardia. The resident points out that Jorge failed to notice that Mr. Gold had a fever and only one peripheral IV. At this point, the resident takes over care. Jorge steps back into a corner to stay out of the way. Because of the patient’s persistent hypotension with possible need for vasopressors and advanced airway management, the resident recommends moving the patient to the ICU for further management of likely sepsis. After the patient is moved to the ICU, Jorge is instructed to call the patient’s family to discuss the need for transfer and the care plan. The patient’s family does not answer the phone, so Jorge leaves this

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message on their machine: “Mr. Gold has deteriorated and has been moved to the ICU for ventilator support and central line placement. Please call the hospital and ask for Jorge for further details.” During subsequent debriefing of entire episode of care, Jorge becomes defensive and argumentative. He blames the nursing staff for giving him inaccurate information about the oxygen requirement and distracting him with “pointless” questions.

Entrustable Learners Expected behaviors for an entrustable learner The entrustable learner responding to an urgent or emergent patient condition has insight into his personal limitations. As this learner encounters new scenarios, he will seek help from colleagues, members of the health care team, and supervisors. Additionally, this learner uses information from credible sources (e.g., the electronic health record, or EHR) to aid in decision making. The entrustable learner has the ability to gather, filter, and prioritize information such as vital signs, focused physical exam, past medical history, recent tests or procedures, and medications to form a focused differential diagnosis, initiate interventions, and drive early testing decisions in the urgent or emergent setting. He can anticipate next steps in care, efficiently communicate the patient scenario to the health care team, interact with other team members based on an understanding of their roles and skills, and facilitate initial tests and interventions to stabilize the patient. During the urgent or emergent episode of care, this learner facilitates early bidirectional communication with the patient, patient families, and health care team members to allow for shared decision making. After the encounter, the entrustable learner seeks guidance and feedback from the health care team to improve future patient care. Vignette for an entrustable learner Jorge is the overnight provider on the hospital internal medicine team. He is called from the nursing station about Mr. Gold, who is complaining of shortness of breath. Jorge immediately leaves his call room to assess Mr. Gold with the nurse. In reviewing the patient’s vital signs, he notices a trend in worsening hypoxia, tachycardia, and hypotension over the past few hours. He quickly reviews Mr. Gold’s medical record,

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which reveals a history of end-stage renal disease on hemodialysis, type 2 diabetes mellitus, hypertension, recurrent pneumonias, and COPD. Additionally, the electronic medical record indicates the patient is DNR/ DNI. Jorge completes a focused physical exam that reveals decreased breath sounds in the right lower lung with no wheezes or crackles; use of accessory muscles for breathing; and cool and clammy skin. Jorge discusses goals of care with Mr. Gold and asks if there is anyone he would like him to call for an update. Jorge discusses his findings with Mr. Gold and his nurse and addresses concerns and possible interventions. He explains that he is most worried about sepsis related to pneumonia. However, he notes that given prolonged hospital stay, tachypnea, tachycardia, and hypoxia, he cannot exclude a pulmonary embolus, myocardial infarction, congestive heart failure, or electrolyte abnormalities as the cause of Mr. Gold’s deterioration. Jorge asks the nurse to maintain oxygen saturation between 88% and 92%. He explains the stepwise approach and equipment limitations of nasal cannula, open facemask, and non-rebreather facemask. Jorge asks Mr. Gold if he has experienced both a facemask and nasal cannula, and Mr. Gold states he prefers the cannula but will wear the mask if Jorge wants him to. Jorge tells him they will start with the nasal cannula and only switch to the facemask if he requires increasing oxygen to maintain oxygen levels in his blood. Jorge asks for placement of a second IV for access, anticipating the need for fluids, antibiotics, and other medications. Jorge orders a portable chest X-ray and arterial blood gas. Jorge tells the nurse he is going to step away for a moment to call and update his senior resident. He also states he will call Mr. Gold’s wife to update her on Mr. Gold’s condition. While Jorge is walking to call the family, he is paged about a patient who has not had a bowel movement in a few days. Jorge expresses his appreciation to the nurse for bringing this to his attention and states he will place the order for a bowel regimen as soon as he is able to stabilize another patient. Jorge places this on his checklist as a reminder for later. He sends a text page to the senior resident to meet him at the patient’s bedside and calls Mr. Gold’s wife, but there is no answer. He leaves a message for her to call him at the hospital for an update.

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After calling Mr. Gold’s wife, Jorge goes back to reassess the patient and finds him to be on a nonrebreather facemask to maintain adequate oxygen saturation. Recognizing further deterioration with persistent hypotension and tachycardia and the possible need for a central line or other invasive procedures, Jorge and Mr. Gold’s nurse identify the need for additional resources. They initiate the rapid response team, which mobilizes a respiratory therapist, increased nursing support, and the senior resident. While Jorge is reviewing the chest X-ray on the bedside computer, the senior resident arrives. At the bedside, Jorge updates the senior resident using the SBAR format as follows: (Situation) “Mr. Gold is our 76 year-old man with end-stage renal disease, COPD, recurrent pneumonias, and type 2 diabetes mellitus who was admitted for a presumed COPD exacerbation yesterday and now has hypotension, tachycardia, and hypoxia. Of note, Mr. Gold has an advanced directive and is DNR/DNI.” (Background) Jorge then presents a focused history and physical exam. He describes his initial testing and interventions, including the increased oxygen therapy, the placement of a second IV, and the chest X-ray findings. He goes on, saying: (Assessment) “I think the patient is developing sepsis secondary to a new pneumonia exacerbating his COPD. (Response) I think we should begin antibiotics. In addition, given the patient’s current condition, I am concerned the patient will require ICU level of care. Are there any questions?” Before being transferred to the ICU, Ms. Gold calls. Jorge confirms her relationship to the patient. Then, he updates her on Mr. Gold’s condition. Ms. Gold reiterates that he is DNR/DNI and Mr. Gold would like testing and interventions up until he requires mechanical ventilation or his heart stops. In either of those cases, he would not want further resuscitation. After Mr. Gold is stabilized and transferred to the ICU, Jorge asks the senior resident for feedback regarding his performance and potential areas for improvement.

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EPA 11: Obtain informed consent for tests and/or procedures Description of the activity

All physicians must be able to perform patient care interventions that require informed consent. From day 1, residents may be in a position to obtain informed consent for interventions, tests, or procedures they order or perform (e.g., immunizations, central lines, contrast and radiation exposures, blood transfusions). Of note, residents on day 1 should not be expected to obtain informed consent for procedures or tests for which they do not know the indications, contraindications, alternatives, risks, and benefits. Functions • • • • • • •

Describes the indications, risks, benefits, alternatives, and potential complications of the procedure. Communicates with the patient/family and ensures their understanding of the indications, risks, benefits, alternatives, and potential complications. Creates a context that encourages the patient/family to ask questions. Enlists interpretive services when necessary. Documents the discussion and the informed consent appropriately in the health record. Displays an appropriate balance of confidence with knowledge and skills that puts patients and families at ease. Understands personal limitations and seeks help when needed.

Pre-Entrustable Learners Expected behaviors for a pre-entrustable learner The pre-entrustable learner regards obtaining informed consent as a task to be performed based on the directive of others. This learner lacks understanding of at least some key elements of informed consent (indications, contraindications, risks, benefits, and alternatives) or knows the elements that should be addressed but does not know the specifics for the given procedure. As a result, conversations with the patient/family often have critical errors of omission. The learner also frequently uses medical jargon, further limiting the ability of patient/family to understand and make an informed decision. Conversations with patients and families are unidirectional, with the learner describing what he knows about the procedure and then providing the form for the patient to sign, without first inviting questions or discussion. If patients raise issues around preferences on their own, the learner at this level will respect them; however, this learner does not solicit preferences that might relate to the procedure absent

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the patient’s prompt. The pre-entrustable learner does not consistently enlist interpretive services when needed, especially if the family does not make an explicit request. The learner at this level also often misses emotional cues from patients, such as anger, fear, or frustration, leaving them unaddressed. The inability of the learner to recognize emotional cues and the lack of knowledge to answer patient questions (e.g., about risks and benefits) may result in patients experiencing an erosion of trust and a request to talk to a more senior member of the team before signing the form. Alternately, the patient may sign without truly being informed. Finally, documentation of the informed consent frequently has errors of commission or omission and/or deviates from policy (e.g., not timed, dated, signed by patient and physician, all sections completed). Vignette for a pre-entrustable learner John is working in a family medicine clinic that has just received its shipment of flu vaccines for the season. He is asked to make sure that all eligible patients receive the vaccine. He enters the room to see Mrs. Lopez, a 65-year-old in for her annual physical. This is only her

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second visit to this clinic since she recently moved. Her chronic problems include hypertension, moderate obesity, and type 2 diabetes. John notices that she speaks with an accent but that her English is “good,” so he proceeds with the interval history and physical. Following the interval history and physical examination, John tells her that she needs the flu vaccine and that he will need her to sign the informed consent. He hands her a flyer on the flu vaccine, along with the informed consent form, and asks her to read it over. She states: “I don’t need to read it, doctor. If you think I need it, then I’ll just sign.” She signs and hands the consent back to John. He states that someone will be in shortly to give her the vaccine. John steps out into the hallway and meets his supervisor. “Here’s the consent form for Mrs. Lopez’s flu shot, Jim. She’s all set to go.” John’s supervisor looks at the sheet and says to John, “She hasn’t filled in the contraindications section. Did you ask her about a history of Guillain-Barre, prior reactions to the flu shot, or an egg allergy?” John admits he did not and notes that he was not sure what Guillain-Barre was or why it was on the list. His supervisor briefly explains Guillain-Barre syndrome and its prior association with the swine flu vaccine. He also notes that John has not signed on the medical provider line of the informed consent to document his discussion with Mrs. Lopez. They enter the room together, and John’s supervisor asks Mrs. Lopez if she has ever had a problem with the flu shot in the past. Mrs. Lopez notes that she does not think she has received the flu vaccine for several years and is not sure why. She thought it was related to her diabetes. The supervisor suggests that John call her prior primary care practitioner’s office and asks Mrs. Lopez’s permission to do so. When John calls, he is told that Mrs. Lopez did not get the flu vaccine for the past eight years because she reported an episode of possible hives three days after the flu vaccine nine years ago. John goes back into the room and explains what he found out to Mrs. Lopez, who then recalls the episode and says she was never really sure the two were related. John, unaware of the current recommendations that a history of hives alone should not prevent flu vaccine administration, suggests that they skip it this year but says he will ask a colleague.

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John then goes out and finds his supervisor, who shows him the updated CDC recommendations. John’s supervisor and John return to Mrs. Lopez’s exam room to explain the risks, benefits, alternatives, and complications for the vaccine and why they are recommending proceeding.

Entrustable Learners Expected behaviors for an entrustable learner The entrustable learner understands the importance of the informed consent process in the patient-doctor relationship and for shared decision making. This learner understands the key elements of informed consent (indications, contraindications, risks, benefits, and alternatives) and begins the process prepared with the specifics for the given procedure. As a result, conversations with the patient/family rarely have errors of omission. The entrustable learner tends to avoid medical jargon in an attempt to maximize the patient’s and family’s ability to understand and make an informed decision. Conversations with patients and families are bidirectional, with the learner sharing his knowledge about the procedure, walking the patient/family through the elements of the informed consent, and then inviting questions and/or discussion. The learner at this level enlists interpretive services as needed, even when not explicitly requested by the patient or family. During the conversation, learners at this level will seek to understand the patient’s and family’s preferences about the procedure. By recognizing and discussing patient or family preferences, the learner engages the patient and/ or family in shared decision making. Additionally, the learner at this level generally can recognize emotional cues from patients, such as anger, fear, or frustration, and address them or seek help from supervisors in addressing them. The learner’s knowledge and concern for the patient’s input demonstrates the confidence necessary to put the patient at ease. Finally, documentation of the informed consent rarely has errors of omission and is consistent with the policy of the institution (e.g., timed, dated, signed by patient and physician, all sections completed).

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Vignette for an entrustable learner John is working in a family medicine clinic that has just received its shipment of flu vaccines for the season. He is asked to make sure that all eligible patients receive the vaccine. He enters the room to see Mrs. Lopez, a 65-year-old in for her annual physical. This is only her second visit to this clinic since she recently moved. Her chronic problems include hypertension, moderate obesity, and type 2 diabetes. John notices that Mrs. Lopez has an accent and asks if she would like to proceed with or without an interpreter. She says, “Thank you for the offer, but I am comfortable without an interpreter.” Following the interval history and physical examination, John tells Mrs. Lopez it is the time of year for the flu vaccine, and he wants to talk with her about whether she would like to receive it during this visit. He hands her a flyer on the flu vaccine, along with the informed consent form, and asks her to read it over. She says, “I don’t need to read it, doctor. If you think I need it, then I’ll just sign.” John then says that he would prefer that she read the materials, especially the “contraindications” section. When she does so, Mrs. Lopez says, “Come to think of it, they haven’t given me the flu shot over the last several years, and I am not entirely sure why. I think I may have had a reaction to it.” John then walks through the contraindications with her, including Guillain-Barre syndrome, egg allergy, and prior severe reaction to a flu vaccine. When Mrs. Lopez notes that she hasn’t had Guillain-Barre and has no egg allergy, she decides it must have been a reaction to the shot, but she can’t remember. John asks if he may call her prior primary care practitioner’s office to investigate, and she consents. John learns that Mrs. Lopez did not get the flu vaccine for the past eight years because she reported an episode of possible hives three days after the flu vaccine nine years ago. John goes online to review the current CDC guidelines and notes that hives without other systemic symptoms is no longer a contraindication; the suggested guidelines include monitoring for 30 minutes postvaccine. He returns to the room and explains what he learned to Mrs. Lopez, who then recalls the episode and says she was never really sure the two were related. He then goes over the risks and benefits one more time and asks Mrs. Lopez to repeat back to verbalize an understanding. She signs and dates the consent form and then John does the same and documents her history of hives and their conversation about the current guidelines.

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EPA 12: Perform general procedures of a physician Description of the activity

All physicians need to demonstrate competency in performing a few core procedures on completion of medical school in order to provide basic patient care. These procedures include: • • • •

Basic cardiopulmonary resuscitation (CPR) Bag and mask ventilation Venipuncture Inserting an intravenous line

Functions • • • • •

Demonstrate the technical (motor) skills required for the procedure. Understand and explain the anatomy, physiology, indications, risks, contraindications, benefits, alternatives, and potential complications of the procedure. Communicate with the patient/family to ensure pre- and post-procedure explanation and instructions. Manage post-procedure complications. Demonstrate confidence that puts patients and families at ease.

Pre-Entrustable Learners Expected behaviors for a pre-entrustable learner The learner at this level approaches a procedure as a mechanical task to perform, often at the behest of others, without understanding the context (such as patient-specific factors, indications, contraindications, risks, benefits, alternatives). She uses medical jargon that limits the patient’s ability to verbalize a clear understanding of why the procedure is being done; this can impede shared decision making. Additionally, the pre-entrustable learner may not be aware of potential complications of the procedure or may minimize or miss them. The pre-entrustable learner usually lacks confidence in her knowledge, making her uneasy when questioned by the patient. This, in turn, may prompt the patient to ask about her previous experience with this procedure or even request a more experienced provider. Conversely, the pre-entrustable learner may overestimate her skill. This may result in potential harm to the patient, both physically if the learner attempts a procedure without proper skill and emotionally if trust is eroded.

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This learner’s mechanical skills in the procedure are often inconsistent, resulting in an inability to reliably complete the procedure. This may include inconsistent use of universal precautions and aseptic technique. This learner’s skill level may also require such intense focus on the task that the learner is unable to attend to the emotional response of the patient (e.g., pain, fear, frustration, anger). Finally, this learner’s documentation of procedures may be incomplete or absent. Vignette for a pre-entrustable learner Shu is working on a general surgical service. On morning rounds, she is asked to replace an intravenous line that fell out in Mrs. Amir, who is post-operative day 2 status post modified right radical mastectomy for breast cancer. Shu tells Mrs. Amir, “I am here to replace your IV.” Mrs. Amir states that she was hoping it wouldn’t need to be replaced this time because she is close to discharge. She asks why it has to be replaced, and Shu states she is not sure but will check. She leaves the room and returns to tell Mrs. Amir that the IV is still needed because of her pain medication. Shu takes a couple of minutes to gather her supplies and returns to the supply cart several times for things she had forgotten. Mrs. Amir watches with growing concern.

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As she readies a tourniquet for the right arm, Shu tells Mrs. Amir that she will be looking for an “antecubital vein.” Mrs. Amir says, “I’m not sure what that is, but I was told I couldn’t have IVs in my right arm.” Mrs. Amir points to a sign above her bed reading “No right arm procedures.” Shu changes to the left arm, applies a tourniquet and grabs an alcohol swab to start preparing. Mrs. Amir asks her if she is going to wash her hands. Shu goes to the sink but forgets to release the tourniquet prompting Mrs. Amir to say her arm is really starting to hurt. Shu returns and releases the tourniquet and apologizes. Mrs. Amir asks Shu, “How many IVs have you put in?” She admits to “a couple.” Mrs. Amir asks for a more senior provider to place the IV. The following day on rounds, Shu notes that the IV was replaced. The attending asks if there is any evidence of phlebitis at the site, to which Shu has to reply, “I’m not sure, I didn’t check.”

Entrustable Learners Expected behaviors for an entrustable learner The learner at this level understands both the skill required and the context of a procedure such as patient-specific factors, indications, contraindications, risks, benefits, and alternatives. The entrustable learner avoids medical jargon in communicating the indications, risks, benefits, and complications of a procedure to the patient. This enables the patient to verbalize a clear understanding of why the procedure is being done and to participate in shared decision making about the procedure. Additionally, the entrustable learner knows and recognizes complications of the procedure and how to mitigate them. The learner at this level has confidence commensurate with her knowledge and skill, thus putting patients at ease during the procedure. This learner’s mechanical skills in the procedure are consistent and reliable in most situations, and this learner knows when to get help for procedures or situations beyond her abilities (e.g., placing an IV in a neonatal intensive care patient). She consistently uses universal precautions and aseptic technique. This learner’s skill level allows her to simultaneously pay attention to the procedure and the patient’s emotional

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response (e.g., pain, fear, frustration, anger). Finally, this learner’s documentation of procedures is usually complete and timely. Vignette for an entrustable learner Shu is working on a general surgical service. On morning rounds, the nurse notifies the team that the intravenous line fell out overnight in Mrs. Amir, who is post-operative day 2 status post modified right radical mastectomy for breast cancer. Realizing that Mrs. Amir is still requiring intravenous pain medication, she volunteers to replace it. Shu uses alcohol gel before entering the room and introduces herself to Mrs. Amir, stating, “I am here to discuss replacement of your IV with you.” She discusses the risks and benefits of placement of a new intravenous line, noting that Mrs. Amir may not need one if she feels that her pain could be managed with oral medications. Mrs. Amir expresses her understanding but requests that a new line be placed in an attempt to get her pain under control first. Shu explains to Mrs. Amir that she will gather supplies and then attempts to place an IV in Mrs. Amir’s left arm because she knows of the increased risk for arm swelling with placement on the same side as her surgery. After washing her hands, Shu returns to the bedside with all necessary supplies. Since Shu uses a wheelchair, she lowers the patient bed to a comfortable height to ensure she has appropriate access to both the patient’s arm and all supplies. She applies a tourniquet to the left arm, and explains that she will attempt to place the IV in one of the big veins that cross Mrs. Amir’s elbow. Shu prepares the area using aseptic technique and successfully completes the intravenous catheter insertion, applying a sterile dressing and making note that the line flushes and draws easily and the site has no evidence of swelling. As Shu exits the room, again using alcohol gel, she communicates details of the line placement to Mrs. Amir’s nurse to ensure they are documented properly. The following day on rounds Shu notes that the IV was replaced and that the site is clean, dry, and intact with no evidence of phlebitis.

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EPA 13: Identify system failures and contribute to a culture of safety and improvement Description of the activity

Since the publication of the IOM reports “To Err is Human”25 and “Crossing the Quality Chasm,”26 the public has been focused on the need to improve quality and safety in health care. Preventing unnecessary morbidity and mortality requires health professionals to have both an understanding of systems and a commitment to their improvement. This commitment must begin in the earliest stages of health professional education and training. Therefore, this EPA is critical to the professional formation of a physician and forms the foundation for a lifelong commitment to systems thinking and improvement. Functions • • • • • •

• •

Understand systems and their vulnerabilities. Identify actual and potential (“near miss”) errors in care. “Speak up” in the face of real or potential errors. Use system mechanisms for reporting errors (e.g., event reporting systems, chain of command policies). Recognize the use of “workarounds” as an opportunity to improve the system. Participate in system improvement activities in the context of rotations or learning experiences (e.g., rapid-cycle change using plan-do-study-act cycles; root cause analyses; morbidity and mortality conferences; failure modes and effects analyses; improvement projects). Engage in daily safety habits (e.g., universal precautions, hand washing, time-outs). Admit one’s own errors, reflect on one’s contribution, and develop an improvement plan.

Pre-Entrustable Learners Expected behaviors for a pre-entrustable learner The learner at this level either does not understand systems or has a superficial understanding that prevents recognition of real or potential errors. Common safety behaviors, such as the use of universal precautions or hand washing, require external prompts because they are not yet a matter of habit. Because these learners do not yet understand the systemic implications of safety behaviors, they are easily frustrated and may see them as overly burdensome (e.g., when asked to wash hands when going into a patient’s room for a couple of seconds to answer a patient’s question). Additionally, the pre-entrustable learner tends to be a passive observer on the team and is dependent on external sources to identify safety risks, even when he is the cause of the risk. When confronted with his role in a real or potential error, he becomes defensive

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and tends to blame others or the system for a lack of support. The pre-entrustable learner is unlikely to submit an occurrence or event report unless prompted and required to do so by supervisors. While this learner is invested in caring for individual patients, he does not recognize how problems in that care may be generalizable to populations of patients. Participation in identifying system solutions or in carrying out improvement plans also requires external prompting. This learner takes a passive role in improvement activities, generally simply doing what he is told to do. The pre-entrustable learner tends to be rigid and rules-based, especially in communication. Thus, he would be hard-pressed to question a supervisor, even when questioning is warranted by an imminent unsafe behavior. When errors do occur, he avoids conversations about them, and tends to develop workarounds that ease his own burden of future work without improving the system for others. Finally, this learner may not recognize his own symptoms of fatigue, or

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fears consequences of disclosing such symptoms to a supervisor, thus increasing risk of harm events.

get the form in two hours earlier to ensure a same-day test. Sudeep hangs up in frustration.

Vignette for a pre-entrustable learner

The next day on rounds, Sudeep is presenting the patient and reports that the patient had another seizure the night before that required acute treatment with lorazepam. When the supervisor interrupts to ask for the EEG results, Sudeep reports that the EEG is scheduled for that day. The supervisor responds, “I thought the whole idea was to hold off on anticonvulsants and get the EEG yesterday to guide our treatment.” Sudeep responds, “It’s not my fault, Dr. Smith. The unit coordinator hides the forms, and it took me so long to find it that they wouldn’t take the patient yesterday. It’s amazing anyone gets an EEG in this place.”

Sudeep has just started on an internal medicine inpatient team. On morning rounds, he is asked to schedule an EEG for a patient admitted with a possible seizure the night before. The team decides to wait on additional antiepileptic medication until the test is completed. Sudeep goes to the computerized prescriber order entry and types in “EEG.” This results in the following message: “This is a test that requires a written request form in addition to the online order.” Sudeep gets visibly upset that he has to find the form and walks toward the central nurse’s station. En route, a patient calls out to him from a room, and he enters to answer her question without washing his hands. As he emerges, a nurse reminds him that he has to wash his hands on entry and exit from the patient’s room, to which Sudeep replies, “I barely went in, and it was just to answer her question.” At the central nurse’s station, Sudeep approaches a nurse to ask where he can find an EEG request form. She replies, “I’m sorry, but I do not know where they are kept.” Sudeep begins to open drawers and file cabinets, becoming increasingly visibly frustrated. Another learner passes, and Sudeep asks him if he knows where the EEG forms are, to which he responds, “No, man. I haven’t had to order one yet.” Sudeep gets paged and has to leave the floor. Two hours later, the unit coordinator for the floor returns from a break. Sudeep has started to search again and asks the unit coordinator if he knows where the EEG request forms are. The individual replies, “Yes, I keep them in a special drawer because the docs were taking them too often and losing them or not filling them out right. I had to keep going to central supply to restock the forms, and that costs the floor a lot of money.” Sudeep responds with obvious frustration: “I’ve spent the last two hours looking for this form. This is ridiculous!” He proceeds to fill out the form and hands it to the unit coordinator to be sent to the EEG lab. Two hours later, the EEG lab pages Sudeep to let him know that the test has been scheduled for the following day. Sudeep gets upset and says he really needed the test that day, to which the EEG lab technician responds he needed to

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Entrustable Learners Expected behaviors for an entrustable learner The learner at this level understands systems well enough to identify real errors and some potential errors. The entrustable learner performs common safety behaviors, such as hand washing and universal precautions, with rare lapses (mostly when stressed or rushed). He understands the implications of these behaviors both to the individual patient and to the population of patients in the system (that is, the practice or institution). The learner at this level is an active member of the team, understanding and taking responsibility for his own role in errors when they occur. Because he has learned to build into his routine “slowing down” to engage in reflection on practice, he often identifies system errors or opportunities for improvement on his own. However, he also relies on external sources for information on his own practice, especially for populations. He also looks to other members of the team for help understanding the root causes of quality or safety issues and identifying the solutions. This learner understands the importance of error reporting and almost always does so whenever he identifies an error. He actively participates in improvement efforts and in identifying systems issues and their solutions, recognizing the importance of learning from individual events when they have implications for populations. The entrustable learner is an active listener. He understands the importance of communication about

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errors, and can create a narrative that is compelling, accurate, and succinct to motivate others on the health care team. His understanding of the need to prevent errors propels him to question or challenge others on the team, including supervisors, when he is concerned that an error is about to occur, even if this means overcoming fears of the supervisor’s response. Finally, this learner recognizes his own symptoms of fatigue and can moderate behavior accordingly or seek help when needed, thus decreasing the risk of harm events. Vignette for an entrustable learner Sudeep has just started on an internal medicine inpatient team. On morning rounds, he is asked to schedule an EEG for a patient admitted with a possible seizure the night before. The team decides to wait on additional antiepileptic medication until the test is completed. Sudeep goes to the computerized prescriber order entry and types in “EEG” This results in the following message: “This is a test that requires a written request form in addition to the online order.” Sudeep begins to walk toward the central nurse’s station to find the form. En route, a patient calls out to him from a room with a question. Sudeep takes a step inside, then stops and looks for a hand soap container on the wall outside the room to wash his hands before entering. At the central nurse’s station, Sudeep approaches a nurse and asks where he can find an EEG request form, and she replies, “I’m sorry I don’t know where they are kept.” Sudeep then asks if the nurse knows who might be able to help him find the form, and the nurse suggests he speak to the unit coordinator, who is on break for 15 minutes. Sudeep heads off to take care of some other work. Thirty minutes later, Sudeep returns to find the unit coordinator and explains that he needs a form for EEGs. The coordinator responds, “I keep them in a special drawer because the docs were taking them too often and losing them or not filling them out right. I had to keep going to central supply to restock the forms, and that costs the floor a lot of money.” Sudeep thanks him for the form, fills it out, and hands it back, requesting that it be faxed to the EEG lab. Sudeep makes a note to call the lab in 15 minutes to make sure the form arrived.

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Fifteen minutes later, Sudeep calls the EEG lab and is told that the lab received the form and is working on scheduling it for that day. The EEG lab receptionist states, “You’re lucky, doc. I received the form at 11:50 a.m., and we try to guarantee same-day scheduling for any request in before noon. You just made the deadline! Should be no problem to get the EEG completed today.” Sudeep says, “I guess I was lucky, but I wonder if there isn’t a better way to make sure the patients get what they need without relying on luck!” He then goes online to fill out an occurrence report, recognizing that the delay in the EEG could have been a major issue for this patient. At afternoon sign-out, Sudeep includes in his written sign-out a reminder for the night team to check results on the pending EEG. If the results are positive, they are to load the patient with phenytoin. If negative, the plan is to hold on antiepileptics and use lorazepam PRN. Sudeep then notes to the team what a hassle it was to get the EEG because the required written request was squirreled away by the unit coordinator and how lucky he was to make the deadline that he didn’t know existed. He wonders if there’s a way to get the form online and to make sure the form notes that requests before noon will result in same-day testing. His teammates like the idea and suggest he bring it up on rounds. The next day on morning rounds, Sudeep presents the patient, noting that the EEG was positive. As a result, the patient was loaded with phenytoin and had an uneventful night. He notes to the attending that the EEG required a written form and submission by noon for same-day testing and that the unit coordinator kept the forms in a special place because the docs were overusing them and he was running out. He wonders if the system would be better if the forms were online and changed to note the required time of submission to guarantee same-day testing. He asks the attending how he might go about suggesting this. The attending says it’s a great idea and tells Sudeep that after rounds, she will help him contact the head of the EEG lab and the chair of the Forms Committee to make his suggestion.

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Appendix: Bulleted List of Expected Behaviors for Pre-entrustable and Entrustable Learners EPA 1 Bulleted List: Gather a history and perform a physical examination Expected behaviors for a pre-entrustable learner • • •

Information gathering and physical exam maneuvers: o Gathers either insufficient or overly exhaustive information. o Incorrectly performs physical exam maneuvers. o Misses key physical exam findings. o Does not seek or is overly reliant on secondary data. o Uses medical jargon or other examples of ineffective communication techniques. Scientific foundation and/or reasoning skills: o Limited ability to filter, prioritize, and connect pieces of information to each other or to previous clinical encounters. o May be less observant of important information or trends; focused on individual patients, potentially without attention to that patient’s community or background. o May jump to conclusions without probing first (that is, shortcut the scientific method). o Lack of experience results in limited ability to develop clinical mental models, which limits ability to gather relevant information and/or perform appropriate maneuvers. o Demonstrates low activation of prior knowledge, either because they lack it or because they do not use it to their advantage in problem solving. Patient-centered skills: o May demonstrate disrespectful interactions with patients, because of stress, fatigue, or unawareness (e.g., forgetting to keep patient draped). o May generalize based on patient’s age, gender, culture, race, religion, disabilities, and/or sexual orientation.

Expected behaviors for an entrustable learner • • •

Information gathering and physical exam maneuvers: o Obtains a complete and accurate history in an organized fashion. o Identifies pertinent history elements in common presenting situations, symptoms, complaints, disease states (acute and chronic). o Obtains focused, pertinent histories in urgent, emergent, and consultation settings. o Identifies and uses alternate sources of information to obtain history when needed, including from family members, primary care physicians, living facilities, and pharmacies. o Performs a complete and accurate physical exam in logical and fluid sequence. o Performs a clinically relevant, focused physical exam pertinent to the setting and focus of the patient visit. o Identifies, describes, and documents abnormal physical exam findings. Scientific foundation and/or reasoning skills: o Demonstrates clinical reasoning in gathering focused information relevant to a patient’s care. o Links current findings to those from previous patients. o Uses analytic reasoning and activation of prior knowledge to guide process. Patient-centered skills: o Demonstrates patient-centered interview skills (attentive to patient verbal and nonverbal cues, patient/ family culture, social determinants of health, need for interpretive or adaptive services; demonstrates active listening skills). o Demonstrates patient-centered examination techniques that reflect respect for patient privacy, comfort, and safety (that is, explaining physical exam maneuvers, telling the patient what the physician is doing at each step, keeping patients covered during the examination).

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EPA 2 Bulleted List: Prioritize a differential diagnosis following a clinical encounter Expected behaviors for a pre-entrustable learner • • • • • • •

Approaches assessment of patient problem from a rigid template, leading to creation of differential diagnoses that are too narrow or contain inaccuracies: o May have a limited ability to filter, prioritize, and make connections between sources of pertinent information. o May struggle to continuously update a differential diagnosis. o May make errors in clinical reasoning, such as premature closure. o May recommend a broad range of diagnostic evaluations that are not tailored to the prioritized differential diagnosis. May rely too much on supervisors and other team members in creating a differential diagnosis and selecting a working diagnosis. Offers management plans that may miss confirmation or disconfirmation of important diagnoses. May develop a management plan without required endorsement or verification. Has little insight into limitations and may over- or underestimate their own abilities. May not be comfortable with ambiguity. May not completely document reasoning so that other team members can understand what led to their assessment.

Expected behaviors for an entrustable learner • • • • • • • •

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Can link current findings to prior data in approaching a patient assessment. Gathers pertinent information from many sources and proposes a relevant differential diagnosis that is neither too broad nor too narrow. Can usually integrate current and emerging information to continuously update the differential diagnosis. Understands limits of knowledge and personal strengths and weaknesses. Understands when to consult supervisors and team members for endorsement and verification of a working diagnosis and for developing a tailored management plan. Can usually articulate a management plan based on the well-reasoned differential and working diagnoses. Has insight into limitations and is comfortable with ambiguity. o Can respond to questions and challenges from patients and team members. o Is comfortable seeking assistance from other members of the health care team. Provides complete and succinct documentation so that other providers have evidence of their clinical reasoning to ensure continuity of care.

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EPA 3 Bulleted List: Recommend and interpret common diagnostic and screening tests Expected behaviors for a pre-entrustable learner • • • • • • • • • • •

Recommends standard templates or order sets for patient evaluation but may not be able to explain the role of each study in screening, diagnosis, management, or follow-up. Identifies key diagnostic tests for some, but not all, common acute and chronic conditions. Frequently recommends unnecessary tests or tests with minimal or no pre-test probability for patients with common acute or chronic conditions. Has difficulty articulating how the test results will affect diagnosis, management, or risk stratification. Understands concepts of sensitivity and specificity, but diagnostic test recommendations do not consistently take these into account. Has difficulty integrating pre-test and post-test probabilities with patient risk factors in recommending screening and/or diagnostic evaluations. May repeat diagnostic or screening tests at intervals that are too frequent or too lengthy. Describes diagnostic plan to the patient but without soliciting or taking into account patient preferences in making recommendations. Infrequently includes consideration of costs or patient resources in the rationale for diagnostic evaluation recommendations. Fails to identify or respond to all critical values. May misinterpret common lab values and overreact to normal or readily explainable variations, fail to recognize important abnormalities, or fail to recognize inappropriately normal findings.

Expected behaviors for an entrustable learner • • • • • • • •

Recommends reliable, cost-effective tests when indicated for screening or evaluating patients with common acute or chronic conditions. Is able to explain how the results of each test will influence diagnosis, management, and health-risk stratification and subsequent evaluation. Incorporates knowledge of sensitivity and specificity and pre-test and post-test probabilities along with patient risk factors in recommending tests. Consistently discusses diagnostic plans with the patient, and provides evidence that patient preferences have been solicited and factored into decision making. Includes in the rationale for recommendations some consideration of costs and patient resources. Correctly interprets abnormal laboratory and imaging findings for common tests. Identifies critical values and responds correctly and with commensurate urgency by (a) initiating confirmatory or corrective measures or (b) notifying the health care team for assistance in recognition of his or her own limitations. Is able to distinguish common, insignificant abnormalities from clinically important abnormalities.

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EPA 4 Bulleted List: Enter and discuss orders and prescriptions Expected behaviors for a pre-entrustable learner • • • • • • • • • • • • • • • •

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Is unable to filter and synthesize information to inform an understanding of a patient’s condition that enables prioritization of correct diagnostics and orders. Focuses on one’s own desire for information, sometimes ignoring patient preferences as a result (e.g., orders a CT scan when an ultrasound might have sufficed despite patients’ expressed concern to avoid radiation). May focus on a single abnormality at the expense of putting all of the pieces together; has a “shotgun” approach to ordering tests. Misses subtle signs and/or physical exam findings that should guide orders. Understands general order sets but does not recognize when the need arises to tailor or deviate from the standard order set. Does not consider either cost of orders (e.g., tests, drugs/prescriptions) or patient factors (e.g., culture) in maximizing compliance. Views cost-containment efforts as externally mandated and interfering with the doctor-patient relationship. Is defensive when questioned about orders and is unable to articulate the rationale behind them (they don’t know what they don’t know). May demonstrate overconfidence by not seeking review of orders even when their experience is limited. Acts impulsively in placing orders rather than pausing to consider the big picture and waiting for cause and effect to play out from earlier orders. Feels compelled to act. Places orders without communicating with the rest of team, patient, and family regarding plans; communication style is unidirectional (“Here is what we are doing…”). Does not involve patient as integral member of team in shared decision making. Does not understand the system; may ignore alerts; may not be able to navigate system or may know the mechanics of the system but not how to apply them (e.g., can find an order set but is unsure what order set is ideal or needed). Does not follow established protocols for placing and carrying out orders within a given system. Has not developed the habits of safe prescription writing, including doing a double check of patient weight, age, renal function, co-morbidities, dose, and/or interval. May rely excessively on technology to highlight drug-drug interactions and/or risks without understanding why there is an interaction (e.g., smartphone or EHR suggests an interaction, but the learner cannot explain why).

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Expected behaviors for an entrustable learner • • • • • • • • • • • • • •

Is able to filter and synthesize information (e.g., history, signs, symptoms) to identify or clarify the condition(s) they are addressing with their orders/prescriptions. Recognizes patterns and takes into account the “big picture” when ordering diagnostics and/or therapeutics. Considers patient’s preferences in placing orders. Communicates recommendations to patients, families, and the health care team. Recognizes limitations and seeks help in a manner that places the needs of patients above one’s own sense of autonomy. Demonstrates flexibility in thinking; accepts questions as learning opportunities and considers other possibilities. Has a parsimonious, reasoned approach to placing orders (e.g., waits for contingent results before ordering more tests). Routinely reflects on how the results of a test will influence clinical decision making and, conversely, on the potential consequences of not doing a test. Articulates the risks and benefits of what they are ordering (e.g., drugs, tests). Considers the costs of their orders and the patient’s ability and willingness to proceed with the plan. Can adapt plan based on the patient’s unique demographic, cognitive, physical, cultural, socioeconomic, or situational needs. Engages in bidirectional communication with patients, their families, and members of the health care team. Uses treatment guidelines and algorithms consistently but recognizes or asks for help when the patient’s condition requires deviation from them. Responds to the EHR’s safety alerts and understands the rationale for them. Uses electronic resources to fill in gaps in knowledge and inform safe order writing and entry (e.g., drug-drug interactions, treatment guidelines).

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EPA 5 Bulleted List: Document a clinical encounter in the patient record Expected behaviors for a pre-entrustable learner • • • • • • • • • •

Communicates and documents using a template with limited ability to adjust or adapt based on audience, context, or purpose. Makes errors of omission and/or commission when documenting and may not document the use of primary or secondary sources important to the encounter. May miss some required elements of written documentation, such as date, time, signature, or other institutionally required elements. May create handwritten documentation that is difficult to read. Demonstrates difficulty meeting needed turnaround time for documentation, limiting its availability to other team members engaged in a patient’s care. Communicates in a unidirectional manner without actively soliciting or recording patient preferences. Does not typically document clinical reasoning in notes, and interpretation of laboratory values may be literal or inaccurate. Demonstrates limited help-seeking behavior to fill gaps in knowledge, skill, and experience, resulting in the learner relying on directives from others to manage patients’ care. Demonstrates frustration with documentation systems (e.g., the EHR) due to a superficial understanding of systems rather than seeing opportunities to engage in system improvement. Is in early stages of identity formation as a physician, which lead to a more passive role in care activities.

Expected behaviors for an entrustable learner • • • • • • • • • •

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Adjusts and adapts communication and documentation to audience, context, or purpose. Provides documentation that is comprehensive and contains important information without unnecessary details or redundancies. Provides documentation that includes institutionally required elements (e.g., date, time, and signature). Creates legible handwritten documentation. Enters documentation in a timely manner to make it readily available to other team members. Communicates in a bidirectional manner, allowing solicitation of patient preferences, which are recorded in the note. Documents clinical reasoning in notes, and interpretation of laboratory values is typically accurate. Engages in help-seeking behavior to fill gaps in knowledge, skill, and experience, enabling the development and documentation of management plans aligned with the patient’s needs. Demonstrates a general understanding of documentation systems that leads to the identification of opportunities to engage with others in system improvement. Documents one’s role(s) in all team care activities in the patient record.

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EPA 6 Bulleted List: Provide an oral presentation of a clinical encounter Expected behaviors for a pre-entrustable learner • • • • • •

• • • • • • • • •

Tends toward unidirectional communication so may ignore the patient/family while presenting. Often fails to verify the information being presented and/or to obtain additional information from patient, family, and other team members. Avoids obtaining sensitive information from the history and does not follow up on ambiguous information. Uses medical jargon and acronyms without clarifying meaning or ensuring a shared understanding. Does not distill the presentation or focus on the most relevant information (e.g., last sentence of all presentations of the history of present illness (HPI) is “Patient denies fevers, night sweats, and chills,” regardless of presenting signs or symptoms). Uses a template rigidly for all presentations without adapting to context of patient care or receiver of information (e.g., failing to tailor the presentation of an urgent or emergent patient issue to a briefer format with only immediately relevant information or adjusting communication style for a patient’s family member as opposed to the health care team). Does not generally match the needs of the communication to the tool of communication (e.g., in person, phone, email). May present in a disorganized and incoherent fashion. Does not generally adjust presentation based on real-time verbal and nonverbal feedback from listener (e.g., a quizzical look suggesting a lack of understanding on the part of the receiver of the information). Does not ensure a shared understanding between the presenter and receiver of information at the conclusion of the presentation. May confabulate information to respond to questions the learner is unable to answer. Lacks situational awareness when discussing patients and presenting sensitive patient information (e.g., presenting in an elevator or in a loud voice in a public place). Presents information without personally verifying or acknowledging the source. Takes all information in the chart at face value, reporting it back sometimes without fully understanding and without questioning inconsistencies. Demonstrates either a lack of confidence or more confidence than merited by capabilities. At times reacts defensively when interrupted during case presentation (e.g., stating, “I’m going to get to that in a minute,” when questioned midway during a presentation).

Expected behaviors for an entrustable learner • • • • • • • • • • • •

Can filter, synthesize, and prioritize information and recognize patterns, resulting in a concise, well organized, and accurate presentation. Engages in bidirectional communication that ensures a shared understanding of a presentation. Avoids medical jargon. Adjusts the presentation for the receiver of information (e.g., faculty, patient/family, team members) and for the context of the presentation (e.g., emergent versus ambulatory). Actively engages patient, family, and other team members in the presentation. Does not shy away from difficult or stressful issues in obtaining or presenting the information. Can efficiently tell a story and make an argument to support the plan. Acknowledges gaps in knowledge base and/or skills in managing a given patient presentation or condition and seeks help. Reflects on areas of uncertainty and seeks additional information. Acknowledges gaps in information without becoming defensive or confabulating information. Respects patient privacy and confidentiality by demonstrating situational awareness when discussing patients. Demonstrates a level of confidence commensurate with knowledge and skills that puts others at ease (e.g., less certain in emergent settings and more comfortable in an ambulatory setting).

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EPA 7 Bulleted List: Form clinical questions and retrieve evidence to advance patient care Expected behaviors for a pre-entrustable learner • • •

Asks relevant clinical questions: o Has more-limited experience, which results in linear, less complex thinking in terms of analytical skills. o Focuses on individual patients, which may result in missing important information or trends in populations or panels of patients. o May jump to conclusions without probing first (that is, shortcut the scientific method). o Lacks awareness of limitations and gaps in own scientific knowledge (that is, biophysical, clinical, epidemiological, social-behavioral) and how to get help to improve. o Lacks experience, which results in limited ability to develop clinical mental models and thus limits ability to form appropriate questions and solve them. o Demonstrates low activation of prior knowledge, either because they lack it or they do not use it to their advantage in problem solving. Retrieves and assesses evidence: o Is unable to manage the volume of possible evidence for review due to lack of focus in question or inability to match evidence to type of question. o Has limited ability to judge quality of evidence, applicability, and/or generalizability. o Is unable to identify gaps/limitations in literature, and is unable or unwilling to think about ways to close gaps. o Accepts findings of studies without critical appraisal. o Is unfamiliar with or unwilling to use new information/informatics technologies. Reports or applies evidence to effect change or improvement: o Does not attempt to apply evidence to one’s patients. o Does not discuss findings with team or patient.

Expected behaviors for an entrustable learner • • • • •

53

Routinely identifies the need to ask for help or seek new information in the context of the clinical setting, based on awareness of one’s own knowledge gaps and patient needs. Maintains a sufficient biophysical, clinical, epidemiological, and social-behavioral scientific knowledge base that can be translated to patient care activities. Asks relevant clinical questions: o Develops well-formed, focused, pertinent clinical question based on clinical scenarios, real-time care of a patient or a panel of patients. o Demonstrates curiosity, objectivity, scientific reasoning. o Is able to focus cognitive processes on discerning relevant factors, identifying the unknowns, and developing knowledge for generating a solution via just-in-time-learning. Retrieves and assesses evidence: o Demonstrates awareness and early skill in appraisal of sources and content of medical information. o Uses info technology to gather and assess information. o Acquires a manageable volume of information. o Assesses applicability/generalizability of the information. Reports or applies evidence to effect change or improvement: o Applies findings by communicating with team and with patient, and changes approach to patient care if necessary. o Reflects on the process by which questions are identified and answered and seeks to improve (may need guidance in understanding subtleties of the evidence).

Association of American Medical Colleges


Core Entrustable Professional Activities for Entering Residency

EPA 8 Bulleted List: Give or receive a patient handover to transition care responsibility Note: this list applies to both the giver and receiver of information. Expected behaviors for a pre-entrustable learner • • • • • • • •

Uses rigid rules of communication (e.g., a handover template) but cannot adjust based on the audience and/ or context. Documents patient information in written or electronic handover tools incompletely with errors of both omission and commission. Demonstrates variability in transfer of information regarding content, accuracy, efficiency, and synthesis. May miss key aspects of the ideal handover, including verbalizing the patient’s illness severity and/or providing action planning and/or contingency planning. Demonstrates minimal situation awareness of the team’s total work load or of the circumstances of the individual to whom one is transferring care. Is unable to organize, prioritize, and anticipate patient care needs consistently. Demonstrates minimal awareness of known threats to handover communication (e.g., interruptions and distractions). Focuses on one’s own handover responsibilities with minimal awareness of the workload and concurrent responsibilities of the remainder of the team.

Expected behaviors for an entrustable learner • • • • • • •

Uses a template for the handover communication but can adapt based on patient, audience, setting, or context, including patient disabilities or language barriers. Generally documents patient information without errors of omission and/or commission. Consistently transfers information regarding content, accuracy, efficiency, and synthesis. Organizes and prioritizes information for handover communications. Provides key aspects of the ideal handover to the recipient, including verbalizing the patient’s illness severity and/or providing action planning and/or contingency planning. Demonstrates situation awareness of both the team’s total work load and the circumstances of the individual to whom one is transferring care. Demonstrates awareness of known threats to handover communication (e.g., interruptions and distractions) by paying attention to the timing and location of the handover communication.

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Core Entrustable Professional Activities for Entering Residency

EPA 9 Bulleted List: Collaborate as a member of an interprofessional team Expected behaviors for a pre-entrustable learner • • • • • • • •

Prioritizes one’s own goals over those of the team. Demonstrates limited understanding of the roles of other team members besides physicians (e.g., seeks counsel from the other physicians to the exclusion of other team members). Typically communicates in a unidirectional manner and in response to a prompt. Displays limited ability to modify communication based on audience, venue, receiver preference, or type of message. Demonstrates difficulty reading one’s own emotions and struggles to anticipate or read the emotions of others. Succumbs to lapses in professionalism particularly when stressed or tired. Is typically a more passive member of the team. Has limited interaction with other team members, with the unintended consequence of not being able to optimally support patients through transitions of care.

Expected behaviors for an entrustable learner • • • • • • •

55

Acts as an active and integrated member of the team who in most situations prioritizes team goals over one’s own professional goals. Understands the roles of other team members, seeks their counsel, actively listens to their recommendations, and incorporates them into practice. Typically communicates in a bidirectional manner and keeps all team members informed and up to date. Modifies and adapts communication content and style based on audience, venue, receiver preference, or type of message. In most situations, is able to read one’s own emotions and anticipates and reads the emotions of others. Maintains a professional demeanor in all but the most trying of circumstances. Actively engages with the patient and other team members to coordinate care and provide for seamless transitions between care providers and from one setting to another.

Association of American Medical Colleges


Core Entrustable Professional Activities for Entering Residency

EPA 10 Bulleted List: Recognize a patient requiring urgent or emergent care and initiate evaluation and management Expected behaviors for a pre-entrustable learner • • • • • • • • • • • •

Does not recognize age appropriateness of trends in and variations of patients’ vital signs. May dismiss concerns of patient deterioration by team members (e.g., nurses, families). Is easily distracted by multiple problems and has difficulty prioritizing for efficient patient care. Does not demonstrate an understanding of the roles and responsibilities of each member of the health care team. Demonstrates limited ability to gather, filter, prioritize, and connect pieces of information (e.g., vital signs, focused physical exam, pertinent medical history, recent test or procedures, medications) to form a patientspecific differential diagnosis, initiate interventions, and drive testing decisions. Requires supervisors and/or other members of the team to initiate correct interventions and testing in an urgent or emergent setting. Inconsistently orders and interprets test results delaying reassessment and further testing or interventions. Delays seeking help due to pride, anxiety, fear, and/or an inadequate awareness of personal limitations. Provides unidirectional communication with health care team and family regarding goals of care and treatment plan. Provides superfluous and/or incomplete patient information to responding members of the health care team. Demonstrates errors of omission when documenting the clinical encounter in the medical record. May become defensive and/or argumentative during debriefing sessions of the clinical encounter.

Expected behaviors for an entrustable learner • • • • • • • • • • • •

Recognizes age appropriateness of, trends in, and variations of patients’ vital signs. Actively listens to and elicits feedback from team members (e.g., nursing, family members) regarding concerns about patient deterioration to determine next steps. Adheres to institutional procedures and protocols regarding escalation of patient care. Uses the health care team members according to their roles and responsibilities to increase task efficiency in dealing with urgent or emergent patient conditions. Gathers, filters, prioritizes, and connects pieces of information (e.g., vital signs, focused physical exam, pertinent medical history, recent test or procedures, medications) to form a patient-specific differential diagnosis, initiate interventions, and drive testing decisions. Initiates interventions and tests with frequent reassessment to determine level of help needed and to anticipate next steps. Interprets common test results to anticipate and respond to early clinical deterioration. Understands and recognizes personal limitations, emotions, and personal biases and seeks help when needed. Demonstrates bidirectional communication with health care team and family regarding goals of care and treatment plan that leads to shared decision making. Provides a focused and concise presentation of accurate patient information to responding members of the health care team. Completes documentation in the medical record of the clinical encounter. Seeks guidance and feedback from supervisors after the clinical encounter.

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Core Entrustable Professional Activities for Entering Residency

EPA 11 Bulleted List: Obtain informed consent for tests and/or procedures Expected behaviors for a pre-entrustable learner • • • • • • • • • •

May be complacent in the informed consent process due to a lack of understanding of its importance in shared decision making. Obtains informed consent only on the directive of others. Does not demonstrate an understanding of the key elements of informed consent (indications, contraindications, risks, benefits, alternatives) or may know the elements but not the specifics for the procedure for which consent is being sought. May let personal biases interfere with the informed consent process (e.g., history of bad experience with the procedure results in overemphasis of risks). May make errors of omission in communicating with patients and families about consent. Uses medical jargon frequently in conversations with patients and families. Uses unidirectional communication strategies―that is, provides information and then requests signature on consent form. Does not solicit patient preferences. Is unable to read emotional cues in others. Provides documentation with errors of both commission and omission.

Expected behaviors for an entrustable learner • • • • • • • • • •

57

Understands the importance of informed consent to rapport building and shared decision making. Demonstrates an understanding of the elements of informed consent generally (indications, contraindications, risks, benefits, alternatives) and the specifics of these elements for the procedures for which consent is being sought. Provides complete information to patients and families. Avoids medical jargon in communicating with patients and families. Uses bidirectional communication to both inform patients and families and seek their input and questions. Solicits patient/family preferences to engage them in shared decision making. Recognizes emotional cues in others (e.g., fear, anger, anxiety) and can address them in real time or seek help from others on the health care team. Demonstrates confidence commensurate with skills. Seeks guidance from superiors around areas of uncertainty. Documents the informed consent in a complete and timely fashion.

Association of American Medical Colleges


Core Entrustable Professional Activities for Entering Residency

EPA 12 Bulleted List: Perform general procedures of a physician Expected behaviors for a pre-entrustable learner • • • • • • •

Approaches procedures as mechanical tasks to be performed and often initiated at the request of others. May not understand key issues in performing procedures, such as: o Patient-specific factors o Indications o Contraindications o Risks o Benefits o Alternatives Demonstrates limited knowledge of complications of procedures or how to minimize them. Has inconsistent mechanical skills and may not be able to reliably complete the procedure. Does not consistently demonstrate patient-centered skills in performing procedures: o Uses medical jargon or other examples of ineffective communication techniques. o May be unable to read emotional response from the patient during the procedure because of focus on the task. o Does not engage patients in shared decision making about the procedure. o Demonstrates a lack of confidence that results in an increase in patient’s stress or discomfort or overconfidence that erodes trust with the patient if the learner struggles with the procedure. Uses universal precautions and aseptic technique inconsistently. Incompletely writes or enters required documentation or neglects to write or enter required documentation in the patient’s health record.

Expected behaviors for an entrustable learner • • • • • • •

Demonstrates the necessary preparation required for performance of procedures. Demonstrates and applies understanding of key issues in performing procedures, such as: o Patient-specific factors o Indications o Contraindications o Risks o Benefits o Alternatives Knows and takes steps to mitigate complications of procedures. Demonstrates reliable mechanical skills in performing procedures in most situations and knows when to seek help for procedures or situations beyond the learner’s abilities. Uses universal precautions and aseptic technique consistently. Demonstrates patient-centered skills in performing procedures: o Avoids medical jargon such that patients are able to verbalize understanding of the procedure. o Participates in shared decision making with patients about procedures. o Has confidence commensurate with level of knowledge and skill that puts patients at ease. o Simultaneously pays attention to both the procedure and the patient’s emotional response. Creates required documentation that is usually complete and timely.

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Core Entrustable Professional Activities for Entering Residency

EPA 13 Bulleted List: Identify system failures and contribute to a culture of safety and improvement Expected behaviors for a pre-entrustable learner • • • • • • • • • •

Does not recognize potential errors and often misses real errors. Is inconsistent in demonstrating common safety behaviors (e.g., universal precautions, hand washing). May get frustrated by system requirements and see them as a burden. Tends to be passive observer on the team. Requires others to point out systems failures. May become defensive or blame the system when faced with an error. Does not recognize generalizability of lessons from understanding errors. Participates in system improvements only when externally prompted to do so. Uses rigid and rules-based communication that prevents “speaking up,” especially when a superior is involved in an error or potential error. Does not recognize one’s own fatigue or is afraid to tell superiors when fatigued.

Expected behaviors for an entrustable learner • • • • • • • • • •

59

Identifies real and potential errors. Performs common safety behaviors (e.g., universal precautions, hand washing). Understands the importance of error prevention both to individual patients and to systems. Takes responsibility for one’s role in errors. Takes time to “slow down” and reflect on one’s work. Still relies on external sources of information to understand one’s population of patients. Reports real and/or potential errors when they occur using the system reporting structure. Participates in improvement activities voluntarily. Speaks up when concerned about a potential error, even if that means questioning or challenging a supervisor. Recognizes one’s own symptoms of fatigue and moderates behavior or seeks help.

Association of American Medical Colleges


Core Entrustable Professional Activities for Entering Residency

References 1. Okusanya OT, Kornfield ZN, Reinke CE, et al. The Effect and Durability of a Pregraduation Boot Camp on the Confidence of Senior Medical Student Entering Surgical Residencies. Journal of Surgical Education. 2012;69(4):536-543. 2. Naylor RA, Hollett LA, Castellvi A, Valentine RJ, Scott DJ. Preparing medical students to enter surgery residencies. American Journal of Surgery. 2010;199(1):105-109. 3. Lyss-Lerman P, Teherani A, Aagaard E, Loeser H, Cooke M, Harper GM. What Training Is Needed in the Fourth Year of Medical School? Views of Residency Program Directors. Academic Medicine. 2009;84(7). 4. Association of American Medical Colleges (AAMC). Recommendations for Clinical Skills Curricula for Undergraduate Medical Education. 2005; https://members.aamc.org/eweb/upload/Recommendations%20 for%20Clinical%20Skills%20Curricula%202005.pdf. 5. The Association of Faculties of Medicine of Canada (AFMC). The Future of Medical Education in Canada (FMEC): A Collective Vision for MD Education. 2012. http://www.afmc.ca/future-of-medical-education-incanada/medical-doctor-project/pdf/collective_vision.pdf. 6. Accreditation Council for Graduate Medical Education (ACGME). Milestones. 2013; http://www.acgme.org/acgmeweb/tabid/430/ProgramandInstitutionalAccreditation/NextAccreditationSystem/ Milestones.aspx. Accessed November 25, 2013. 7. Raymond MR, Mee J, King A, Haist SA, Winward ML. What New Residents Do During Their Initial Months of Training. Academic Medicine. 2011;86(10):S60-S63. 8. Langdale LA, Schaad D, Wipf J, Marshall S, Vontver L, Scott CS. Preparing graduates for the first year of residency: Are medical schools meeting the need? Academic Medicine. 2003;78(1). 9. Young JQ, Ranji SR, Wachter RM, Lee CM, Niehaus B, Auerbach AD. “July Effect�: Impact of the Academic Year-End Changeover on Patient Outcomes A Systematic Review. Annals of Internal Medicine. 2011;155(5). 10. Englander R, Cameron T, Ballard AJ, Dodge J, Bull J, Aschenbrener CA. Toward a Common Taxonomy of Competency Domains for the Health Professions and Competencies for Physicians. Academic Medicine. 2013;88(8):1088-1094. 11. Frank JR, Snell LS, Ten Cate O, et al. Competency-based medical education: theory to practice. Medical Teacher. 2010;32(8):638-645. 12. Ten Cate O. Nuts and bolts of entrustable professional activities. J Grad Med Educ. 2013;5(1):157-158. 13. Ten Cate O. Entrustability of professional activities and competency-based training. Medical Education. 2005;39(12):1176-1177. 14. Hall Render. The Lexicon of Supervision: CMS Versus ACGME Defined Terms. 2011. http://www.hallrender.com/library/articles/862/070511HLN.html. Accessed October 17, 2013. 15. Van der Vleuten CPM, Schuwirth LWT. Assessing professional competence: from methods to programmes. Medical Education. 2005;39:309-317. 16. Kennedy TJT, Regehr G, Baker GR, Lingard L. Point-of-Care Assessment of Medical Trainee Competence for Independent Clinical Work. Academic Medicine. 2008;83(10):S89-S92.

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17. Ten Cate O, Scheele F. Viewpoint: Competency-based postgraduate training: Can we bridge the gap between theory and clinical practice? Academic Medicine. 2007;82(6):542-547. 18. Pediatrics Milestone Working Group. The Pediatrics Milestone Project. 2012. http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramResources/320_PedsMilestonesProject.pdf. Accessed December 6, 2012. 19. The Americian Board of Surgery. The General Surgery Milestone Project. 2013; http://www.acgme.org/acgmeweb/Portals/0/PDFs/Milestones/SurgeryMilestones.pdf. 20. The American Board of Emergency Medicine. The Emergency Medicine Milestone Project. 2013; https://www.acgme.org/acgmeweb/Portals/0/PDFs/Milestones/EmergencyMedicineMilestones.pdf. 21. The American Board of Internal Medicine. The Internal Medicine Milestone Project. 2013; http://www.acgme.org/acgmeweb/Portals/0/PDFs/Milestones/InternalMedicineMilestones.pdf. 22. The American Board of Psychiatry and Neurology. The Psychiatry Milestone Project. 2013; https://www.acgme.org/acgmeweb/Portals/0/PDFs/Milestones/PsychiatryMilestones.pdf. 23. Interprofessional Education Collaborative Expert Panel. Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C. 2011. 24. Regehr G, Regehr C, Bogo M, Power R. Can we build a better mousetrap? Improving the measures of practice performance in the field practicum. Journal of Social Work Education. 2007;43(2):327-343. 25. Institute of Medicine (IOM). To err is human: Building a safer health system. Washington, D.C.: National Academy Press; 2000. 26. Institute of Medicine (IOM). Crossing the quality chasm. Washington, D.C.: National Academy Press; 2001.

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Physician Competencies Reference Set (PCRS)* - FINAL, July 2013

No. 1. 1.1 1.2

1.3 1.4 1.5

1.6 1.7 1.8

1.9 1.10 1.11 1.99 2.

2.1 2.2 2.3

2.4

2.5

2.6 2.99

Domain/Competency Text Patient Care: Provide patient-centered care that is compassionate, appropriate, and effective for the treatment of health problems and the Perform all medical, diagnostic, and surgical procedures considered Gather essential and accurate information about patients and their conditions through history-taking, physical examination, and the use of laboratory data, imaging, and other tests Organize and prioritize responsibilities to provide care that is safe, effective, and efficient Interpret laboratory data, imaging studies, and other tests required for the area of practice Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment Develop and carry out patient management plans Counsel and educate patients and their families to empower them to participate in their care and enable shared decision making Provide appropriate referral of patients including ensuring continuity of care throughout transitions between providers or settings, and following up on patient progress and outcomes Provide health care services to patients, families, and communities aimed at preventing health problems or maintaining health Provide appropriate role modeling Perform supervisory responsibilities commensurate with one's roles, abilities, and qualifications Other patient care Knowledge for Practice: Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care Demonstrate an investigatory and analytic approach to clinical situations Apply established and emerging bio-physical scientific principles fundamental to health care for patients and populations Apply established and emerging principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based health care Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resources, and disease prevention/health promotion efforts for patients and populations Apply principles of social-behavioral sciences to provision of patient care, including assessment of the impact of psychosocial and cultural influences on health, disease, care-seeking, care compliance, and barriers to and attitudes toward care Contribute to the creation, dissemination, application, and translation of new health care knowledge and practices Other knowledge for practice

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aamc-pcrs-comp-c0103 aamc-pcrs-comp-c0104 aamc-pcrs-comp-c0105

aamc-pcrs-comp-c0106 aamc-pcrs-comp-c0107 aamc-pcrs-comp-c0108

aamc-pcrs-comp-c0109 aamc-pcrs-comp-c0110 aamc-pcrs-comp-c0111 aamc-pcrs-comp-c0199 aamc-pcrs-comp-c0200

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aamc-pcrs-comp-c0205

aamc-pcrs-comp-c0206 aamc-pcrs-comp-c0299

 *Source: Englander R, Cameron T, Ballard AJ, Dodge J, Bull J, and Aschenbrener CA. Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Acad Med. 2013;88:1088-1094.


Physician Competencies Reference Set (PCRS)* - FINAL, July 2013

No. 3.

3.1

partial_uri (For Developer Use) Domain/Competency Text aamc-pcrs-comp-c0300 Practice-Based Learning and Improvement: Demonstrate the ability to investigate and evaluate one’s care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning Identify strengths, deficiencies, and limits in one's knowledge and expertise aamc-pcrs-comp-c0301

3.2 3.3

Set learning and improvement goals Identify and perform learning activities that address one's gaps in knowledge, skills, and/or attitudes 3.4 Systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement 3.5 Incorporate feedback into daily practice 3.6 Locate, appraise, and assimilate evidence from scientific studies related to 3.7 Use information technology to optimize learning 3.8 Participate in the education of patients, families, students, trainees, peers and other health professionals 3.9 Obtain and utilize information about individual patients, populations of patients, or communities from which patients are drawn to improve care 3.10 Continually identify, analyze, and implement new knowledge, guidelines, standards, technologies, products, or services that have been demonstrated to improve outcomes 3.99 Other practice-based learning and improvement Interpersonal and Communication Skills: Demonstrate interpersonal and 4. communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals 4.1 Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds 4.2 Communicate effectively with colleagues within one's profession or specialty, other health professionals, and health related agencies (see also 7.3) 4.3 Work effectively with others as a member or leader of a health care team or other professional group (see also 7.4) 4.4 Act in a consultative role to other health professionals 4.5 Maintain comprehensive, timely, and legible medical records 4.6 Demonstrate sensitivity, honesty, and compassion in difficult conversations, including those about death, end of life, adverse events, bad news, disclosure of errors, and other sensitive topics 4.7 Demonstrate insight and understanding about emotions and human responses to emotions that allow one to develop and manage interpersonal Other interpersonal and communication skills Professionalism: Demonstrate a commitment to carrying out professional 5. responsibilities and an adherence to ethical principles 5.1 Demonstrate compassion, integrity, and respect for others 5.2 Demonstrate responsiveness to patient needs that supersedes self-interest 5.3

Demonstrate respect for patient privacy and autonomy

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aamc-pcrs-comp-c0403 aamc-pcrs-comp-c0404 aamc-pcrs-comp-c0405 aamc-pcrs-comp-c0406

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*Source: Englander R, Cameron T, Ballard AJ, Dodge J, Bull J, and Aschenbrener CA. Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Acad Med. 2013;88:1088-1094.


Physician Competencies Reference Set (PCRS)* - FINAL, July 2013

No. 5.4 5.5

5.6

Domain/Competency Text Demonstrate accountability to patients, society, and the profession Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation Demonstrate a commitment to ethical principles pertaining to provision or withholding of care, confidentiality, informed consent, and business practices, including compliance with relevant laws, policies, and regulations

5.99 Other professionalism Systems-Based Practice: Demonstrate an awareness of and 6. responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care 6.1 Work effectively in various health care delivery settings and systems relevant to one's clinical specialty 6.2 Coordinate patient care within the health care system relevant to one's clinical specialty 6.3 Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care 6.4 Advocate for quality patient care and optimal patient care systems 6.5 Participate in identifying system errors and implementing potential systems solutions 6.6 Perform administrative and practice management responsibilities commensurate with one’s role, abilities, and qualifications 6.99 Other systems-based practice Interprofessional Collaboration: Demonstrate the ability to engage in an 7. interprofessional team in a manner that optimizes safe, effective patientand population-centered care 7.1 Work with other health professionals to establish and maintain a climate of mutual respect, dignity, diversity, ethical integrity, and trust 7.2 Use the knowledge of one’s own role and the roles of other health professionals to appropriately assess and address the health care needs of the patients and populations served 7.3 Communicate with other health professionals in a responsive and responsible manner that supports the maintenance of health and the 7.4 Participate in different team roles to establish, develop, and continuously enhance interprofessional teams to provide patient- and populationcentered care that is safe, timely, efficient, effective, and equitable 7.99 Other interprofessional collaboration Personal and Professional Development: Demonstrate the qualities 8. required to sustain lifelong personal and professional growth 8.1 Develop the ability to use self-awareness of knowledge, skills, and emotional limitations to engage in appropriate help-seeking behaviors 8.2 Demonstrate healthy coping mechanisms to respond to stress 8.3 Manage conflict between personal and professional responsibilities 8.4 Practice flexibility and maturity in adjusting to change with the capacity to alter one's behavior

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aamc-pcrs-comp-c0601 aamc-pcrs-comp-c0602 aamc-pcrs-comp-c0603 aamc-pcrs-comp-c0604 aamc-pcrs-comp-c0605 aamc-pcrs-comp-c0606 aamc-pcrs-comp-c0699 aamc-pcrs-comp-c0700

aamc-pcrs-comp-c0701 aamc-pcrs-comp-c0702

aamc-pcrs-comp-c0703 aamc-pcrs-comp-c0704

aamc-pcrs-comp-c0799 aamc-pcrs-comp-c0800 aamc-pcrs-comp-c0801 aamc-pcrs-comp-c0802 aamc-pcrs-comp-c0803 aamc-pcrs-comp-c0804

*Source: Englander R, Cameron T, Ballard AJ, Dodge J, Bull J, and Aschenbrener CA. Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Acad Med. 2013;88:1088-1094.


Physician Competencies Reference Set (PCRS)* - FINAL, July 2013

No. 8.5

Domain/Competency Text Demonstrate trustworthiness that makes colleagues feel secure when one is responsible for the care of patients 8.6 Provide leadership skills that enhance team functioning, the learning environment, and/or the health care delivery system 8.7 Demonstrate self-confidence that puts patients, families, and members of the health care team at ease 8.8 Recognize that ambiguity is part of clinical health care and respond by utilizing appropriate resources in dealing with uncertainty 8.99 Other personal and professional development

partial_uri (For Developer Use) aamc-pcrs-comp-c0805 aamc-pcrs-comp-c0806 aamc-pcrs-comp-c0807 aamc-pcrs-comp-c0808 aamc-pcrs-comp-c0899

*Source: Englander R, Cameron T, Ballard AJ, Dodge J, Bull J, and Aschenbrener CA. Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Acad Med. 2013;88:1088-1094.


10/31/2016

LCME Standards Addressed Through This Data • Standard 6

[Course Name] [Course Director’s Name]

– – – –

Dissemination of learning objectives Clinical experience monitoring Active and lifelong learning Inpatient/outpatient experiences

• Standard 8 – – – – –

Program evaluation Use of student evaluation data in program improvement Monitoring of required experiences Comparability across sites Duty hours monitoring

1


10/31/2016

Outcomes [In this box list the learning outcomes identified for your course]

[Name] Course Overview [In this box list describe your course. What will students learn from this course? How does it fit into the larger CINCYMedEd Curriculum?]

2


10/31/2016

Required

[Name] Course Orientation • Orientation

Encounters

Procedures

• In this box list the encounters each student is required to participate in your Course

• In this box list the procedures each student is required to complete in your Course

3


10/31/2016

Self-Directed Student Educational Opportunities [List and briefly any learner-center educational opportunities unique to your Course here. Including and opportunities for students to: 1.Identify/analyze and synthesize information relevant to their learning needs 2.Assess credibility information sources 3.Share the information with peers and supervisors 4.Receiving feedback on their information-seeking skills.]

Instructional Methods [In this box, list and briefly describe the teaching methods used in your Course (i.e. didactics, small groups, clinical cases etc]

4


10/31/2016

Clinical Skills Lab [In this box identify any Clinical Skills Labs each student is required to participate in your Course]

Grades [Provide an overview of the final grade distribution in your course. Include any graphical representation (e.g. Histogram) and statistics (e.g. mean, median, and Standard deviation) you feel would best illustrate student performance and learning]

5


10/31/2016

Course Assessments [In this box described the assessment tools included in your course. What skills/knowledge do they evaluate?] Assessment

N

AVG

SD

Non-grade/Evaluated Assignments? Assignment

Is Feedback Provided?

Skills/Knowledge Evaluated?

Description

6


10/31/2016

Student Course Evaluation

Future Directions/Continuous Improvement

• [Likert items- how did our students rate their experience in the following categories? Include a summary of each as well as any items that stood out as being rated exceptionally high or low] – [Organization and communication] – [Learning environment] – [Interprofessional Experience] • [Trends in open ended data?- based on the open ended comments, were there any common experiences or opinions that stood out to you? Why? What proportion of the student responses do these trends represent?]

• Areas strength • Areas of innovation • Opportunities for continuous improvement • Strategies for continuous improvement [Future directions need to be based on evidence presented in the previous slides.]

7


10/28/2016

LCME Standards Addressed Through This Data • Standard 6

[Name] Clerkship [Clerkship Director’s Name] [Clerkship Coordinator’s name]

– – – –

Dissemination of learning objectives Clinical experience monitoring Active and lifelong learning Inpatient/outpatient experiences

• Standard 8 – – – – –

Program evaluation Use of student evaluation data in program improvement Monitoring of required experiences Comparability across sites Duty hours monitoring

1


10/28/2016

Outcomes 1. 2. 3. 4. 5. 6. 7. 8. 9.

Gather appropriate and accurate history. Perform appropriate exam for the presenting problem/reason for visit. Generate an appropriate problem-based differential diagnosis and plan. Communicate effectively with patients of diverse backgrounds (e.g. age, gender, social, racial and economic backgrounds). Communicate patient information to the clinical team (e.g. written and oral form). Follow through on the appropriate diagnostic and therapeutic action plan. Collaborate with an inter-professional health care team. Demonstrate a commitment to lifelong learning by developing your knowledge and skills outside of the traditional learning environment. Demonstrate professional behavior in clinical interactions (e.g. empathy, attire, punctuality, motivation, reliability).

[Name] Clerkship Overview • [#] weeks – [#] Inpatient – [#] Outpatient • [#] Sites – [Type: Major/Minor health systems/ solo practitioners] – [Location of Cites/Towns? E.g. Cincinnati KY, IN] • [#] Preceptors – [Residents? Fellows?]

2


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[Name] Clerkship Overview (Cont.) • [Types of Clinical Experiences?] • Patient Population [describe the general patient population in terms of diversity at your sites]

[Name] Clerkship Orientation • Orientation

3


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Inpatient Experience [If applicable]

[Name] Intersession • • • •

[When during the Clerkship?] [How long does this experience last?] [Where assigned?] [How many students are assigned to each site?] • [Briefly describe this experience]

4


10/28/2016

Outpatient Experience [If applicable] • [When during the Clerkship?]

• [How long does this experience last?] • [Where assigned?] • [How many students are assigned to each site?] • [Briefly describe this experience]

Required Encounters

Procedures

• In this box list the encounters each student is required to participate in your clerkship

• In this box list the procedures each student is required to complete in your clerkship

5


10/28/2016

Self-Directed Student Educational Opportunities [List and briefly any learner-center educational opportunities unique to your clerkship here. Including and opportunities for students to: 1.Identify/analyze and synthesize information relevant to their learning needs 2.Assess credibility information sources 3.Share the information with peers and supervisors 4.Receiving feedback on their information-seeking skills.]

Midclerkship Feedback • When: [at what point in the clerkship does this occur?] • Process: [briefly describe the process followed from collecting and reviewing the data on each student to the interview itself] • Items discussed – [list the items discussed with each student during the midclerkship interview]

6


10/28/2016

Instructional Methods

Clinical Skills Lab

[In this box, list and briefly describe the teaching methods used in your clerkship (i.e. didactics, small groups, clinical cases etc]

[In this box identify any Clinical Skills Labs each student is required to participate in your clerkship]

7


10/28/2016

Standard Assessment Model

Grades NEURO

ScoreClerkship=(PrecepEval*50%)+(NBME*25%)+(PhysEx*10%)+(Other*15%)

100% 90%

• • • •

Honors: 42% High Pass: 51% Pass: 11% Fail: 3%

PROPOSED

80%

Assessment Type Preceptor  Evaluation NBME  Shelf Exam Physical/Stan dardized Exam Other  Assignments

70% 60% 50% 40% 30% 20% 10% 0%

Fail

Pass

High Pass

Family Psychiatry  Medicine 

OB/Gyn

Pediatrics

Internal Surgery Neurology Medicine

50%

50%

50%

50%

50%

50%

50%

25%

25%

25%

25%

25%

25%

25%

10%

10%

10%

10%

10%

10%

10%

15%

15%

15%

15%

15%

15%

15%

Honors

8


10/28/2016

NBME shelf exam Year 2015/16 OB/GYN National  Data 15/16 2014/15

N

AVG

SD

65

79.20

8.47

Preceptor Evaluation Year 2015/16

N

AVG

SD

65

94.05

5.47

2014/15 2013/14

2013/14

9


10/28/2016

Physical Exam

“Other” Assessments

[In this box describe the assessment tool used/developed to evaluate the ability of each student in completing a Physical Exam] [Include a screen shot of the evaluation tool] CLERKSHIP OB/GYN

N

AVG

SD

65

98.47

2.80

[In this box described the assessment tools included in your “OTHER” category. What skills/knowledge do they evaluate?] Assessment TOTAL

N

AVG 96.97

SD

Description Total weighted average score and SD of all  4.33 assessments included in ”OTHER”  category.

10


10/28/2016

Non-grade/Evaluated Assignments? Assignment

Is Feedback Provided?

Skills/Knowledge Evaluated?

Student Clerkship Evaluation • [Likert items- how did our students rate their experience in the following categories? Include a summary of each as well as any items that stood out as being rated exceptionally high or low] – [Organization and communication] – [Learning environment] – [Interprofessional Experience] • [Trends in open ended data?- based on the open ended comments, were there any common experiences or opinions that stood out to you? Why? What proportion of the student responses do these trends represent?]

11


10/28/2016

Future Directions/Continuous Improvement • Areas strength • Areas of innovation • Opportunities for continuous improvement • Strategies for continuous improvement [Future directions need to be based on evidence presented in the previous slides.]

12


Clerkship Evaluation Template Instructions As part of our effort to better align our curricular structure with the LCME Standards and to develop a framework for the ongoing improvement of our curriculum, we have developed a standardized template for evaluating courses and program areas of #CincyMedEd. This template aligns carefully with LCME standards in terms of data collection, analysis of findings, and strategies for continuous improvement. 1. Complete all slide categories included in this template. 2. Please add additional slides for each category if you desire. You may find that you are unable to fit all the necessary information for each category on a single slide. Feel free to add additional slides to each category. 3. In the notes section, please include a detailed explanation of key points in each slide. For purposes of EPC review and LCME required documentation, we need you to provide appropriate annotation to fully explain each category. Note that the PowerPoint may be the tool used for independent review of your Clerkship. 4. The areas you are expected to complete are identified by BLUE text for your convenience: a. Outcomes- These are prepopulated for all clerkships using the standardized outcomes approved by EPC in 2015 b. Clerkship Overview- Provide numerical values for the duration, site types and preceptors that characterize your clerkship. List and Describe the types of clinical experiences students encounter. Provide a broad overview of the patient population. Please be sure to describe diversity. c. Clerkship Orientation: Identify and describe the materials and instructional methodologies used during your clerkship’s Orientation. Be sure to articulate how the Orientation helps to prepare students for your clerkship. d. Intersession Overview: Please briefly describe what components of the Intersession prepare students for your clerkship. e. Inpatient Experience (if applicable): Describe the inpatient experience for your clerkship. When during your clerkship do students engage in this experience? How long does it last? Where do these experiences take place? How many students are assigned to each site? Be sure to include other the numbers of learners from other health professions who are scheduled at the same time as our students. f. Outpatient Experience (if applicable): Describe the outpatient experience for your clerkship. When during your clerkship do students engage in this experience? How long does it last? Where do these experiences take place? How many students are assigned to each site? Be sure to include other the numbers of learners from other health professions who are scheduled at the same time as our students.


g. Required Experiences and Procedures: List all procedures and experiences required of students in your clerkship. Be sure to explain why they are required for your speciality. h. Self-Directed Student Educational Opportunities- Self-directed learning experiences and time for independent study allow medical students to develop the crucial skills of lifelong learning (Paraphrased from Liaison Committee on Medical Education Data Collection Instrument- 6.3). List and describe all opportunities within your clerkship where students: •

Self-assess their learning needs

Independently identify, analyze and synthesize relevant information

Appraise the credibility of their information sources

i.

Midclerkship Feedback: Identify when midclerkship feedback is given to students. What does this process look like? What specific items are addressed during this session? How does your clerkship use midclerkship feedback to help students identify and strategize opportunities for improvement?

j.

Instructional Methods: Using the AAMC listing of Standard Instructional Methodologies at the end of this document, please list all the instructional methodologies utilized in your clerkship.

k. Clinical Skills Lab: Please describe any OSCE or skills session in the SIM Center. Be sure to identify how it is evaluated. l.

Clerkship Grades: Provide a graphic representation of the grade distribution for the current year in your clerkship (Fail/Pass/High Pass/Honors). We recommend using a histogram to communicate this information. If you are having difficulty, please contact Laurah Lukin for assistance (turnela@ucmail.uc.edu).

m. Standard Assessment Categories i. NBME Shelf Exam: Include the mean score and standard deviation for your Clerkship’s NBME SHELF Exam for the current year. Also include the national mean and standard deviation for the current year, as well as these statistics for last 3 previous years if available. You may include other statistics or graphical representations if you feel it is necessary. ii. Preceptor Evaluation: Include the mean score and standard deviation for your Clerkship’s Preceptor Evaluation for the current year. Also include these statistics for last 3 previous years if available. You may include other statistics or graphical representations if you feel it is necessary. iii. Physical Exam: Please describe how you evaluate the Physical Exam for your clerkship. Include the mean score and standard deviation for your Clerkship’s Physical Exam for the current year. Also include these statistics for last 3 previous years if available. You may include other statistics or graphical representations if you feel it is necessary. iv. “OTHER” Category: Using the AAMC listing of Standard Assessment Methodologies at the end of this document, please list and describe all assessments included in the OTHER category for your clerkship. Also, describe how each assessment is evaluated. Finally, please include the mean score and standard deviation for each assessment for the current year as well as these statistics for the last 3 previous years if available. You may include other statistics or graphical representations if you feel it is necessary.


n. Non-Graded/Evaluated Assignments: Using the table provided on the PowerPoint slide, identify non-graded or pass-fail assignments. Please also identify any mandatory assignments that are not evaluated and/or reviewed. o. Student Clerkship Evaluations. Using the results of the End of Clerkship and Preceptor Evaluations you received If you are having difficulty, please contact Laurah Lukin for assistance (turnela@ucmail.uc.edu ). i. Likert Items-Provide the mean for each item. For any items where the mean falls below 3.0, identify whether there are trends in the comments section that can help to explain. Additionally, where the mean falls drastically above or below the norm for your course, refer to the trends in the comments section to help explain this variation. ii. Qualitative trends – Once you have grouped comments from all open-ended questions into categories, only report trends where you have 7-10 similar comments in a single category. We define a trend as 5% percent representation or more. p. Summary i. Identify strengths of the Clerkship based on the data presented. ii. Highlight areas of innovation that had a positive impact on student learning. iii. Identify opportunities for continuous improvement (be sure to also explain how you will evaluate the impact of these changes to be reported the following academic year)

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