VIC Summary Document
The educational program is comprised of three levels. Level One is the foundation of the educational program and features the development of fundamental science knowledge in a clinically relevant context and the acquisition of clinical skills. Initial courses in the fundamentals of medical science are followed by a series of organ system-based courses. Level Two consists of core clerkships emphasizing the basic principles and practices of clinical medicine. This level is comprised of 9 clerkships with rotations in family medicine, pediatrics, outpatient medicine, inpatient internal medicine, surgery, obstetrics and gynecology, psychiatry, neurology, and the bridge clerkship. . Level Three provides students with additional opportunities for the application of medical knowledge with increased responsibilities for the care of patients. This level requires an Acting Internship in Internal Medicine and another acting internship in a discipline selected by the student, a required rotation in emergency medicine, completion of a teaching practicum or scholarly project; clinical electives comprise the remainder of this course work. Clinical correlations are prominent in the curriculum at all levels, beginning with meeting a patient on the first day of medical school. The methods for development of the 4-year clinical skills curriculum are listed in Appendix 2.
Level 1 – Foundations
The purpose of Level One/Foundations is for students to develop a fundamental understanding of health and illness as framed by systems from single genes to entire populations.
|Course||Lecture||Lab||Small Groups*||Patient Contact||Other†||Total|
|Foundations of Medicine||57||0||43.5||9.5||115.5||225.5|
|Human Structure & Function||100||128||12||27||167.5||434.5|
|Attacks and Defenses||69||0||33||1.5||101.5||205|
|Nutrition, Metabolism and the Gastrointestinal System||86.25||10||28||5.5||126.75||256.5|
|Professionalism, Communication and Reflection||4||0||65.25||2||1||72.25|
|Doctoring in Vermont||4.5||0||2||32||38.5||77|
|Cardiovascular, Respiratory, and Renal Systems||80||18.5||56.5||8||104||267|
|Public Health Projects||3.5||0||43||0||1||47.5|
* Includes case-based or problem solving sessions
† Describe – Self-directed learning, exam reviews, COMET modules, eLearning Modules
The week-long orientation is designed to prepare the entering student for a successful transition to the College of Medicine. New students are mentored by faculty members and more senior students, and are provided opportunities for building professional, collegial communities.
PROFESSIONALISM, COMMUNICATION, AND REFLECTION
The medical community recognizes that leadership and professionalism require knowledge of and skills for collaboration, cultural awareness, decision-making, life-long learning, and self-assessment. The Professionalism, Communication & Reflection (PCR) course is designed to introduce and support the development of the capacities, attitudes, and behaviors critical to medical professionalism. This course focuses on the practice of leadership and professionalism in daily interactions with peers, mentors, colleagues and families as the foundation of medical practice.
The purpose of PCR is to foster the development of competent professionals, leaders, and life-long learners who share, interpret, and transfer medical school experiences and knowledge into effective actions to better themselves and others. This course addresses medical leadership and professionalism through weekly small group sessions that meet throughout the first year of the Foundations Level. It supports professional development through collaborative group learning activities linking personal experience, cultural awareness, leadership topics, and concurrent VIC course content. Learning activities also include periodic large group presentations and regular assignments that will include reading, written reflection, portfolio development, and projects. (33 weeks)
FOUNDATIONS OF MEDICINE
This course introduces basic principles, concepts, and methods that are foundational to the study and practice of medicine, drawing from disciplines including biochemistry, cell biology, epidemiology, ethics, genetics, pharmacology, and public health. Students learn to apply basic scientific principles and develop frameworks for clinical decision-making and the practice of evidence-based medicine during course activities that include team-based learning, small- and large-group discussions, interactive modules, lectures, and clinical skills practice with standardized patients. The integrated, interdisciplinary organization of the course highlights clinical, ethical, and public health implications of basic medical sciences. Interactive sessions also include guided practice with a variety of learning strategies to help students develop effective approaches that will prepare them for success in their ongoing studies. (6 weeks)
HUMAN STRUCTURE AND FUNCTION
Students in this course study the composition of the human body and how it performs in the healthy state in an integrated study of microscopic and gross anatomy, physiology, basic imaging principles, embryology and clinical skills. Although the emphasis is on normal healthy structure and function, representative examples of pathology and clinical applications sharpen the contrast between normal and abnormal. The course includes traditional pedagogical methods with innovative and unique computer based lessons and small group learning. (12 weeks)
ATTACKS AND DEFENSES
Attacks and Defenses is the bridge course between Fundamentals and Systems Integration courses and addresses the vocabulary, principles, and pathophysiology of disciplines that are not necessarily organ based. The course integrated studies in hematology, immunology, microbiology, toxicology, pathology, pharmacology, and neoplasia. Students will be introduced to advanced history taking skills, clinical problem solving skills and application of evidenced medicine. Instructional methods include lectures, weekly laboratories and small group exercises, evidence-based medicine assignments, team-based learning, team-based problem solving and standardized patient exercises. (6 weeks)
NUTRITION, METABOLISM, AND THE GASTROINTESTINAL SYSTEM
This course utilizes both an organ- and disease-based focus to organize studies in nutrition and metabolism, the gastrointestinal and endocrine systems, and liver and biliary tree function. It is designed to integrate cell metabolism, normal and pathologic anatomy, pharmacology, physiology, pathophysiology and the physical examination and related interviewing, diagnostic testing and imaging. Understanding the metabolic and pathophysiologic consequences of public health problems including alcoholism, obesity and diabetes reinforce concepts learned. Learning is facilitated through faculty lectures, computer based tutorials, assigned readings, small group case discussions and workshops for problem solving and skills development. Clinical correlations reinforce the lessons of the community preceptorships. (8 weeks)
Students in this course learn about the nervous system through integrative study of behavior, cellular and systems neurobiology, neuroanatomy, neuroethics, neuropharmacology, neurophysiology, pathophysiology, and psychopathology. Students also learn the neurologic and mental status examinations, related interviewing, diagnostic testing and imaging. Several instructional methods support learning in this course, including lecture, online independent study modules, readings from a variety of sources, laboratory sessions, physical examination and interviewing skills sessions, simulation, team-based learning and case discussions prepared by students. (9 weeks)
PUBLIC HEALTH PROJECTS
During the second year of the Foundations Level, Professionalism, Reflection and Communication groups formed during the first year apply their group leadership, professional, and team skills to a public health project. Public health projects are designed to teach students about public health and the health issues that face our communities as they work side by side with the groups, organizations, and individuals in these settings. These projects begin to develop the background in population-based medicine and prevention a physician needs to fully address a range of health issues. Public health projects are carried out in Vermont communities and enable students to apply the principles and science of public health to health needs in the community. (19.5 weeks)
Students in Connections study skin, connective tissue, and the musculoskeletal system using appropriate aspects of cell metabolism, endocrinology, normal and pathologic anatomy, pharmacology, physiology, pathophysiology and the physical examination and related interviewing, diagnostic testing and imaging. It introduces students to the fields of the orthopedics, rheumatology and dermatology during the basic sciences. (2 weeks)
CARDIOVASCULAR, RESPIRATORY, AND RENAL SYSTEMS
The Cardiovascular, Respiratory, and Renal Systems (CRR) course emphasizes the pathophysiology of diseases that affect these 3 organ systems. In addition to learning fundamental pathophysiology, students learn to recognize life and organ threatening disease processes and begin to learn pharmacological and interventional management of diseases affecting the cardiovascular, respiratory and renal systems. Throughout the course, basic biology and genetics are integrated with clinical data including diagnostic testing and clinical imaging. A series of “Bench-to-Bedside” lectures emphasize the scientific and genetic contributions to the clinical management of sudden cardiac death, cystic fibrosis, asthma, autosomal dominant polycystic kidney disease, and hypertension. The final week of CRR emphasizes organ integration in diseases such as hypertension, shock and acid-base. Multiple learning formats are utilized throughout the course. Clinical skills pertaining to the cardiovascular and respiratory systems are also taught. (9 weeks)
Generations is a seven week course which studies human life cycle development, the male and female reproductive system, age related illnesses, and diversity with respect to LGBTQ health and disability. These areas are covered in tandem with one another, using a chronological approach beginning with the health of the fetus and continuing up through childhood, adolescence, the adult reproductive years, and the geriatric years. Students are introduced to the process of integrating life cycle factors into their consideration of differential diagnoses and their approach to therapeutic care. Lectures, Team Based Learning and pathology labs are supported by small group meetings and workshops.
The Convergence course uses problem-based learning to reinforce topics covered in previous courses and teaches clinical problem solving skills in preparation for the students’ transition into their clerkships. The course format includes the presentation of cases that are discussed and formulated within the context of small group settings. (4 weeks)
DOCTORING IN VERMONT
Doctoring in Vermont is a course that spans the first and second year of Foundations. Students spend 8 sessions in the office of a primary care physician within a one-hour drive of Burlington. Students travel to their preceptor’s office, observe direct patient care, and practice interviewing and examination supervision. In the second half of this course students perform two graded histories and physical examinations using standardized patients.
Level 2 – Clinical Clerkship
The Clerkship Year is designed to build on competencies acquired in Foundations to develop the knowledge, skills and attitudes needed for clinical care and decision-making in a variety of medical settings. The year is composed of 8 clerkships which are departmentally-based and provide clinical experiences supported by structured educational programs, and a four week longitudinal Bridge Clerkship. All clerkships must be completed under the supervision of UVM College of Medicine faculty at an approved clinical site. Upon completion of this level students complete a summative clinical skills exam (Total = 49 weeks of required clerkships, and 3 weeks of vacation.) UVM students gain clinical experience during clerkship and advanced integration at a variety of inpatient and outpatient settings and locations including The University of Vermont Medical Center in Burlington, Danbury Hospital in Danbury CT, St. Mary’s Medical Center in West Palm Beach FL and Eastern Maine Medical Center in Bangor ME.
Class of 2015
|Weeks of Instruction||Credit Hours||Lecture Hours||Clinical Hours||Exam Hours||Other Hours||Total Hours|
FAMILY MEDICIN CLERKSHIP
This clerkship emphasizes the acquisition of skills and knowledge related to the care of patients in the outpatient setting. Family Medicine physicians care for a diverse group of patients of all ages on a longitudinal basis providing acute care, chronic disease management, prevention, health maintenance and education. They also coordinate care when subspecialty consultation is required. Students will examine the role of the Family Physician, both in leading the patient-centered medical home and within the complex health care system as a whole. The clerkship begins with small group, hands-on instruction utilizing the Simulation Center and Standardized Patients and other diverse teaching tools to learn skills and procedures for the office setting. Students then spend five weeks in a continuity clinical practice site, mostly based in rural New England. Along with working one-on-one with a preceptor in their outpatient clinic, many community faculty involve the students in their hospital work, nursing home care and home visits. Some physicians include obstetrics or other special focus in their work such as sports medicine. Students complete a community project and study from a national on-line curriculum designed by the Society of Teachers of Family Medicine. (6 weeks)
INTERNAL MEDICINE CLERKSHIP
The inpatient medicine clerkship integrates medical knowledge acquired in the Foundations level) with bedside clinical knowledge in the management of acute medical problems and chronic illness. Students expand their medical knowledge, develop their clinical skills including history taking and physical examination, interpret clinical information including laboratory and imaging data, learn differential diagnoses, practice diagnostic and therapeutic decision making, and develop proficiency in how to effectively communicate this information in both oral and written formats. Students are integral members of the ward team which includes a hospitalist, 2nd or 3rd year medical resident, intern and acting intern. The clerkship relies on experiential learning supported by structured learning activities and didactic sessions throughout the clerkship. (6 weeks)
The Neurology Clerkship is a combined inpatient-outpatient experience. Students spend most of the rotation on the wards on both the Inpatient General Neurology Team and the Acute Interventional Neurology Team, learning to care for neurological patients in an acute care setting. Students take an active role in following and managing those patients assigned to them. In the outpatient experience, students complete focused history and physicals on patients presenting with acute and chronic neurological conditions. This rotation is an experiential experience supported by structured learning activities and group case discussions using clinical cases to discuss important concepts related to clinical neurology. (3.5 weeks)
OBSTETRICS AND GYNECOLOGY CLERKSHIP
The Obstetrics and Gynecology clerkship provides students with learning experiences that promote their observation of normal reproductive transitions, which include puberty, pregnancy and menopause. Also, the student studies the effects of reproductive tract problems on the overall physical and emotional health of females from birth to death. Students learn to promote emotional and physical wellness of their female patients, by working with clinical teaching teams consisting of educators, health care providers and patients. The student is trained to recognize and understand the pathophysiology and approach to the management of common and threatening problems related to reproduction. Clinical and scholarly experiences during the clerkship encourage lifelong self-learning in any field of medicine. These activities are conducted in an environment of respect for patients, students and teachers. (6 weeks)
OUTPATIENT INTERNAL MEDICINE CLERKSHIP
This outpatient clerkship provides learners with the foundation of skills, experience and knowledge that prepares them to care for adults in an ambulatory setting. Specifically, students will manage both acute and chronic medical problems. In addition to learning prevention and health maintenance, students experience the breadth of disease management. The clerkship consists primarily of experiential learning. It provides an opportunity for daily interaction with patients as well as one-on-one mentoring with a physician preceptor. Students continue to develop problem solving skills, oral and written communication skills and lifelong learning skills. They will gain an understanding of the role of a primary care physician in the management of patients and populations. The clerkship focuses on Basic Generalist Competencies and specific Clerkship Directors of Internal Medicine Learning Objectives/Training Problems. (3.5 weeks)
The pediatric clerkship consists of ambulatory and inpatient components. The goals are for students to acquire the basic knowledge, clinical and communication skills necessary to care for children from birth through adolescence. Students assess growth and development, develop skills necessary for diagnosis and initiation of management plans for acute and chronic illnesses. They continue to develop problem solving skills, oral, and written communication skills, and develop health promotion strategies. They gain an understanding of the role of the pediatrician in caring for patients and will develop knowledge of the influence of family, community and society on health care of children and adolescents.
The Psychiatry Clerkship provides the opportunity to improve their knowledge of psychiatric illnesses and their management. Students recognize the signs and symptoms of psychiatric disorders, and the acute phase of response to pharmacological and psychotherapeutic interventions in largely inpatient, and some outpatient, settings. Through the didactics and clinical teaching, students will develop knowledge of the etiology and pathogenesis of psychiatric illnesses and gain understanding of the indications for, mechanisms of action of, and potential adverse effects of a variety of treatments for psychiatric disorders. Students will develop empathy for those suffering with mental illnesses and knowledge of the role that psychiatric conditions play in clinical practices in all specialties. (6 weeks)
Students become part of the surgical team and experience the unique relationship surgeons have with their patients. Students will develop skills in recognizing the clinical presentation of common surgical disease, a, in completing histories and physicals, developing differential diagnosis, developing assessment and plans for common surgical problems. They will develop their communication skills, and learn to apply principles of evidence-based medicine to the care of surgical patients. Students will be involved in the preoperative and post operative management of patients, and will display professionalism and ethics in the care of patients. This clerkship will provide the opportunity for students to develop technical skills in selected procedures. (7 weeks)
THE BRIDGE CLERKSHIP
This longitudinal multidisciplinary curriculum is designed to support professional growth and to focus on topics that are important in all disciplines of medicine. This course includes topics of global health, palliative care, nutrition, patient safety, healthcare delivery and the economics of health care, complementary medicine, pain management, genetics, communication skills, and evidence based medicine. In the Professionalism, Communication, and Reflection Sessions (PCRII) Students continue to explore concepts of first discussed in the Professionalism, Communication and Reflection I course, with emphasis of application in the clinical setting.
Level 3 – Advanced Integration
The Advanced Integration level comprises required activities that enhance the student’s clinical skills and knowledge of basic and clinical science, and elective activities that allow the student to shape his or her own professional development. All students are required to include in their schedules:
- Two acting internships (AI). One of the AIs must be in Internal Medicine and the other is a discipline selected by the student.
- One month of surgical specialty training.
- A teaching practicum/scholarly project.
ACTING INTERNSHIP IN INTERNAL MEDICINE
The Acting Internship in Internal Medicine consolidates and refines the student’s Internal Medicine medical knowledge and clinical skills at a level of competency necessary to deliver comprehensive care to medical inpatients. Through increased responsibility in the evaluation and management of patients and through closely supervised direct patient care experiences, students attain a level of competence and self-confidence sufficient to be prepared for entering their first year of residency. This Acting Internship must be completed at either The University of Vermont Medical Center in Burlington or Danbury Hospital in Danbury, Connecticut. (4 weeks)
Each student completes at least one month of Acting Internship in addition to the Acting Internship in Internal Medicine. This Acting Internship is in a specialty of the student’s choosing and consolidates and refines the student’s medical knowledge and clinical skills at a level of competency necessary to deliver comprehensive care to inpatients. Through increased responsibility in the evaluation and management of patients and through closely supervised direct patient care experiences, students attain a level of competence and self-confidence sufficient to be prepared for entering their first year of residency. This Acting Internship may be in any inpatient service that fulfills the requirements and be completed at The University of Vermont Medical Center, or at an approved affiliate site. (4 weeks)
SURGERY SPECIALTY / SUBSPECIALTY
This rotation is designed to provide the student with further knowledge of surgical subspecialty areas of interest to them. Students can select either two separate two-week surgical specialty/subspecialty rotations, or one full month of an acting internship in a surgical specialty/subspecialty. (4 weeks)
If taken as an acting internship, this requirement can also satisfy the second Acting Internship Requirement.
TEACHING REQUIREMENT/SCHOLARLY PROJECT
The Teaching Practicum/Scholarly Project reinforces foundational sciences through teaching or scholarly activity and strengthens longitudinal integration in the VIC by revisiting foundational sciences with clinical perspective. Students may fulfill the practicum experience in one of two ways: the Teaching Practicum or a Scholarly Project.
In the Teaching Practicum, students spend one month as a teaching assistant in the VIC foundations courses. Duties could include small group facilitation, laboratory teaching, tutoring, leading review sessions, developing on-line teaching materials, and preparing assessment and other teaching materials. Students attend two teaching workshops during the month, the first providing specific instruction tailored to their teaching duties, the second on assessment and feedback.
The Scholarly Project encourages the development of students as physician-scholars by engaging in scientific inquiry. The scholarly project enhances inquiry, analytical, and communication skills. It solidifies the foundation for lifelong learning by through critical evaluation of data. The research project may be in the basic or clinical sciences.
Students are required to take a total of 13 of credit-bearing activities, including elective courses. Students choose from an array of elective offerings from all departments of the College of Medicine. These electives are designed to expand clinical skills and knowledge and to assist students in exploring career choices. During Advanced Integration, students may also choose extramural rotations. They must have educational benefit and be approved by students’ advisors at least one month before the rotation begins.
SENIOR SURGERY MAJOR
Students with interest in careers in the surgical fields may choose to be in the Surgery Major program. Applications for the Senior Surgery Major are coordinated through the Department of Surgery. In addition to the requirements listed above, students electing to take the Surgery Major must fulfill the following requirements:
- Acting Internship in Surgery. Surgery majors must elect to take an acting internship in a surgical subspecialty. This can satisfy the above requirement for a second acting internship.
- Students must elect to perform a scholarly project.
- An anatomy elective month
- Surgical Residency Readiness Course
Assessment of Student Performance
Students are assessed in cognitive, affective, and psychomotor domains in all courses with an emphasis on formative evaluation throughout each course, providing frequent feedback to the student. Examinations and quizzes are coordinated in all components. Honors/Pass/Fail grading is used in most courses; written and narrative assessment of student performance is provided where appropriate. Students are assessed individually based on curriculum standards and are not ranked against each other. Standardized examinations of clinical skills are administered frequently. Measurement of clinical skill culminates in a comprehensive assessment at the end of Level Two. Those students failing this comprehensive clinical assessment are required to remediate and retake the assessment to ensure clinical competence. The United States Medical License Examination (USMLE) Step 1 must be passed before advancing to Level Two. Students must pass both parts of the USMLE Step 2 to graduate.
Evaluation of the Curriculum
Ongoing evaluation of all elements of the curriculum is essential to maintain continuous improvement. Evaluation of the curriculum is performed by students, faculty and staff. The process is coordinated by the staff of the Office of Medical Student Education and is performed by the Foundations and Clerkship Director’s Committees. These committees are responsible for the initial evaluation of all required courses and clerkships. The Medical Curriculum Committee has overall responsibility for management and evaluation of the curriculum. For each course and clerkship, selected students complete an evaluation of the course/clerkship and faculty. These data are provided to course faculty, course/clerkship directors, and department chairs. The course directors use these and other data to prepare a quality assurance report that is reviewed with their peers (i.e., the foundations or clerkship committee), who discuss the course and offer suggestions for improvement. These findings are compiled into the Quality Assurance Report.
The Quality Assurance Report is distributed by the course director to the Medical Curriculum Committee at its regular monthly meeting. The Committee considers the findings and recommendations of the Foundations or Clerkship Committee and may ask for a response from the course/clerkship director. The Committee will then consider actions for improvement and amend the report to included mandated changes in objectives/competencies, course content, methods of instruction and assessment, gaps and redundancies in the curriculum, timing of content, etc. After resolution of all outstanding issues, the amended report is approved by the Medical Curriculum Committee and sent to the course director for implementation of the mandated changes.The Medical Curriculum Committee monitors the curriculum by examining course, clerkship and component assessments. The Medical Curriculum Committee performs program evaluation using outcome data from various sources, including internal assessments, USMLE Step I and II scores and results of other standardized examinations, data from the AAMC Graduation Questionnaire and surveys of first year residency program directors.
Appendix 2. Clinical Skills and Behaviors Assessed in the UVM College of Medicine Curriculum
- Using the AAMC 2005 and 2008 Clinical Skills Competency Report, the Clinical Skills Task Force identified items they considered as required competencies for all UVM COM students.
- Using the same report, a document was prepared with VIC courses, bridges and end of level exams across the top and the combined AAMC Clinical Skills Competency Reports on the side.
- All items IN THE PROCEDURES SECTIONS that is underlined, bolded and in italics are those items that the Clinical Skills Task has chosen as required competencies.
- For the Patient Examination Section- We have listed all of the VIC Physical Exam Skill Sets that we currently teach.
- The document was presented to Foundations and Clerkship Directors, faculty who directed selected courses within the Clerkship Bridges, and a selected group of three 4th year medical students during an elective rotation in the Clinical Simulation Laboratory to review.
- They were asked to review the document and assign the level of competency they believed all students achieved at the completion of the course, bridge, clerkship or exam. In order to do that we choose a developmental scale. We chose the Miller’s Pyramid. We defined each level as:
- Knows (taught or shown to individual, small or large group)
- Knows How (hands on work with individual or small group or large group, with or without non standardized feedback)
- Shows How (individual standardized formative feedback)
- Does (individual standardized summative evaluation)
- A “D” assumes that students have passed through A, B and C levels in the course.
- A “C” assumes that students have passed through A, and B levels in the course.
- A “B” assumes that students have passed through A levels in the course.
The process was iterative and the final decision on the competency level was made by the course director. A complete copy of the report is available by contacting the Office of Medical Student Education at 802-656-0722.
Last modified December 18 2014 11:32 AM