Transcript Slide 1

2M Model
Two Metaphor Education
Bergus Curriculum Modeling Committee
2M Model Highlights
• Think like experts
• Clinical, Professional and Scientific Knowledge
and Skills
Comprehensive
Continuous
Integrated
• High information retention, low student stress
Goal
• Create a complete physician
• Two metaphors of learning
Knowledge
Know the facts
Acquisition
2M
Clinical and
Model
Professional
Professional
Clinical Care
Development
Complete
physician
Topics in Medicine Groups
Graduation
Capstone Conference
ACLS/etc. training
Residency Boot Camp
Topics in Medicine
Groups
Clinical Skills Groups
Electives
Topics in Medicine Groups
Clinical Skills Groups
Capstone
Course
Sub-I (4)
ER or ICU (4)
Lab/EKG (2)
Clinical Skills Groups
Longitudinal Clinical
Experience (weekly)
Year 4
Internal Medicine (6)
Family Practice (4)
Geriatrics (2)
Longitudinal Clinical
Experience (weekly)
General Surgery (6)
Selectives (6)
Clinical Experience Groups
Psychiatry (6)
Neurology (4)
Ophthalmology (2)
Pathogens &
Human Responses
Clinical Experience Clerkships
Pediatrics (6)
OB/GYN (6)
Clinical and
Professional
Development
Molecules to
Mendel
Clinical Presentations
Language of Clinical Medicine
Human Structure
Year 3
Mortality and Morbidity-style Conferences
USLME Step 1
Clinical Presentations
Year 2
Cardio
Pulmonary
GI
Renal
Reproductive
Special Senses
Endocrine
Language of Medical Science
Summer: Service, Research, MECO, etc.
Semester 2
Neurology
MSK
Skin
Blood
Didactic
Semester 1
Threads
Basic sciences
Development and Aging
Behavioral health
Social determinants of health
Preventive Health
EBM, imaging, pathology
Patient care
Pain
Economics, greening
Medical ethics, law
Patient safety
Professionalism
6 Key Innovations
Language of
Medical Science
Four 12-week
M3 blocks
Clinical and
Professional
Development
Clinical Presentation
Curriculum
M4
Capstone Course
CCORE
Threads
CCORE Threads
Curricular
Content
Organizing &
Evaluation
“Threads”
12 consistent themes
Semester 1
Language of
Medical Science
Clinical and
Professional
Development
Human Structure
Molecules to Mendel
Pathogens and
Human Responses
Clinical Experience (2 sessions/week)
Clinical Skills (2 sessions/week)
Topics in Medicine (1 sessions/week)
• Language of Medical Science
• Clinical and Professional Development
Semester 1
Monday
Tuesday
Wednesday
Thursday
Friday
AM
Classroom
learning
Classroom
learning
Lecture or
Tests
Classroom
learning
Classroom
learning
PM 1
Dissection
Dissection
Topics in
Medicine
Free
Teach
dissection
PM 2
Clinical
Experience
Free
Topics in
Medicine
Clinical
Experience
Learn
dissection
PM 3
Free
Clinical
Skills
Topics in
Medicine
Clinical
Skills
Learn
dissection
• AM: Classroom Learning
• PM: Dissection, Clinical Experience or Clinical Skills
Semesters 2–4: Clinical Presentations
Clinical Skills Groups
Topics in Medicine
Groups
Cardio
Pulmonary
GI
Renal
Reproductive
Special Senses
Endocrine
Neurology
MSK
Skin
Blood
Longitudinal Clinical
Experience (weekly)
Clinical Presentations
Longitudinal Clinical
Experience (weekly)
Clinical Skills Groups
Topics in Medicine
Groups
USLME Step 1
Clinical and
Professional
Development
Didactic
Clinical Presentations
Year 2
Summer: Service, Research, MECO, etc.
Semester 2
Clinical Presentation Model
• Finite number of biological responses
• Finite number of chief presenting complaints
• Clinical knowledge organized into diagnostic
categories (schemes)
“Blood in the Stool” Scheme
Lower GI
(Blood in Stool/
Hematochezia*)
Small Bowel
Colorectal
Diverticular
Disease
Other
(30 – 50%)
Perianal
• Hemorrhoids
• Fissures
Neoplasms
• Polyps
• Cancer
(5%)
Angiodysplasia
(20 – 30%)
Colitis
• Infectious
• IBD
• Ischemic
•
•
•
•
•
•
Vascular Ectasia
NSAID Enteropathy
Tumors
Crohn's disease
Infections
Meckel’s
Diverticulum
*If patient presents with
severe hematochezia,
10% will have an upper
GI lesion.
Copyright Paul L. Foster
School of Medicine
Semesters 2–4
AM
Monday
Tuesday
Clinical
Presentation:
Blood in the Stool
Histology
Wednesday
Thursday
Pharmacology
Biochemistry
Small groups:
dividing cases
Immunology
Physiology
Anatomy
Pathology
Microbiology
Lunch
Clinical Skills:
Simulated rectal
exam
Abdominal exam
PM
Friday
Longitudinal
Clinical
Experience
Topics in
Medicine:
Pain, CAM,
Economics,
Nutrition,
Culturallyappropriate care
Clinical Skills:
Physical findings
in abnormal
abdominal exam
Small groups:
presenting GI
cases
Internal Medicine (6)
Family Practice (4)
Geriatrics (2)
General Surgery (6)
Selectives (6)
Psychiatry (6)
Neurology (4)
Ophthalmology (2)
Year 3
Mortality and Morbidity-style
Conferences
Clinical Experience Clerkships
Pediatrics (6)
OB/GYN (6)
• Core clinical
clerkships and
CCORE threads
• Clinical Skills
Training
• Topics in Medicine
Language of Clinical Medicine
Year 3: Clinical Training
Clinical Skills Groups
Topics in Medicine Groups
Clerkships: CCORE Threads
• Morbidity and Mortality
(M&M) Conference
• Example: Pediatrics
M&M Conference
2-year-old
well-child check
Basic sciences
Patient care:
2-mo-old child with
hematochezia
Vaccinology
Focused review of
anatomy
Microbiology
Pathophysiology and
differential diagnosis
Discussion of minor
illness and red flags
Understanding
parents’ fears
Chronic Illness Care, Palliative
Care, Disease Management,
CAM, Culturally-appropriate care Naturopathic
medications
Naturopathic
medications for colic
Year 4: Clinical Training
Graduation
Clinical Experience
Clerkships
Capstone Conference
ACLS/etc. training
Residency Boot Camp
Capstone
Course
Electives
– Capstone Conference
– Skills Training (ACLS)
– Residency “Boot Camp”
Mortality and
Morbidity-style
Conferences
Sub-I (4)
ER or ICU (4)
Lab/EKG (2)
• Electives
• Distinction Tracks
• Capstone Course
Year 4
Capstone Conference
Daily Topic
Addiction
Morning Reception at 7:30 AM
Keynote Session
Breakout Sessions
Lunch Break
Breakout Sessions
Reflection, Writing,
Discussion Groups
Daily Topic ends by 5:00 PM
Future Challenges
• Clinical Sites
• Faculty
• Faculty Development
• Coordination
• Time for development
2M Model Highlights
•
•
•
•
Think like experts
CCORE Threads
Early clinical experience
M1–M3 clinical skills development
2M
Model
Complete
physician
2M Model Highlights
•
•
•
•
Think like experts
CCORE Threads
Early clinical experience
M1–M3 clinical skills development
2M
Model
Complete
physician
2M Model
Two Metaphor Education
Bergus Curriculum Modeling Committee
Curricular Threads
Basic sciences
Well child check: age 2 years
Hot topic: vaccinology: combination vaccines vs
other
Development
Behavioral health
Denver screen
Problem screen, address self regulation
Social
determinants
Preventive Health
Family income, mobility, residence, social capital
Evidence based
medicine
anticipatory guidance in nutrition, exercise,
outdoor play, peer group activities
Immunizations indicated for prevention DTap,
IPV, MMR-V, Influenza,
Patient Care: Disease
management, CAM
Discussing handling minor illness and red flags,
naturopathic meds
Pain
Use of behavioral modalities to alleviate pain:
blowing away bubbles, imagination
Internal rate of return on immunization was
12.4% in 2005 18 % by 2020, business case for
preventative health visits, discussing
environmental health hazards mercury,
pesticides
Counter arguments of immunization critics
Economics, Greening
medicine
Medical ethics, Law
2 month old child with hematochezia
Focused review of anatomy, pathophysiology
and differential diagnosis of a GI bleed in
2month old
Development of a 2 month old
Normal 2 month old behavior: colick, infant
attachment
Societal attitudes towards breastfeeding
Nutritional needs of a 2 month old
Breast milk versus formula
The science of infant nutrition
Management of milk protein allergy: evidence
for switching formula
Best test to determine source of GI bleeding?
Naturopathic medications to treat colick
Assessing pain in a pediatric patient
Cost and effectiveness of in home nursing visits,
weight checks and lactation consultation.
The environmental cost of child rearing (diapers,
disposable bottles)
Patient safety, QI/QA Knowing proper needle length, contraindications
of vaccines; Offering VFC vaccines or if not
knowing who does, time slots after hours to
improve compliance with checkups. VAERS
Parent education and preparation prior to
discharge from the nursery
Professionalism,
team
Utlizing community resources in patient care: ex.
La Leche League, AEA
Interprofessional: nursing with pre-drawn
syringes and plan for immobilizing patient for
speedy throughput