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Curriculum Quarterly Educational Newsletter for Tulane School of Medicine - Spring 2021

N. Kevin Krane, MD. -- Vice Dean for Academic Affairs

In a “normal” year, I like to post a Curriculum Quarterly at regular intervals to provide regular updates and other information that should be helpful for students. Needless to say this past year has been different and we have tried to provide on-going updates about important information. This is a new year with vaccine administration generating some optimism so it’s a good time to resume these updates. I hope the following updates and a look in the crystal ball are helpful to you. If there are topics you’d like to see explored further in the future, please don’t hesitate to let me know. In the meantime, stay well and look out for your friends, families and community.

Curriculum Updates:

End of Phase 1 Shelf Exams: These exams are offered every year at the end of Phase 1 to ensure students have learned necessary content, using standardized NBME “board-style” questions to further prepare students for eventually taking USMLE Step 1. Several alterations were made this year and include additional study time in the curriculum, a review for the gross anatomy shelf, additional preparation of the exams to ensure they match content for this year’s courses, and a blueprint/outline of each shelf exam that will be distributed around Feb 15th to assist in study efforts.

CBSE: The Comprehensive Basic Science Examination (CBSE) is a general, integrated achievement test covering material typically learned during basic science education, with somewhat more emphasis on second-year courses. This exam reflects content coverage on USMLE Step 1 and uses the same item formats. This exam is given to T2’s well in advance of the Step 1 exam so students can use their overall score and profile report to identify areas of strength and weakness and focus their study efforts.

Step 1: We are well aware that T2’s are beginning to gear up for their Step 1 exam but this year, we also have a number of T3’s who were not able to take their exam last Spring. Dr. Naquin is doing Step prep; individual consultations are also available.

Clinical Curriculum: Beginning with the clinical orientation the first week of May, clerkships that were reduced in time will return to their pre-covid lengths of either 4 or 8 weeks.

Transition to Residency Elective Course: We now offer an elective for 4th year students in March to provide enhanced preparation for residency. This course is in addition to specialty specific electives that are already offered. This year the course will be both on-line and in-person; activities will provide exposure to general topics important for all future interns.

“Hybrid” Classes: As soon as the technology enhancements are completed in the Leone and DeBakey facilities, we will begin hybrid classes, whereby a limited number of students can come in for in-person presentations.

Away Rotations: At this time, we are still not approving any “away” rotations for current or rising 4th year students. However on January 25, the Coalition for Physician Accountability which includes the AAMC and a cross-organizational group of national medical education organizations recommended the following:

  1. After April 15, learners may begin applying for and scheduling in-person away rotations with a start date of August 1, 2021, or later.
  2. Programs hosting learners for away rotations are encouraged to adhere to May 1 as the date to begin processing away rotation applications that begin on or after August 1.
  3. Given the compressed timeline paired with an inadequate quantity of electives available for completion, medical schools are encouraged to limit approved away rotations in any specialty to one per learner, except in cases where additional rotations are needed to complete graduation or accreditation requirements. Residency programs are encouraged to take into consideration if a learner exceeded the one away rotation limit during the residency selection process.
  4. Programs may continue to offer virtual electives to provide opportunities for learners to explore the specialty and program.

What’s New at Tulane

Scott Dean and Sarah Williams Join the Office of Medical Education

The Office of Medical Education, located on the 5th floor of the Murphy Building, has added two new personnel to improve educational support, Sarah Williams, MS, Educational Evaluation and Research Specialist and Scott Dean, BS, as Administrative Coordinator.

The Liaison Committee on Racial and Social Justice was formed as a student advisory committee to work with the Curriculum Committee to enhance education in racial and social justice across the curriculum. Recommendations from this committee are in the process of being finalized.

eMedley

eMedley: The Office of Medical Education has been working with the Offices of Student and Academic Affairs to have an integrated registration, learning management and curriculum system. This has been a slow and sometimes painful process to develop one system to meet all needs including exam administration. This will mean that Canvas, ExamSoft, and E*Value will no longer be used by the end of this academic year.

What does the future Hold?

Return to un-masked, large class activities: IF the vaccine roll-out is expanded so we are all vaccinated and if the Covid-19 numbers (positivity rates, hospitalizations, etc.) improve significantly, then we may be able to “return to normal” by the time the next class of students begin in August. This is aspirational, but I think there is more room for optimism as herd immunity becomes more of a reality.

On-line medical education: Here to Stay. Medical education has undergone its most rapid changes ever seen in curriculum delivery. Almost overnight, almost all medical schools went to on-line education and it’s very unlikely to go away in medical education. The challenge is ensuring that it also is used for interactive learning with engaged discussions. In addition, on-line learning can also be asynchronous and is likely to be part of our educational delivery in the future. On-line education is also likely to become a hybrid process where students may choose to participate on-line or in-person. We are all trying to determine what is the best use of on-line learning in medical education for the future.

Remote, on-line exam administration: This has also become a reality and allows for significantly more flexibility for administration and convenience for students. This is almost certainly going to become the standard for the future. As we know all too well, even the threat of a hurricane can cause significant disruption of our normal activities, but on-line education can be particularly helpful in minimizing this disruption.

Step 1 Pass/Fail: The real impact of going pass/fail for Step 1 is yet to be determined. Overall, medical educators (as do students) see this as very positive however all of us want to be sure that this leads to a more holistic residency program application process. Concerns remain that Step 2 scores will take on more significance causing a negative impact on the curriculum, but no one is certain yet how this will all play out. We fully anticipate that our students will continue to enter the specialties they seek in the programs they are aiming for, as seen from evidence in previous match lists.

Pass/Fail for Clerkships: While a few schools have moved in this direction, the vast majority of medical schools still have grades for clerkships. Moving to a pass/fail system requires a very robust evaluation system, something that everyone agrees is important but is also very challenging for all schools. However, we are continuously working to improve our student evaluations and as other schools also move in this direction, we will continue to re-evaluate this issue.

Credits:

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