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Evaluation of the Medical Curriculum

The primary mission of the COM is to educate medical students in humanistic, scientific and practical principles of medicine in keeping with the emerging needs of society. Therefore, an effective, dynamic curriculum that serves its students and supports its teaching faculty must be continually reviewed to determine its quality and how students perform within it.

The following are the general goals of the curriculum evaluation system:

  1. To ensure that the curriculum is “appropriate” for the education and development of competent physicians.
  2. To assess whether the measurement tools are “appropriate” to gather data about the effectiveness of the programs.
  3. To update deans, teaching faculty and students as to the effectiveness of the educational program.

Curriculum planning at the UF COM is guided by a set of principles, which were adopted by the Curriculum and Executive Committees. These 12 principles describe which characteristics that the overall curriculum design should possess. The principles, therefore, should be the yardsticks to measure the success of the overall program. A specific evaluation plan is designed to assess the degree of accomplishment of each principle.

These principles are listed below:

  1. A general professional education is the goal of the curriculum.The curriculum is intended to provide a set of knowledge, skills and behaviors that encompass a broad overview of the practice of medicine and is relevant to becoming a competent caring physician regardless of subsequent specialty choice.Evaluation Issue:
    • Is there “appropriate” content in the curriculum for a general professional education?
    • Determine whether the general professional education program is having the desired impact on students

    Evaluation plan:

    • Solicit opinions of graduates as to how well the curriculum prepared them for the general practice of medicine.
    • Review periodically the college’s-adopted list of competencies to ensure a general professional education of each student.
    • Annual survey of UFCOM students performance in residency programs.
  2. The educational program and evaluations are competency based.The general professional education is defined by a set of competencies expected to be “mastered” by the students.Evaluation Issues:
    • Does the curriculum content and structure, and the student evaluation system, adequately include the use of competencies?

    Evaluation Plan:

    • Determine whether all competencies are addressed in the curriculum (i.e., that at least one course teaches it and evaluates students to be sure they are competent in the area).
    • Review competency categories to determine where each objective fits into the curriculum .
    • Course and clerkship reports should be analyzed for the extent to which education and evaluation is competency based.
    • Review descriptors to be sure appropriate descriptors are being used for competencies.
    • Assess competency list every 3-5 years to update/modify it.
  3. A conceptual framework for defining knowledge promotes learning and effective utilization of that knowledge and serves as a basis for curriculum integration.The curriculum committee has adopted the clinical presentation model as the primary mechanism for integrating basic and clinical science content.Evaluation plan:
    • An annual narrative report should be provided by the evaluation subcommittee to describe progress in implementing the clinical presentation model.
    • Course and clerkship reports should be analyzed for the extent to which they use the clinical presentation model.
  4. The ability to learn independently is essential for the physician to provide quality health care.Evaluation Issue:
    • Does the curriculum require students to learn independently (and if so, specify where)?

    Evaluation plan:

    • Annually evaluate student’s perception of their academic environment as a promoter of independent learning. Specific items in the annual class survey should assess student independent learning.
    • Course and clerkship reports should include information about activities to promote independent learning.
  5. Incorporation of the characteristics of outstanding physicians in the educational program is essential for complete professional development of students.Evaluation plan:
    • Utilize student self and peer evaluation.
  6. Effective health care delivery requires the attention to family and community context.Evaluation plan:
    • Assess how and where in the curriculum this topic is being formally addressed.
  7. A balanced variety of clinical settings are essential for students acquiring the mastery of competencies.Evaluation plan:
    • Decide upon and monitor the amount of inpatient versus outpatient clinical training site.
    • Decide upon and monitor the amount of primary care versus specialty care training.
  8. Informatics is essential for effective acquisition and utilization of information by students.Evaluation plan:
    • Provide a narrative description of the progress made toward implementing the Informatics plan adopted by the curriculum committee.
    • Evaluate students use of informatics.
    • Determine what course and clerkships utilize formal informatics activities.
    • Urban vs rural; underserved vs others
  9. The evaluation program is competency-based.
    • Is the competency system having the desired outcome in terms of student performance?
    • Have (for each clinical rotation/basic science course) an additional test, besides the shelf exams, that includes questions designed to see if students are competent in OUR competency areas, e.g., domestic violence, etc.
    • Using the data from the competency tracking system, each class should be annually assessed to ensure that the students as a group are making adequate progress in each of the competency categories.
    • Using data from our Performance Based Exam Series, each class should be annually assessed to ensure that the students as a group are making adequate progress in the competency categories assessed by those exams.
  10. Discovery of new knowledge and solutions are part of the medical profession.Evaluation plan:
    • Assess the level of student educational scholarship, e.g., medical student research and publications.
  11. Health care delivery requires individual and team efforts.Evaluation plan:
    • Determine the quality of activities which span colleges, departments, specialties, and provider types.
  12. Learning and professional development requires a humane environment, which fosters respect, personal integrity, service orientation and a sense of personal well being.Evaluation plan:
    • Insert items, addressing these issues, in the annual class surveys.
    • Institute a critical incident report program

Student Evaluation in Courses and Clerkships

Introduction

A set of graduation competencies (see attachment 1) that define the general professional education has been adopted. Course objectives and course student evaluation systems must now be aligned with competency attainment. This process will allow us to be in compliance with LCME standards and prepare us for our upcoming LCME site visit in the year 2000.

The following steps describe the process we must complete in order to implement this system in July of 1999.

Definitions

  • Competency: A knowledge, skill or behavior which must be demonstrated by medical students in order to achieve the primary goal of the medical education program-the general medical professional education.
  • Competency Category: A set of competencies grouped around a common theme.
  • Learning Objective: A competency or competency category utilized in a course as a statement of educational intent. For practical purposes learning objective and a competency are the same. A competency becomes a learning objective when it is utilized to express educational intent in a course.

Step 1: Alignment of course syllabi with the competency-based system

  1. Each course director will select specific competency categories, which their course is capable of teaching and assessing
  2. Learning objectives that are contained in the course syllabus will written in the following format:
    1. Learning objectives
    2. Learning activity associated with objective
    3. Method of assessment (see page or example)
  3. All clinical clerkships must include learning objectives based on professional behavior competencies
  4. All courses must include learning objectives based on core discipline competencies.Clinical clerkship core discipline learning objectives contain two components:
    • A set of clinical presentations assigned to the clerkship Each clerkship will be assigned a set of clinical presentations they will be responsible for teaching. This set was derived from a survey indicating what each course director stated they were currently doing.
    • Competency derived objectives unique to the discipline.

    These are, for the most part, the current course objectives.

    Basic science course core discipline learning objectives should include two components:

    • Competency based learning objectives related to clinical presentationsThis format is optional at this point in that we have not yet worked out the model for doing this. Courses, which have clinical correlation components, are encouraged to relate them to the clinical presentation list and list them as a separate set of learning objectives labeled “Clinical Presentation Learning Objectives.”
    • Competency based learning objectives unique to the discipline.

    These are, for the most part, the current course objectives.

Step 2: Develop a student evaluation form based on the competency based learning objectives

  1. Student evaluation will be based on competency attainment in the categories or specific competencies selected by the course director.
  2. Each competency or category will be weighted in order to determine the student’s final grade in the course (see example pages ).
  3. A standard competency assessment scale will be utilized in all courses (see attachment).
  4. COMEC will prepare a customized student evaluation sheet based on the course selections. These forms will be used for both formative and summative feedback.
  5. Competencies will be summed across all evaluators and all courses, thereby, allowing the generation of a student competency development profile.
  6. Additional competencies may be added if desired, but not additional competency categories.
  7. Equivalent competencies may be substituted for a graduation competency. In pediatrics for instance, the Diagnostic Competency, “Demonstrates ability to perform a comprehensive physical examination” might be replaced by “Demonstrates ability to perform a comprehensive examination of the newborn.”
FOOTNOTES*1 In preparing this report, the recommendations of two subcommittees that prepared reports on Faculty Evaluation in 1997 were reviewed. A subcommittee chaired by Pat Alguire submitted their report on April 9, 1997. A second report, prepared by Patrick Duff, Jeaninne Webb, and Tim VanSusteren, was submitted to the Curriculum Committee on September 10, 1997. In general, we confirm and support the recommendations of the Alguire Subcommittee. The major recommendations of the other subcommittee dealt with modifying the questions and format of the evaluations forms used in the College of Medicine, as part of the SUS standardization of the evaluation of the faculty. Since the COM is required to conform to the SUS standards, it is not productive to propose such modification.}