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Educational Program database - Rush University Medical Center

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					FSECTION II. EDUCATIONAL PROGRAM FOR THE M.D. DEGREE
GENERAL INSTRUCTIONS FOR COMPLETING THE DATABASE

Each question in the database is preceded by the relevant LCME accreditation standard. In some cases two standards
are closely related, and the questions are germane for documenting compliance with each of the two standards.
Additional related information is sometimes contained in the responses to questions that deal with other standards;
in those cases, cross-references to the additional information are included in italics. The cross-references are
intended to help self-study groups and the survey team identify all relevant data for assessing compliance with
standards.

For comprehensive instructions regarding database completion, please refer to the document “Background and
Instructions for Completing the LCME Medical Education Database and Institutional Self-Study,” available on the
LCME web site at: www.lcme.org/pubs.htm.

       The school should maintain a master database that contains all of the information used for the self-study.
        When it becomes necessary to update database sections after the self-study report is complete but prior to
        the survey visit, the school should create a separate database containing the updated information only.

       Most questions require a narrative answer or completion of a table; in some cases, it will be necessary to
        duplicate a blank table (for example, to summarize each of the school’s clinical teaching sites). Use as
        much space as necessary to answer each question completely, or to complete the tables.

       Any supporting documents that are requested in the database (e.g., bylaws, organizational charts, policy
        documents) should be compiled in a separate (red) binder, divided by tabs for each section of the database;
        do not include such appended materials in the individual database sections.

       The header on each page should indicate the most recent academic year for which information is available
        at the time of the self-study, not the academic year in which the database is being completed; in most cases,
        the year for which information is available will be academic year 2003-04 for self-studies conducted in
        2004-05. When the requested data are for a different time period than that indicated in the header, the
        applicable time period should be included in the response to the question.

        If database information is updated after completion of the self-study, the academic year listed in the header
        should be changed accordingly, and marked with the word “Update” in the header along with the year
        shown (e.g., “Update 2004-05”). Note that changing the header will affect all pages of a database section;
        therefore, a fresh (blank) copy of the database section should be used for updates.

       If requested information is available from the school’s web site, make sure to print a copy of the web site
        information for the master database maintained by the school. Changes to such documents after completion
        of the self-study should be printed and stamped “Updated” to indicate that they have changed, and included
        in the updated database. In addition, database pages that list URLs of modified web pages should indicate
        that the web site information has been altered from the original data available to the self-study groups.

       The database copies sent to the LCME Secretariat should include printed copies of any information referred
        to by website URL. The Secretariat is required to maintain complete print records of all database
        information.

       Most of the Key Quantitative Indicators (Part A of each database section) can be completed using
        information contained in the Longitudinal Statistical Summary Report. This report is prepared annually by
        the AAMC Section for Institutional, Faculty, and Student Studies, and sent directly to the dean.
Academic Year 2003-2004


SPECIAL INSTRUCTIONS FOR SECTION II: EDUCATIONAL PROGRAM FOR THE M.D. DEGREE

   Definitions:

        Curriculum Year: an academic period of study, usually but not necessarily corresponding to an academic
        year. In most cases, curriculum years correspond to the blocks of time that end with students being
        considered for promotion.

        Educational objectives: statements of the items of knowledge, skills, behaviors, and attitudes that students
        are expected to exhibit as evidence of their achievement. They are not statements of mission or broad
        institutional purpose, such as education, research, health care, or community service. Educational
        objectives are commonly stated in terms of what students are expected to learn, not what is to be taught.

        Educational (curriculum) track: a distinct educational program that (1) is designed to meet specific
        educational goals and objectives, (2) uses instructional settings or formats that differ from the standard
        program, and (3) is offered to some students during one or more years of the curriculum. For example, a
        school may offer a “PBL track” as an alternative to a traditional lecture-based program in the first two
        years of the curriculum.

        Geographically separate campus: an instructional site that offers a significant portion of the educational
        program (one complete year or more) at a distance from the medical school.

   For medical schools that use the AAMC Curriculum Management and Information Tool (CurrMIT), it is
    possible to answer several of the questions in Section II: Educational Program for the M.D. Degree, using
    CurrMIT reports. Consult the CurrMIT help line at the AAMC for further information. (E-mail:
    helpcurrmit@aamc.org Telephone: 202-828-0408)

   When answering the question for standard ED-28, limit your response to a few appropriate examples of
    evaluation materials that illustrate how the relevant skills are evaluated. Additional information or examples can
    be provided on site if requested by the survey team.

   Complete questions for standards ED-39 through ED-45 only if your school operates one or more
    geographically separate campuses as defined above.




LCME Medical Education Database 2004-05                   p. 2                                 II. Educational Program
Academic Year 2003-2004


SECTION II. EDUCATIONAL PROGRAM FOR THE M.D. DEGREE

                                      Part A: Key Quantitative Indicators

a. Total number of scheduled weeks of instruction for the complete educational program (Source: LCME Part II
Medical School Questionnaire)

                                                       150


b. For U.S. schools only: Provide the USMLE results for first-time takers during the three most recently
completed academic years (Source: National Board of Medical Examiners School Reports).

STEP 1:
                                  Number         Percent          Mean            National Mean
                   Year          Examined        Passing        Total Score        Total Score
                 2002-2003          118            94              221                 216
                 2001-2002          123            94              220                 216
                 2000-2001          110            95              222                 215


STEP 2:
                                  Number         Percent          Mean            National Mean
                   Year          Examined        Passing        Total Score        Total Score
                 2002-2003          105            96              217                 216
                 2001-2002          121            96              214                 216
                 2000-2001          112            96              211                 215


c. Show the percentage of graduating students who agree or strongly agree (sum of the two categories) with the
statement “Overall, I am satisfied with the quality of my medical education.” (Source: AAMC Longitudinal
Statistical Summary Report)

  1997-98        1998-99          1999-00          2000-01           2001-02           2002-03            2003-04
    87.1           93.0             92.9             85.5              87.2              89.2              91.1*

                                                    * Datapoint gathered from the Preliminary 2004 GQ report (n=70).




LCME Medical Education Database 2004-05                 p. 3                                  II. Educational Program
Academic Year 2003-2004


                    SECTION II. EDUCATIONAL PROGRAM FOR THE M.D. DEGREE

                                       Part B: Narrative Data and Tables
ED-1. The medical school faculty must define the objectives of its educational program.
       Educational objectives are statements of the items of knowledge, skills, behaviors, and attitudes
       that students are expected to exhibit as evidence of their achievement. They are not statements of
       mission or broad institutional purpose, such as education, research, health care, or community
       service. Educational objectives state what students are expected to learn, not what is to be taught.
        Student achievement of these objectives must be documented by specific and measurable outcomes
        (e.g., measures of basic science grounding in the clinical years, USMLE results, performance of
        graduates in residency training, performance on licensing examinations, etc.). National norms
        should be used for comparison whenever available.
ED-1-A. The objectives and their associated outcomes must address the extent to which students have
progressed in developing the competencies that the profession and the public expect of a physician.

        There are several wide recognized definitions of the characteristics appropriate for a competent physician,
        including the physician attributes described in the AAMC’s Medical School Objectives Project, the general
        competencies of physicians resulting from the collaborative efforts of the ACGME and ABMS, and the
        physician roles summarized in the CanMEDS 2000 report of the Royal College of Physicians and Surgeons
        of Canada. To comply with this standard, a school should be able to demonstrate how its institutional
        learning objectives facilitate the development of such general attributes of physicians. A school may
        establish other objectives appropriate to its particular missions and context.
_____________________________________________________________________________________________________________________
a. Complete the following table showing specific competencies expected of graduates, institutional objectives
related to each competency, and the outcome measure(s) indicating achievement of the objectives. Add rows
to the table as needed.

General Competency                     Institutional Learning Objective          Outcome Measure(s)

KNOWLEDGE:                              1. Demonstrate knowledge of key          All internal course examinations, all
Student must demonstrate                concepts of sciences basic to            NBME miniboards, NBME Step 1
mastery of the biologic, clinical,      medicine                                 and 2
epidemiological, and social-            2. Application of basic science          All internal course examinations, all
behavioral sciences as they relate      knowledge to prevention, diagnosis       NBME miniboards, NBME Step 1
to the practice of medicine.            and treatment of disease                 and 2, surgery essay exam, pediatrics
                                                                                 quizzes, Clinical Skills Assessment
                                        3. Demonstrate proficiency in the        Course examinations M-2 year, in
                                        principles and practice of               Preventive medicine courses,
                                        epidemiology and biostatistics as        Biochemistry, Physiology,
                                        they relate to patient care              Neurobiology

                                        4. Demonstrate awareness of              Clinical evaluations, Clinical Skills
                                        cultural and socioeconomic factors       Assessment (CSA), pathophysiology
                                        as they relate to disease distribution   cases, discussions & exams,
                                        in populations and to management         pediatrics sessions on the end-of life
                                        of individual patients                   discussions with patients & family.
                                        5. Awareness of the legal and            Ethics course, participation in
                                        ethical issues and controversies         scenarios in the Simulator lab
                                        associated with the practice of
                                        medicine




LCME Medical Education Database 2004-05                   p. 4                                  II. Educational Program
Academic Year 2003-2004



PATIENT CARE SKILLS:                  1. Ability to perform an accurate      Physical diagnosis, Interviewing and
The student must demonstrate the      and complete history and physical      Communication and Introduction to
ability to provide clinically         examination of patients of all ages.   the Patient exams, CSA, Clinical
relevant patient care.                                                       evaluations from all clerkships and
                                                                             electives, Observed Physical exam is
                                                                             performed during the Pediatrics &
                                                                             Internal Medicine clerkships
                                      2. Ability to record the history and   Clinical evaluations from all
                                      physical examination data in an        clerkships & electives, Physical
                                      organized, accurate and legible        Diagnosis, Introduction to the
                                      manner.                                Patient, and Interviewing and
                                                                             Communication course exams. CSA.
                                                                             Medicine & Surgery review of notes
                                      3. Ability to present clinical         All core & elective clinical
                                      information verbally in an             evaluations, CSA, presentation in
                                      organized, accurate and succinct       surgery selectives, during internal
                                      manner.                                medicine clerkship: participation in
                                                                             the ‘debate’ of an issue
                                      4. Ability to select diagnostic        Essay in surgery
                                      studies in an efficient and cost-      Clinical evaluations
                                      effective manner.
                                      5. Ability to identify a clinical      Clinical evaluation in core and
                                      problem, to assess the problem, to     electives, CSA, Pathophysiology
                                      develop an initial management plan     participation in case discussions and
                                      and sound diagnostic hypothesis.       exams
                                      6. Offer appropriate screening         Pediatrics, Internal Medicine, &
                                      options based on individual patient    Family Medicine clerkship
                                      risk profile and provide continuing    discussions & exams. Preventive
                                      care.                                  Medicine exams. CSA
                                      7. Ability to perform basic common     Clinical evaluations of cores and
                                      clinical procedures, with              electives. Specific procedures to be
                                      understanding of indications, yield,   taught in the cores include:
                                      risks and techniques                   Family Medicine: adult-pediatric
                                                                              preventive practices & chemical
                                                                              dependency/substance abuse.
                                                                             Internal Medicine: EKG
                                                                              interpretation, thoracenteses,
                                                                              evaluation of chest pain,
                                                                              management of HTN and DM
                                                                             Neurology: Lumbar puncture, C.T.
                                                                              neuro-imagery, performance and
                                                                              interpretation of the neuro-exam
                                                                             Obstetrics/Gynecology: pelvic exam,
                                                                              breast exam, PAP, wet mount prep
                                                                              for vaginitis
                                                                             Pediatrics: pediatric physical exam,
                                                                              communication skills, health
                                                                              maintenance
                                                                             Psychiatry: interviewing skills and
                                                                              Folstein Mini-Mental status exam
                                                                             Surgery: nutrition, fluid/electrolytes,
                                                                             abdominal radiographic exam,
                                                                             suturing, IV access



LCME Medical Education Database 2004-05                 p. 5                                II. Educational Program
Academic Year 2003-2004


                                       8. Analyze research literature and      Preceptorship, shared medical
                                       utilize electronic resources.           decision making literature search
                                                                               exercises, preventive medicine
                                                                               exercises and exams
                                       9. Ability to communicate with and      Clinical evaluations for cores and
                                       educate a diverse patient population    electives, CSA, Physical Diagnosis,
                                                                               Introduction to the Patient and
                                                                               Interviewing and Communication
                                                                               course exercises and exams.
                                        10. Provides comfort and support       Clinical evaluations for all cores and
                                        for patients and their families.       electives
                                        1. Display respect for all patients,   clinical evaluations for each core and
ATTITUDES/BEHAVIORS
                                        regardless of race, color, sex,        elective clerkship, course director
The student must demonstrate a
                                        gender, sexual orientation, creed,     summary for each clerkship, surgery
commitment to professional
                                        religion, national origin, ancestry,   measure. Interviewing and
behavior.
                                        age, marital status, parental          Communication exam
                                        status, or veteran status
                                        2. Advocate for the needs of the       Clinical evaluations for each core and
                                        patient                                elective
                                        3. Interact with other members of      Clinical evaluations for each core and
                                        the health care team cooperatively     elective
                                        & professionally, with integrity and
                                        honesty, facilitating patient care
ATTITUDES/BEHAVIORS                     1. Demonstrate activity in research,   Participation in Rush Research
The student must exhibit a pattern      presentations at conferences and       Forum, annual surveys of PGY-1 and
of self-directed and continuous         publications.                          PGY-2 alumni and periodic surveys
learning.                                                                      of all alumni as to research
                                                                               productivity and paper/poster
                                                                               presentations.
                                        2. Attend continuing medical           Periodic surveys of alumni as to
                                        education presentations and            frequency of attendance at CME
                                        professional conferences               presentations and professional
                                                                               conferences


An ad-hoc Objectives Project Committee recently updated and restated the above objectives to make them easier to
measure and to clarify our broader general competencies. These updates will be brought to Curriculum Committee
and Faculty Council for approval. The version being presented for approval appears in the table above. The
objectives which are currently in place appear in the Institutional Setting database.

b. Indicate the year in which present institutional learning objectives were originally adopted and the year in
which they were most recently reviewed or revised.
                                          Year Adopted       Year Last Revised
                                              1997                2004*
                         * Our updated objectives (above) are being considered by the Curriculum
                         Committee. They will also need formal adoption by Faculty Council.


See also information for standard ED-47 in this section of the database.




LCME Medical Education Database 2004-05                   p. 6                                II. Educational Program
Academic Year 2003-2004


ED-2. The objectives for clinical education must include quantified criteria for the types of patients (real or
simulated), the level of student responsibility, and the appropriate clinical settings needed for the objectives
to be met.

       Each course or clerkship that requires physical or simulated patient interactions should specify
       the numbers and kinds of patients that students must see in order to achieve the objectives of the
       learning experience. They should also specify the extent of student interaction with patients and
       the venue(s) in which the interactions will occur. A corollary requirement of this standard is that
       courses and clerkships will monitor and verify, by appropriate means, the number and variety of
       patient encounters in which students participate, so that adjustments in the criteria can be made if
       necessary without sacrificing educational quality.
____________________________________________________________________________________

a. Describe how both individual departments and the curriculum committee determine the number and kinds
of patients and the clinical settings needed to meet the objectives for clinical education.

The determination of “numbers of” and “types of” patients will be developed by each core clerkship course director
in partnership with the Curriculum Committee and the Director of Clinical Education. This process will be informed
by the data available from the Internal Medicine log books (which students have completed), data from the Surgery
core rotation tracking instrument and data from all other core clerkship courses.

All programs with student/patient contact occur in varying inpatient and ambulatory combinations at eight medical
centers and five private practices. Departments select course directors who are skilled educators. Because
departments have not yet specified the numbers and types of patients they expect students to see, the Curriculum
Committee is not currently involved with determining kinds of patients and numbers required to meet course
objectives. The clerkship directors have had a long-standing commitment to requiring students to use a web-based
tracking system but have been awaiting resources for this activity. Requests for a system to our own Information
Services remain unattended for three years. The Curriculum Committee created an ad hoc task force to select a web-
based tracking system for patient contacts. Students will be able to log-in from an Internet-connected computer and
record patient contact with demographics and diagnoses (at whatever level of specificity the course director will
require). We expect to have this system implemented sometime during the academic year. It will also allow course
directors to track in real time clerkship students’ experiences and to make adjustments in patient assignments to
meet all students’ educational objectives for the course.

The clinical settings for our preceptorship and our required clerkships in family medicine, obstetrics and
gynecology, psychiatry, and surgery as well as our sites for our subinternships in family medicine, internal
medicine, pediatrics, and surgery have been specifically selected because they offer the broadest patient mix and the
most diverse patient population necessary for each student to attain the goals and objectives of the respective
program. Students in the Internal Medicine Core Clerkship (MED 601) are rotated through the same three sites,
including both inpatient and outpatient units, to ensure sufficient and comparable experiences. In NEU 601, all
students spend two weeks in the Critical Care/Stroke unit and are required to evaluate a patient with either epilepsy
or multiple sclerosis. In PED 601, students complete thirty-one simulated pediatrics cases in order to be exposed to
similar content. The course directors for PCM 505, FAM 601 MED 601, NEU 601, PSY 601, SURG 601, FAM 610,
and MED 610 reported they have specific quantitative criteria for the numbers or types of patients students are
expected to see for these courses. Students in all programs assume responsibility commensurate with their training
level and are always under the supervision of a resident or attending. In PCM 505, offered in the M2 year, students
are limited to completing a history and physical exam.

In all seven clerkships, students additionally develop differentials, write SOAP notes, formulate assessments and
plans, and follow-up with patients when possible. All subinterns function as junior housestaff. They are expected to
assume full responsibility for patients under the close supervision of a practicing physician who must cosign all
orders that are submitted.

Specific clerkship information follows for the clinical settings:




LCME Medical Education Database 2004-05                     p. 7                              II. Educational Program
Academic Year 2003-2004


Family Medicine Core Clerkship (FAM 601): The Family Medicine Core Clerkship is a six-week ambulatory
rotation, offering students a wide variety of experience encountering the acute, chronic, and undifferentiated clinical
problems of primary care medicine. Learning sites consist of Family Medicine Residency Programs (six sites), as
well as private practices in the area (five sites). The student is expected to work regular weekday hours in a
physician’s office, which may include some evening or Saturday hours. There are no formal requirements for
overnight or weekend call, but students are encouraged to participate in these experiences by individual
arrangement. The expectation is that students spend eight half-day patient care sessions each week observing and
providing care for patients under the direct supervision of a practicing family physician (attending or resident), such
that by the end of the rotation, students are seeing five to eight patients per half day.

Family Medicine Subinternship (FAM 610): The subinterns are assigned to a team of junior and senior residents
responsible for a service of adult general medicine patients. The subinterns are assigned to Rush Copley, MacNeal
Memorial Hospital, Rush Oak Park Hospital, or John H. Stroger Jr. Hospital of Cook County. Students take call
seven times during the rotation, with supervision from a senior resident. On these call nights, as well as during the
days (other than post-call), they admit patients and serve in a role similar to an intern, with close resident
supervision. They maintain a service of three to five patients during the rotation. The inpatient services of the
residencies are busy and accept a diverse range of adult medical patients. The senior resident does try to assign a
broad case mix to the subintern, but the experience is dependent upon the patients that are admitted. Subinterns
participate in discussions with other team members’ patients on the inpatient service during morning report and
during teaching rounds. Faculty teaching rounds also allow discussion of specific disorders. Subinterns evaluate and
manage their patients from admission through discharge, selecting diagnostic and therapeutic intervention, under
close supervision by a senior resident, who must examine the patient and cosign all orders. Subinterns see their
patients at least daily and communicate with the attending physician. The senior resident of the team is responsible
for assigning patients to junior residents and subinterns.

Internal Medicine Core Clerkship (MED 601): Students spend one month apiece at each of three sites during their
internal medicine clerkship. Each student spends one month at Rush University Medical Center on a general
medicine floor, one month at John H. Stroger Jr. Hospital of Cook County on a general medicine service, and one
month in an ambulatory setting. Each setting offers a variety of patients. By rotating students across each of these
sites, we assure all students receive comparative experiences.

Internal Medicine Subinternship (MED 610): Subinterns function as junior house staff and have two patients
assigned during each on call day. The patient population is the same for subinterns as for interns. There is a wide
mixture of general medical patients as well as subspecialty-oriented patients with general medical problems. The
student-patient interactions are entirely hospital based. Subinterns function as junior house staff. They have potential
for full responsibility with very close supervision of senior residents. All orders must be signed off on by a resident.

Neurology Core Clerkship (NEU 601): For a balanced experience, the curriculum at Rush has been designed such
that students spend two weeks each on the Critical Care/Stroke and General Neurology services. They are assigned
1-4 patients to follow on a daily basis. Additionally, they are each required to evaluate a patient with multiple
sclerosis and epilepsy as described earlier. At the Stroger site, students evaluate patients in outpatient clinics in
addition to having inpatient responsibilities.

Obstetrics and Gynecology (OBG 601): Patient experiences are derived from those who receive care at any of the
three sties (RUMC, Stroger, and West Suburban). The patients represent an extremely diverse group regarding age,
race, ethnic background, socioeconomic factors, and the variety of obstetric and gynecologic conditions that are
associated with each of these factors.

Physical Diagnosis II (PCM 505): Each student is assigned one patient per day. Students actually see a wide variety
of patients, including medical, neurological, post-surgical, and post-transplant. Patients only need to be alert, be able
to converse with the student, and be able to give their permission. The student assumes responsibility only to do the
History and Physical. There is no responsibility toward treatment or follow-up of patients.

Pediatric Core Clerkship (PED 601): Students on this clerkship do not currently use a tracking system but plans exist
to put this in place in the upcoming academic year. The course is broken down into components with the expectation
that a certain amount of time in a clinical setting will lead to adequate exposure to allow accomplishment of the



LCME Medical Education Database 2004-05                     p. 8                                 II. Educational Program
Academic Year 2003-2004


course goals and objectives. Beginning in July, 2004, students will complete all 31 CLIPP (Computer Assisted
Learning in Pediatrics Project) cases as a part of this clerkship. This new system ensures all students have the same
exposure to content. These multi-media cases cover the core objectives of the Committee on Medical Student
Education in Pediatrics’ curriculum that forms the basis for the course. [See http://www.CLIPPcases.org for details].
CLIPP cases completed that week by students are reviewed in detail in structured sessions with faculty one
afternoon each week. Most often, students interact with patients on the general pediatrics floor, although some
students will evaluate patients in the Emergency Department. Students are expected to see patients relatively
independently, depending on the setting. As an example, students assigned to the pediatrics wards are expected to
work independently with patients, under the direct supervision of the house staff and attending physician. Students
take on the responsibility of patient assessment and decision-making under close supervision.

Pediatric Core Clerkship (PED 610): Students are exposed to the variety of patients admitted to the hospital. The
supervising senior resident and the attending physician, along with the subintern, are responsible for monitoring the
case mix that the student cares for. The senior resident, in particular, is able to vary the students’ experiences
through the assignment of cases. Although there is some seasonal variation, students have an opportunity to manage
a wide variety of patients. Most often, students interact with patients on the general pediatrics floor, although some
students will evaluate patients in the Emergency Department. Students take on the same responsibilities as interns,
although they are responsible for fewer patients.

Psychiatry Core Clerkship (PSY 601): The three major settings, as they apply to psychiatry, are incorporated in this
clerkship: inpatient, outpatient, and consultation/liaison. Students are exposed to two of the three. Students assigned
to the inpatient unit see a wide variety of psychiatric diagnoses, including depression, bipolar disorder, and
schizophrenia. Students on the C/L service see a variety of medical conditions that may exacerbate or even cause
psychiatric disturbances. The outpatient setting provides students the opportunity to see a variety of psychiatric
illnesses and their treatments in an ambulatory setting.

Surgery Core Clerkship (SUR 601): Each student is required to complete a web-based instrument which tracks
patients and disease process in their clinical setting on a daily basis. Students interact on hospital wards, the
operating room, the ambulatory clinic, and the emergency room.

General Surgery Subinternship (SUR 610): The criterion for the subinternship is that students function as interns,
not whether they see a specific number or mix of patients. Students are assigned to a general surgery service. Patient
mix and variety will vary according to the site and service. Interactions with patients occur on the hospital wards and
in the operating room.

Provide a list of all clerkships that employ quantified criteria for patient number and types or clinical settings
needed to achieve clerkship objectives.

MED 601: Internal Medicine Core Clerkship: Students are instructed to admit one to two patients during each of
 their 14 nights on call. These expectations are also given to the attending physicians and housestaff who supervise
 the students. Students are expected to see at least 4-6 patients per day during their ambulatory block. All students
 see patients in three clinical settings: a tertiary care hospital, a county hospital, and a general internal medicine
 office.

MED 610: Internal Medicine Subinternship clerkship: Students have two patients assigned each day on call.

NEU 601: Neurology Core Clerkship: Students see one to four patients on a daily basis.

PED 601: Pediatrics Core Clerkship: On the inpatient rotation, students are expected to follow at least two patients
at all times, more if the student is capable. Students submit a copy of one history and physical every week.

b. How is the adequacy of the number and variety of patient encounters monitored? Who is responsible for
assuring that the number and variety of patient encounters are adequate?




LCME Medical Education Database 2004-05                    p. 9                                 II. Educational Program
Academic Year 2003-2004


Although this project is still under development, the course directors expect to review data from students about their
patient encounters. The OMSP is evaluating web-based tools to facilitate the collection and review of such data. We
hope to acquire this technology in the next few months. The Curriculum Committee plans to recommend a standard
guideline that the core clerkships should follow when monitoring such information during the clinical experience.

Overall, course directors are responsible for monitoring the number and variety of patient encounters as well the
adequacy of these encounters. Students in PCM 505, FAM 601, MED 601, NEU 601, PSY 601 and SUR 601
maintain patient logs to track the number and variety of patients encountered. In PCM 505, preceptors are
responsible for assuring an adequate number and variety of patient encounters. The respective clerkship directors of
Family Medicine Core Clerkship (FAM 601), Internal Medicine Core Clerkship (MED 601), Psychiatry Core
Clerkship (PSY 601), and Surgery Core Clerkship (SURG 601) monitor these logs and make necessary adjustments.
While there are no formal logs in Obstetrics and Gynecology Core Clerkship (OBG 601), the clerkship director
conducts an ongoing evaluation of student encounters. Patient mix for students in PED 601 is reviewed by residents
and faculty; students are exposed to five clinical components with the expectation that this will lead to an adequate
mix of patients. In Neurology Core Clerkship (NEU 601) and Psychiatry Core Clerkship (PSY 601), the senior
resident reviews the patient logs and makes modifications to student exposure if necessary. The senior resident in all
four subinterships assigns and oversees the student’s case panel in order to optimize their educational experience.

Any proposals for a new core clerkship would be reviewed by the Curriculum Committee (which requires detailed
plans and data to ensure that students would get an adequate volume of patients as well as diversity in patient
demographics and diagnoses).

Examples from specific courses follow:

Family Medicine Core Clerkship (FAM 601): Students maintain a logbook identifying patient encounters, and
general types of medical issues, as well as common procedures. These data are reviewed twice a year, with
discussion with site directors to make any necessary changes. The course director assesses feedback from students
regarding their Family Medicine experience, and relays any deficiencies to the site directors for correction at their
various locations.

Family Medicine Subinternship (FAM 610): While we do not currently track patient encounters on the
subinternship, we plan to do so when web-based data entry and analysis is acquired by the medical college. The site
coordinator and the teaching attending physician, along with the senior resident on the service monitor the
subintern’s patient panel to maintain adequate service size and diversity within the constraints of the overall patient
census on the service.

Internal Medicine Core Clerkship (MED 601): Each student completes a logbook to document the patients he/she
has followed over the course of the clerkship. The clerkship director and co-directors regularly meet with students to
review cases and monitor the students’ experiences informally.

Internal Medicine Subinternship (MED 610): Resident evaluations.

Neurology Core Clerkship (NEU 601): Patient log sheets are submitted by each student. The senior resident is
responsible for assigning patients to optimize the student’s educational experience. The senior resident and clerkship
director are responsible for assuring that the number and variety of patient encounters are adequate.

Obstetrics and Gynecology Core Clerkship (OBG 601): There is an ongoing evaluation of the patients for which
students participate in the care. The clerkship director is responsible for assuring the number and mix are adequate.

Physical Diagnosis II (PCM 505): Students keep patient logs that track variety and number of patients seen. In the
future, preceptors will be responsible to ensure that each student gets a proper mix of patients.

Pediatric Core Clerkship (PED 601): This clerkship does not currently use a system to track exposure in clinical
settings. They plan to do so when web-based data entry and analysis is acquired by the medical college. The rotation
is broken down into components with an expectation that a certain amount of time in these clinical settings will lead




LCME Medical Education Database 2004-05                    p. 10                                II. Educational Program
Academic Year 2003-2004


to adequate exposure to allow accomplishment of goals and objectives. The CLIPP cases guarantee the same
exposure from one student to the next. The residents and faculty monitor the variety of the students’ experiences.

Pediatric Subinternship (PED 610): We do not require students to maintain logs but plan to implement a web-based
system to allow students to track patients they see and their experiences when it is acquired by the medical school.
Students carry an average of three patients and accept one to two new admissions when on call. The supervising
resident, the attending physicianand the course director assure that the number and variety of encounters are
adequate.

Psychiatry Core Clerkship (PSY 601): The chief resident or the chief of service for the various areas assigns patients
to students and monitors the number and variety of encounters for students. The course director is ultimately
responsible to assure the number and variety of patients are adequate for the students’ education. Students are
required to keep a tracking log of all patient encounters during the rotation. This log is returned to the course
director at the end of the rotation and kept with the student’s permanent file.

Surgery Core Clerkship (SUR 601): It is monitored by reviewing the tracking instrument on an annual basis. The
clerkship director is responsible for assuring that the number and variety of patient encounters are adequate.

Surgery Subinternship (SUR 610): There are no tracking logs for subinterns. The chief resident of the service
monitors the adequacy and variety of encounters. The course director reviews patients and procedures for each
service.

See also the Required Clerkship Forms.




LCME Medical Education Database 2004-05                   p. 11                                II. Educational Program
Academic Year 2003-2004


ED-3. The objectives of the educational program must be made known to all medical students and to the
faculty, residents, and others with direct responsibilities for medical student education.

       Among those who should exhibit familiarity with the overall objectives for the education of medical
       students are the dean and the academic leadership of clinical affiliates where the educational program
       takes place.
____________________________________________________________________________________

Describe how the general objectives of the educational program are made known to: (a) medical students;
(b) instructional staff, including full-time and volunteer (community) faculty, graduate students, and resident
physicians with responsibility for teaching; and (3) academic leadership of the medical school and its
affiliated institutions.

The general objectives are made available on the Rush Medical College website to all three groups:
http://www.rushu.rush.edu/bulletin/rmcobj.html

Part of the process for approval of the revised RMC objectives includes discussion at the course director, teaching
faculty, standing committee and Faculty Council levels. A separate though very important process will be seeking
feedback from the student body. We expect to utilize the structure of the Student Council for the RMC to conduct
meetings and web-based informational exchange. We plan to launch a web-based survey to all departments involved
in RMC instruction. This approach will both instruct them in the objectives for RMC while also seeking feedback
about additional ways to measure these objectives. Each course director will review the RMC objectives and align
with each objective applicable course objective written as learner objectives. The product of this project will be an
electronic document organized by course detailing specific course objectives, linked to institutional RMC objectives
and assessment information specific to each course objective.

These objectives are operationalized through the course objectives developed for each course and clerkship. Ideally,
the revised course objectives will be included in materials containing course objectives. Some representative
examples follow:

The Core Clerkship Handbook was an annual publication that specifies learning goals and expectations for each
clerkship and subinternship. This handbook was distributed at the beginning of the year to all students, to all site
coordinators and to the leadership of Rush Medical College. The goals and objectives are reiterated to students
during orientation sessions at the start of each program. This information is now available in an online directory
(OASIS) which allows us readily to update courses to reflect any changes in course directors or objectives. More
importantly, it allows students to register for courses over the web, to make changes in their schedule, and to
determine which clerkships have openings for students in a specific rotation.

Clerkship directors relay goals and objectives to site coordinators through meetings, correspondence, and telephone
contact. The coordinator at each site communicates the goals and objectives to supervising attendings and residents.
Clerkship students in family medicine, pediatrics, and internal medicine and the pediatrics subinternship receive
supplemental manuals that further detail the educational goals and expectations of the respective clerkships. The
pediatrics clerkship and subinternship publish a manual for supervising physicians that describes the role of faculty
and housestaff in accomplishing program goals and objectives.

Family Medicine Core Clerkship (FAM 601): The students receive a copy of the Family Medicine Clerkship
educational goals and objectives, as well as the student expectations and responsibilities, in writing, approximately
two weeks prior to the start of their rotation. These are all reiterated verbally, by the course director, at the
orientation session at the start of each rotation. In addition, all students receive site specific goals/objectives and
expectations from the various practice sites. At the start of each academic year, the site coordinators at the various
locations used for the rotation receive an updated version of the student clerkship manual. The course director also
communicates regularly with all site coordinators to provide and obtain any particular feedback

Family Medicine Subinternship (FAM 610): Objectives and schedules are provided to subinterns the first day of the
rotation by the site coordinator or his/her faculty designee. Protocols for supervision and teaching are also provided.
Site coordinators communicate expectations to the teaching faculty and housestaff with whom the subinterns work.



LCME Medical Education Database 2004-05                    p. 12                                 II. Educational Program
Academic Year 2003-2004


The course director communicates expectations to the coordinators of each site and to the Office of Medical Student
Programs.

Internal Medicine Core Clerkship (MED 601): Students receive a copy of the goals and objectives as part of the
student handbook and curricular guides, which are distributed at the Internal Medicine Clerkship orientation on the
first day of each rotation. These are all reiterated verbally by the course director during orientation. Rush housestaff
all receive information about objectives during a yearly day-long resident retreat. Faculty members receive this
information through faculty development sessions and in meeting with the clerkship director and/or co-directors.

Internal Medicine Subinternship (MED 610): The educational goals for the subintern are to put all experiences
together as a junior intern. The expectations are the same as those of an intern. The student is given the opportunity
to function at that level. The clerkship director meets with the director at Stroger hospital to disseminate educational
objectives.

Neurology Core Clerkship (NEU 601): Students are informed of educational objectives via email before the rotation
begins and verbally, during orientation. Previously, educational staff was informed via departmental mail/verbal
communication. This will now be done through email. Leadership of the medical institution and the clinical sites are
informed through the curriculum office/clerkship handbook. At the Stroger site, this is done by the site director, who
is quite familiar with the educational objectives as set forth by the department’s education committee.

Obstetrics & Gynecology Core Clerkship (OBG 601): Written materials are distributed to students at the orientation
for this clerkship. There are fifty pages of material, which include the APGO objectives. These objectives are also
made accessible to students through the APGO website. Residents are given these same materials. The weeklong
orientation for new interns includes a presentation by the clerkship director to help orient them on how to work
effectively with medical students. Faculty members are provided the written educational objectives as well as a
written policy concerning the grading system.

Physical Diagnosis II (PCM 505): Educational objectives are put in Student Manuals. Educational objectives are
made available to teaching staff in the Preceptor Guides that have been developed. Preceptor orientations are also
given. A copy of the student and preceptor guide is always available to the Dean's office.

Pediatric Core Clerkship (PED 601): Approximately one week prior to beginning the pediatric core clerkship,
students receive an electronic copy of The Student Handbook which details the curriculum, educational objectives
and expectations of the students. A copy of The Student Handbook is available upon request. Similar to The Student
Handbook, we also developed The Physician Supervisor’s Handbook -- which describes the course objectives and
roles of the faculty and house staff in accomplishing those goals and objectives. Pediatrics 601 uses only two sites:
Rush and the John H. Stroger Jr. Hospital of Cook County. The site director at Stroger, Alok Rastogi, coordinates all
activities for the Stroger students. Students at both sites meet every Wednesday for the same CLIPP case
discussions. The schedules (amount of time and areas of the hospital to which the student is assigned) of the two
groups of students are very similar.

Pediatric Subinternship (PED 610): Students receive printed goals and objectives at the beginning of the sub-
internship. Faculty and residents receive a copy of the goals and objectives of the sub-internship in addition to a
copy of The Physician Supervisor’s Handbook, which details expectations. Rush is the only clinical site we use for
the sub-internship. Copies of these handbooks have been given to the leadership of the medical school.

Psychiatry Core Clerkship (PSY 601): They are distributed to students during orientation (first day of the rotation).
Faculty members responsible for didactic lectures are given learning objectives about their respective topics; their
lectures are to be designed to incorporate these objectives. This material is distributed to the various sites on an
annual basis. In addition, the course director maintains contact with the various sites throughout the year, both in
person and over the telephone, to insure that learning educational objectives are being met.

Surgery Core Clerkship (SUR 601): Students are informed during orientation session and orientation manual. The
course director corresponds annually and on an as needed basis with faculty. The leadership and sites are informed
through course director correspondence.




LCME Medical Education Database 2004-05                    p. 13                                 II. Educational Program
Academic Year 2003-2004


Surgery Subinternship (SUR 610): Orientation of students by chief resident. The course director corresponds with
faculty. The leadership and sites are informed through course director correspondence.




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Academic Year 2003-2004



ED-4. The program of medical education leading to the MD degree must include at least 130 weeks of
instruction.
____________________________________________________________________________________

Provide the number of scheduled weeks of instruction in:

               Year One              35
               Year Two              35
               Year Three            39*
               Year Four             39*
               * 78 weeks of required clerkships and electives must be completed in the third and
               fourth years. As the sequence is individualized for each medical student, the number of
               weeks completed in a particular year may vary.


See also Part A, item (a.) in this section of the database.




LCME Medical Education Database 2004-05                       p. 15                           II. Educational Program
Academic Year 2003-2004


ED-5. Medical faculty must design a curriculum that provides a general professional education, and fosters in
students abilities to learn through self-directed, independent study throughout their professional lives.
____________________________________________________________________________________________________________________________________________________________

a.   Supply a copy of the default “Course Schematic” report from the online AAMC Curriculum Directory, for the
     most recent academic year completed. The “Course Schematic” shows the approximate sequencing of, and
     relationships between, required courses and clerkships in each academic period of the curriculum.

     The Course Schematic is provided in the Appendix.

b. Supply a copy of the default “Required Courses & Clerkships” report from the online AAMC Curriculum
Directory, for the most recent academic year completed. The “Required Courses & Clerkships” report shows a list
of required courses and clerkships, with educational methods, in each academic period of the curriculum.

           The Required Courses & Clerkships report is provided in the Appendix.


c. If the school offers multiple educational program tracks, provide a separate description of any tracks not included
in the AAMC Curriculum Directory.

           Only one educational program track is offered.




LCME Medical Education Database 2004-05                                     p. 16                                            II. Educational Program
Academic Year 2003-2004


ED-6. The curriculum must incorporate the fundamental principles of medicine and its underlying scientific
concepts; allow students to acquire skills of critical judgment based on evidence and experience; and develop
students’ ability to use principles and skills wisely in solving problems of health and disease.

ED-7. It must include current concepts in the basic and clinical sciences, including therapy and technology,
changes in the understanding of disease, and the effect of social needs and demands on care.
____________________________________________________________________________________

Provide one or more examples of how students acquire the following skills and understanding:

a. Ability to learn through self-directed, independent study

In the pre-clinical years, students have the opportunity and are encouraged to direct their own study in several
courses. ANA 451, 471, and 472 each require the student to work independently in the laboratory. In ANA 451,
students view histologic structures in a self-directed mode with assistance from the laboratory instructor as
requested. In ANA 471 and 472, students study independently, or in small groups, in the gross anatomy lab. MED
501-503 emphasizes small-group learning and independent study. Students assign one another research assignments,
which are reported to the group at a later session. The topics assigned are largely determined by the students. Other
courses, such as PCM 531 and PSY 501, include in its syllabus many leading references which the interested student
may pursue.

During the clinical years, the clerkships and sub-internships, including MED 601, NEU 601, OBG 601, PED 601,
SUR 601, and PED 610 expect students to independently read about their patients’ disease processes.

Examples from specific courses follow:

Histology (ANA 451): Students work in laboratory identifying histologic structures in a self-directed mode with
assistance from the laboratory instructor as requested.

Human Anatomy I and II (ANA 471 & 472): Students study independently or in small groups in the Gross Anatomy
lab. They review previous material and prepare for examinations.

Internal Medicine Core Clerkship (MED 601): Since the clerkship is primarily centered around patient care, students
are encouraged and assessed on their ability to learn about their patients’ problems independently on a daily basis.
Our curricular guide contains an outline of topics for study that students are expected to read about and learn
independently, utilizing housestaff and faculty as resources. Each student participates in a “Student Grand Rounds”
during the Rush block of the clerkship. During this session each student must ask a structured clinical question about
a patient, conduct a literature search and pull the “best article” that addresses the question, and present this material
at a student run conference in the format of a “critically appraised topic.”

Internal Medicine Subintership (MED 610): Subinterns have extended responsibility for patient care. For each
patient encounter, the student must develop an assessment and plan for patient care and then institute it. This
requires accessing information as to diagnostic and therapeutic interventions.

Neurobiology (NEU 451): This course uses case-based exercises to develop skills in localization of lesions and
exploration of mechanisms of neurologic disorders. The course requires presentation of strategies and approaches
to decoding neurologic problems. Students generally practice these skills independently and in study groups, and
as part of our formal course in Grand Rounds sessions.

Neurobiology Core Clerkship (NEU 601): Students are assigned patients for whose initial evaluation and daily
follow up care they are responsible, under supervision. There is a recommended reading list and they are encouraged
to read and perform literature reviews pertinent to their patients’ conditions. They may also be assigned topics for
presentation.

Obstetrics and Gynecology Core Clerkship (OBG 601): As the student participates in the clinical care of patients,
the student is required to learn through self-directed, independent study in order to formulate clinical impressions,


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Academic Year 2003-2004


develop differential diagnoses, and make management plans. As the student progresses and demonstrates increasing
abilities in this area, they are called upon to further increase the amount of learning that they accomplish
independently.

Introduction to Patients (PCM 501): Practice time of basic physical diagnosis skills

Physical Diagnosis IV and Physical Diagnosis VI (PCM 504 & 506): Each session requires students to do
independent reading and studying. We encourage students to practice exam stills and to listen to heart and lung
sounds on friends and family on their own time.

Interviewing and Communication I and IV (PCM 511 & 514): In-class exercises: presenting symptom information
on patients, with preparation based on transforming self directed reading into communication language
understandable to the patient.

Pediatric Core Clerkship (PED 601): Students complete a weekly “case analysis” independently which is graded.
The cases all involve topics in the curriculum. In addition, while on the pediatric ward for four weeks of the course,
students develop clinical questions which they independently pursue.

Pediatric Subinternship (PED 610): Subinterns independently manages patients assigned to them under supervision
of the resident and attending faculty.

Physiology I and II (PHY 451 & 452): Although this is not addressed directly, many small group sessions rely to
varying extents on self directed study. It might also be noted that the highest degree of success in this course does
require some degree of independent self-directed study.

Health of the Public (PCM 531): The course syllabus includes many leading references to which the interested
student is referred to learn more about a given topic.

Psychopathology (PSY 501): Recommended reading assignments are provided for each topic.

Psychiatry Core clerkship (PSY 601): Students are purposely given free time to read and to examine the particular
diagnoses of their patients. These concepts are then discussed with their supervising residents.

Pathology I, II and III (PTH 511, 512 & 513): The syllabus includes a set of learning objectives and reading
assignments, which will enable the student to find the necessary information as a supplement to the lectures.

Surgery Core Clerkship (SUR 601): Students are given a patient to workup and follow in hospital. The student is
expected to read about this patient’s disease process. During teaching rounds, the student is expected to be able to
answer questions about this patient’s disease process.

b. Skills of critical judgment based on evidence

Students are required to analyze visual information, and apply that knowledge towards answering simple clinical
case questions in ANA 471 and 472. In MED 501-503, students analyze a case presentation, and then decide on a
differential diagnosis.

The skills underlying evidence-based medicine are taught in PCM 531, including sensitivity and specificity,
incidence and prevalence, and others.

Evidence-based medicine in also taught in NEU 451, when students are asked to develop and rank alternative
hypotheses, formulate questions, and search for literature to support a particular hypothesis.

Evidence based medicine is also addressed in the internal medicine clerkship (MED 601), when each student
participates in a “Student Grand Rounds.” During this session the student must ask a structured clinical question,
conduct a literature search and pull the “best article” that addresses the question, and present this material at a



LCME Medical Education Database 2004-05                    p. 18                                 II. Educational Program
Academic Year 2003-2004


student run conference in the format of a critically appraised topic. In the internal medicine subinternship (MED
610), students meet weekly and review journal articles with the course director. In the pediatrics clerkship (PED
601), students prepare a debate on a controversial clinical subject using current literature.

Examples listed by specific courses follow:

Histology (ANA 451): Students must be able to analyze visual information from specimens to determine the
tissue/organ origin of the specimen.

Human Anatomy I and II (ANA471/472): They are required to identify specific anatomical structures during
practical exams. They are also tested with written questions that expect them to apply anatomical knowledge in
order to answer simply clinical case questions.

Biochemistry I, II and III (BCH 470, 471 & 472): Students are expected to read and participate in discussions of
how basic biochemistry is related to disease based on clinical cases.

Behavioral Science: Ethics in Medicine I and II (BHV 481 & 482): We give many readings for lecture and small
group classes. Students are asked to read these, but also to search for other relevant material as required. Also, for
term paper assignments, students frequently search the literature to enhance their comprehension of the assignment.

Pathophysiology I, II and III (MED 501-503): Students generate questions from the cases discussed in the facilitator
sessions and look these up before subsequent sessions. Also students are expected to have read reading objectives
prior to coming to class.

Internal Medicine Core Clerkship (MED 601): Each student participates in a “Student Grand Rounds” during the
Rush block of the clerkship. During this session, each student must ask a structured clinical question about a patient,
conduct a literature search and pull the “best article” that addresses the question, and present this material at a
student run conference in the format of a “critically appraised topic.”

Internal Medicine Subinternship (MED 610): The students meet weekly and review journal articles with the course
director. This year’s focus has been on the national clinical exam.

Neurobiology (NEU 451): Evidence-based approaches are inherent in the case exercises for this course (i.e., the
development and ranking of alternative hypotheses, questions needed to confirm these, and literature searches to
help support a particular hypothesis).

Neurology Core Clerkship (NEU 601): These are acquired through their independent study, daily attending teaching
rounds, and required conferences (including weekly didactic lectures, teaching sessions, ambulatory care
conference, Grand Rounds, and CRPC).

Obstetrics and Gynecology Core Clerkship (OBG 601): The student is challenged by the residents and attending
staff to support their clinical impressions, differential diagnoses and management plans with evidence. The relative
merits and shortcomings of various evidence is considered and appropriate weight is given, based upon the scientific
quality of the findings. As this process is repeated, the students develop critical judgment.

Introduction to Patients (PCM 501): We have lectures on professionalism and cultural competence.

Preventive Medicine: Health of the Public (PCM 531): We present in class the definition of “Evidence-Based
Medicine,” and the hierarchy of medical evidence.

Pediatric Core Clerkship (PED 601): Every student must present a “clinical controversy” to the whole class.
Students are paired for a debate on a topic of their choosing that they must review with the course director. Students
prepare both sides of the debate using current literature.




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Academic Year 2003-2004


Pharmacology I and II (PHR 501-502): Some of our quiz and exam questions are written to require critical judgment
of evidence in order to select the correct answer. All quiz and exam sessions are followed by a focused review,
allowing direct feedback and learning as part of this process.

Physiology I and II (PHY 451/452): This is not addressed directly, but many small group workshops require that
students draw important conclusions on the basis of selected sets of facts/data that are provided to them.

Introduction to Psychopathology (PSY 501): Routinely tests on the final exam

Psychiatry Core Clerkship (PSY 601): The course director holds a weekly conference based on evidence-based
psychiatry. This concept is again examined in an oral proficiency exam during the last two weeks of the clerkship.

Pathology I and II, and III (PTH 511, 512 & 513): Clinical case scenarios are created in the review sessions, exam
questions and lab sessions, which enhance the skills in critical judgment.

Surgery (SUR 601): During weekly student conference, each student is given a clinical example. Each student is
asked to provide the next workup step or treatment for the example given

c. Skills of medical problem-solving

Skills of medical problem-solving are introduced early in the curriculum. Solving ethical problems is the basis of
BHV 481 and 482. In ANA 451, clinical vignettes are used to demonstrate how abnormal histology can lead to
pathology. Some of the workshop problems in PHY 451 are medical in nature, and require the development and
application of medical problem solving skills. MED 501-503 presents material in the form of clinical cases, which
require students to assess relevant information, including history, physical exam, and lab data, to develop a
differential diagnosis. This process is reinforced in all the clinical clerkships, which expect students to analyze
available data to develop a diagnosis and treatment strategy.

Examples listed by specific courses follow:

Histology (ANA 451): Clinical vignettes are sometimes used to demonstrate how abnormal histology can lead to
pathology.

Human Antomy I and II (ANA 471 & 472: The dissection lab is an excellent example of problem solving. The
students are required to read and then come to the lab and use a method of dissection in order to identify structures
on the cadaver. They use this skill to identify the same structure on a number of different cadavers.

Behavioral Science: Ethics in Medicine I and II (BHV 481 & 482): These courses are entirely based on resolving
ethical conflicts encountered in the context care.

Pathophysiology I, II and III (MED 501-503): The hallmark of our sessions is going through cases (that are real
cases from both the inpatient and outpatient setting) and it is our expectation that the students derive a differential
diagnosis, which is cardinal in medical problem solving.

Internal Medicine Core Clerkship (MED 601): Students meet with preceptors weekly during both inpatient months.
During these sessions, students are evaluated on their ability to synthesize information and are expected to have read
about problems encountered on the rotation. They are expected to follow a format called IDEA (interpretive
summary, differential diagnosis, explanation of reasoning and alternatives). Using IDEA, students write an
assessment in paragraph form that includes a summary of the patient’s presentation, a differential diagnosis and
commitment to the most likely diagnosis, and an explanation of their thinking both in choosing the most likely and
rejecting other less likely diagnoses. Preceptors are trained to recognize types of problem solving, and to offer
specific remediation to students who demonstrate a lack of problem solving skills. While rotating at John H. Stroger
Jr. Hospital of Cook County, students participate in a weekly hour-long “morning report”-style conferences where
they talk through the differential diagnosis, work-up, and management of inpatient cases.

Internal Medicine Subinternship (MED 610): All clinical encounters require medical problem-solving.



LCME Medical Education Database 2004-05                     p. 20                                 II. Educational Program
Academic Year 2003-2004


Pediatric Subinternship (PED 610): Subinterns evaluate the history of a patient, perform a physical exam, and
develop differential diagnoses, and diagnostic and management plans.

Neurology (NEU 601): These skills are acquired through daily patient care as well as through their independent
study, daily attending teaching rounds and required conferences.

Obstetrics and Gynecology Core Clerkship (OBG 601): Emphasis is placed upon collection of a clinical data base,
arriving at a clinical impression, forming a differential diagnosis and creating a management plan. Through various
methods of medical problem solving (e.g., Bayes theorem), the students acquire necessary skills to solve medical
problems.

Pediatric Core Clerkship (PED 601): In addition to the weekly case analysis, medical problem solving skills are
practiced with every patient interaction the student has under the supervision of residents and attendings.

Pharmacology I and II (PHR 501-502): We offer limited problem-solving in the form of short clinical problems,
which are discussed in a workshop format following each topic in the course plan.

Physiology I (PHY 451): Workshop problems are generally medical in nature (some more than others) and require
the development and application of some medical problem solving skills.

Preventive Medicine: Health of the Public I (PCM 531): The syllabus is replete with examples of medical problem
solving, including sensitivity and specificity, incidence and prevalence, and other common basic principles students
will use repeatedly in everyday medical practice.

Introduction to Psychopathology (PSY 501): Tested on final exam by case vignettes

Psychiatry Core Clerkship (PSY 601): The course director holds a weekly conference focusing on medical problem
solving as it applies to psychiatry.

Pathology I, II, and III (PTH 511, 512 & 513): Skills are developed through case presentations and by asking
students for appropriate solutions to a clinical problem

Surgery Core Clerkship (SUR 601): All students are given eight basic surgery topics to master and, at the end of the
clerkship, each student takes an essay exam on problem-solving which tests four of the eight subjects.

d. Understanding of societal needs and demands on health care

This topic is taught by lecture and practical experience. PCM 501 offers lectures on professionalism and cultural
competence. BHV 451 provides five lectures on related issues. In BHV 481 and 482, small group sessions focus on
social/contextual features inherent in all medical ethics decision-making scenarios. In NEU 451, diseases which may
be encountered in only certain patient populations, such as cistercercosis, are discussed, with emphasis on the
societal context of such a disease.

In SUR 601’s weekly student conferences, differences of experience among patient populations are discussed.
Because societal problems tend to have a prominent role in pediatrics, students’ exposure to these issues is broad in
PED 601. In OBG 601, students receive lectures surrounding this topic. In MED 601, students all rotate at John H.
Stroger Jr. Hospital of Cook County, where they are exposed to the direct impact of societal needs on direct patient
care.

Human Anatomy I and II (ANA 471 & 472): There are a number of clinical correlation lectures delivered by
physicians and during these lectures, they introduce such concepts as communication with patients as a method of
making a diagnosis. They also explain how to evaluate symptoms for making a diagnosis.

BHV 451: The course includes five lectures, which include content on social needs and demands on health care.




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Academic Year 2003-2004


Behavioral Science: Ethics in Medicine I and II (BHV 481 & 482): In small group format, we discuss social /
contextual features inherent in all medical ethics decision-making scenarios

Internal Medicine Core Clerkship (MED 601): During the ambulatory block, students participate in two workshops.
In the first, students learn about healthy patients and the evidence that exists to recommend routine screening in
healthy individuals. In the second students are assigned a position in a debate about specific screening issues.
Students research their topic and present evidence, including larger societal needs and the costs of testing, both for
and against the diagnostic test being considered. Students also participate in a lecture/discussion on social
determinants of health during one of the inpatient months. This lecture helps students to put patients’ healthcare into
a context of other societal issues that affect our patients such as homelessness, domestic violence, and poor health.

Internal Medicine Subinternship (MED 610): In caring for patients, the subintern has a hands-on experience seeing
the issues patients face related to accessing health care, costs of medications and long term care issues.

Neurobiology (NEU 451): These are not explicit in the focus of this course, although some of these issues are
discussed in clinical lectures on relating to specific classes of neurologic disease, (e.g. dementia and aging, stroke, &
multiple sclerosis). Some topics have emerged as collateral issues in case studies. One featured case is the parasitic
disease, cistercercosis, often associated epileptic complications. A disease not endemic to the U.S. is very likely to
appear in an urban practice because of immigrant Latino and other populations. Most cases have epidemiologic or
management or moral issues attached to them.

Neurology Core Clerkship (NEU 601): This is addressed within the context of patient care, daily attending rounds
and conferences.

Obstetrics and Gynecology Core Clerkship (OBG 601): The students are exposed to societal needs and demands
upon health care in didactic lectures as well as in participation in clinical care.

Pediatric Core Clerkship (PED 601): These topics arise most often in a student’s work with patients. Social
problems tend to have a prominent role in pediatrics so students’ exposure to these issues is broad.

Preventive Medicine: Health of the Public (PCM 531): We have an entire session devoted to “Common
Confounders in Causation,” that gives some of the background information about the interplay between society and
societal factors and healthcare delivery.

Intro to Psychopathology (PSY 501): Didactic lectures – this point is certainly emphasized.

Psychiatry Core Clerkship (PSY 601): The course director routinely emphasizes the impact of psychiatric disorders
on society and the health care system.

Surgery Core Clerkship (SUR 601): During a weekly student conference, faculty and students compare the
differences of experience and patient populations at the university, public, and community hospitals among our
rotations.

See also information for standard ED-28, and the Required Course and Required Clerkship Forms.




LCME Medical Education Database 2004-05                    p. 22                                 II. Educational Program
Academic Year 2003-2004


ED-8. There must be comparable educational experiences and equivalent methods of evaluation across all
alternative instructional sites within a given discipline.

         Compliance with this standard requires that educational experiences given at alternative sites be
         designed to achieve the same educational objectives. Course duration or clerkship length should
         be identical, unless a compelling reason exists for varying the length of the experience. The
         instruments and criteria used for student evaluation, as well as policies for the determination of
         grades, should be the same at all alternative sites. The faculty who teach at various sites should be
         sufficiently knowledgeable in the subject matter to provide effective instruction, with a clear
         understanding of the objectives of the educational experience and the evaluation methods used to
         determine achievement of those objectives. Opportunities to enhance teaching and evaluation
         skills should be available for faculty at all instructional sites.

         While the types and frequency of problems or clinical conditions seen at alternate sites may vary,
         each course or clerkship must identify any core experiences needed to achieve its objectives, and
         assure that students received sufficient exposure to such experiences. Likewise, the proportion of
         time spent in inpatient and ambulatory settings may vary according to local circumstance, but in
         such cases the course or clerkship director must assure that limitations in learning environments
         do not impede the accomplishment of objectives.

         To facilitate comparability of educational experiences and equivalency of evaluation methods, the
         course or clerkship director should orient all participants, both teachers and learners, about the
         educational objectives and grading system used. This can be accomplished through regularly
         scheduled meetings between the director of the course or clerkship and the directors of the various
         sites that are used.

       The course/clerkship leadership should review student evaluations of their experiences at
       alternative sites to identify any persistent variations in educational experiences or evaluation
       methods.
__________________________________________________________________________________

We identified a need to enhance coordination of educational efforts at our academic affiliates. Thus, a
new position, the Associate Dean, Academic Affiliations was created to serve as chief academic officer
responsible for the affiliated programs and institutions that support the RMC academic mission. His
duties includes assessing needs of Rush entities for affiliation outside of RUMC, assessing the needs of
Rush affiliates, triage requests for affiliation with Rush entities, interacting with appropriate individuals
from affiliates, and advocating for Rush programs to affiliates. While his role includes GME, research,
and clinical programs, a significant piece of his work addresses undergraduate medical education. Some
of his most recent efforts have including updating all affiliation agreements and subagreements to ensure
by contact adequate resources are provided to our students. This will facilitate comparable experiences at
multiple sites for a clerkship.

For each course or clerkship offered at more than one site, describe the following:

Note: All first- and second-year courses at Rush Medical College are offered only at one site. These
answers only address clerkships, with the exception of our use of preceptors for our Preceptorship
Program and for Physical Diagnosis V.

a. How faculty members at all sites are oriented to the objectives and grading system for the course or
   clerkship.

At the beginning of each year, faculty members in PCM 505, FAM 601, OBG 601, PED 601, and SUR
601 are provided with detailed, written educational objectives and with program grading policy. The
course directors of NEU 601, PSY 601, FAM 610 and SUR 610 delineate objectives and grading policies


LCME Medical Education Database 2004-05                   p. 23                                 II. Educational Program
Academic Year 2003-2004


to faculty through telephone conversations, emails and letters. Residents who supervise NEU 601
clerkship students receive a brief orientation at the beginning of the year to explain their role in teaching
and evaluating medical students. The Internal Medicine department runs annual retreats for its residents.
Quarterly faculty development sessions are offered to all Internal Medicine faculty involved with teaching
students. The co-director at John H. Stroger Jr. Hospital of Cook County meets monthly with residents to
review the course objectives and the grading system.

Family Medicine Core Clerkship (FAM 601): The course director provides the site coordinators at each of
the various locations used for the FM clerkship with a variety of materials. These include: written
goals/objectives;, student expectations/responsibilities; and clearly delineated grading policies of the
course director. There is also frequent written and verbal communication between the course director and
the sites regarding updates, student issues, comments, etc.

Family Medicine Subinternship (FAM 610): The site coordinators communicate educational expectations
to the teaching faculty and housestaff with whom the subinterns work. Faculty receives evaluation forms
from subinterns that describe in detail the knowledge, skills, and behaviors to be mastered on the rotation;
the final grade is a composite of evaluations received from the teaching attending physicians and senior
residents with whom the subintern worked.

Internal Medicine Core Clerkship (MED 601): At Rush, housestaff all receive information about
objectives and grading during a daylong resident retreat. Faculty preceptors receive specific training
regarding the objectives for the students. Faculty development workshops are run quarterly and one
session reviews evaluations and feedback. Housestaff attend a one-day retreat in their R2 year about
leadership and teaching, and objectives and the grading system is reviewed. The clerkship director
emphasizes objectives, the grading system, and any problems that may arise at monthly housestaff
conferences. The ambulatory block director visits each ambulatory site on a regular basis. Faculty
members meet with the ambulatory director to review objectives and grading prior to having a student in
the office. In addition, ambulatory faculty receives yearly feedback on their performance and on their
evaluation of students. Faculty is invited to participate in faculty development sessions about student
assessment/evaluation, and receive informal feedback from course directors on a regular basis. At John
Stroger Jr. Hospital of Cook County, faculty members are given the criteria for determining students’
grades before they start each month on the inpatient wards. Residents are informed of objectives and the
grading system during monthly orientation sessions. Final student grades are a synthesis of evaluations by
faculty and residents of Rush University Medical Center, John H. Stroger Jr. Hospital of Cook County,
ambulatory faculty, and the course directors.

Internal Medicine Subinternship (MED 610): Direct discussion takes place with the John H. Stroger Jr.
Hospital of Cook County subinternship director.

Neurology Core Clerkship (NEU 601): Faculty members involved in student teaching receive a written
description of clerkship objectives. Memos or oral communication are also used as periodic reminders of
the grading system and importance of written evaluations and there is frequent discussion of objectives at
the monthly education committee meeting. The clerkship director meets with residents at the beginning of
each year for 15 to 30 minutes to explain their role in teaching and evaluating medical students.

Obstetrics and Gynecology Core Clerkship (OBG 601): Faculty members are provided written
educational objectives as well as a written policy concerning the grading system.

Physical Diagnosis V (PCM 505): The same instructional materials and preceptor guides, as well as a
preceptor orientation is given at all sites.



LCME Medical Education Database 2004-05              p. 24                             II. Educational Program
Academic Year 2003-2004


Pediatric Core Clerkship (PED 601): The course has three handbooks: one for students, one for faculty
and one for the course directors. The handbooks help to standardize the course for both teacher and
students.

Pediatric Subinternship (PED 610): See Pediatric Core Clerkship: Physician Supervisor’s Handbook
(copy available from the LCME Coordinator). Rush is the only site that is used for the subinternship.

Preceptorship Experiences I through VI (PCM -526): Students spend multiple half-day experiences in the
office of family medicine practitioners over the course of their first two years. Each preceptor is provided
with course objectives by the course director. Preceptors are selected partly with the expectation that there
will be an adequate flow of patients with a variety of presenting concerns to give each student a variety of
exposures to various medical problems. There is no “formal” curricular component but students’ notes on
patients are reviewed by faculty members after each session.

Psychiatry Core Clerkship (PSY 601): Personal communication by the course director with the faculty.
Residents who teach students in a formal manner (i.e., giving lectures on a specific subject) are provided
learning objectives, written by the course director, about the particular lecture subject. The course director
also reviews the resident's lecture slides and/or handouts to adequately ensure the proper material is being
covered. Students fill out evaluations on each resident lecture; this feedback is provided to the resident
lecturer and reviewed by the resident and the course director.

Surgery Core Clerkship (SUR 601: The student handout of objectives and grading is available to the
faculty. All faculty members are initially oriented when arriving at the institution. On an annual basis,
faculty members are notified by memo of all changes.

Surgery Subinternship (SUR 610): Course director correspondence and evaluation form of medical
college.

b. How and how often individuals responsible for the course or clerkship at all sites communicate
regarding planning, implementation, student evaluation, and course evaluation.

Those responsible for the course/clerkship at all sites are contacted as often as once a week for OBG 601,
and communicate annually for FAM 610 and SUR 601 via emails and reports. Formal meetings take
place twice a year for the family medicine clerkship and informal communication takes place as often as
necessary. Those responsible for PCM 505 and MED 610 meet several times throughout the year. The
clerkship director of NEU 601 meets monthly with Rush faculty to discuss these issues and is also in
monthly contact with Stroger faculty. The course director and all co-directors for the internal medicine
clerkship meet quarterly. In addition, the course director has monthly meetings with both the co-director
at Stroger as well as the ambulatory block director.

Specific examples, by course, follow:

Family Medicine Core Clerkship (FAM 601): Formally, prior to the academic year and at the mid-year
point; informally, as frequently as needed.

Family Medicine Subinternship (FAM 610): Course director communicates at least yearly with the site
coordinators, generally via telephone and email.

Internal Medicine Core Clerkship (MED 601): Course directors meet on a quarterly basis to review
student evaluations. The course director and co-directors at Stroger meet on a monthly basis to discuss



LCME Medical Education Database 2004-05               p. 25                             II. Educational Program
Academic Year 2003-2004


planning, implementation and course evaluation. The course director and ambulatory block director also
meet monthly to discuss planning, implementation and course evaluation.

Internal Medicine Subinternship (MED 610): Meetings take place several times per year.

Neurology Core Clerkship (NEU 601): There is a monthly departmental education committee meeting.
Communication is also accomplished via phone and email discussion as frequently as necessary

Obstetrics and Gynecology (OBG 601): At least weekly (usually by phone), and more frequently if
necessary. These conversations follow the weekly meeting with the students and concerns they bring up
are shared with the site directors so that corrective action can be taken.

Physical Diagnosis V (PCM 505): Course faculty meets several times throughout the year concerning
these items.

Pediatric Core Clerkship (PED 601): We regularly exchange phone calls and emails regarding issues that
arise in the course. In addition, we meet twice annually to review the course and any needed changes.

Psychiatry Core Clerkship (PSY 601): The course director is in regular contact with staff at the three sites
and routinely meets with them to discuss these concepts.

Surgery Core Clerkship (SUR 601): At least once a year, a report is circulated regarding planning,
implementation, student evaluations, and course evaluations.

Surgery Subinternship (SUR 610): Annually and as needed by course director.

c. Faculty development activities related to teaching and evaluation skills that are available to
instructional staff across sites.

Faculty development takes place at quarterly workshops for faculty of the internal medicine clerkship and
subinternship. Faculty development activities are detailed in a handbook that is distributed to all pediatric
clerkship and subinternship faculty members at the beginning of each year. The associate chairperson for
the neurology department organizes faculty development activities and is available for individual
mentorship for those faculty involved in the neurology clerkship. An educational specialist is available
daily to the surgery clerkship/subinternship faculty. The individual site coordinators for the Family
medicine clerkship and subinternship orient the onsite faculty and residents. Faculty development occurs
at the preceptor orientation sessions (for Physical Diagnosis, PCM 505). Faculty members of the
obstetrics clerkship are encouraged to use The Association of Professors of Gynecology web site that
explores sixty-four educational objectives.

Specific examples, by course, follow:

Family Medicine Core Clerkship (FAM 601): Site coordinators receive updated material pertinent to the
course prior to the start of each academic year. It is their responsibility to orient the onsite faculty and
residents.

Family Medicine Subinternship (FAM 610): These are carried out at the individual program level.

Internal Medicine Core Clerkship (MED 601): Faculty development has been offered to faculty in our
clerkship in the form of quarterly evening workshops. Topics have included giving effective feedback,
evaluating students and asking effective questions. Although designed for our ambulatory faculty we have


LCME Medical Education Database 2004-05               p. 26                             II. Educational Program
Academic Year 2003-2004


included faculty from all sites who are actively involved with student teaching. Inpatient preceptors have
all received training on the IDEA method (interpretive summary, differential diagnosis, explanation of
reasoning and alternatives) of evaluating student write-ups. Preceptors are trained to recognize types of
problem solving strategies, and to offer specific remediation to students who demonstrate a lack of
problem solving skills.

Internal Medicine Subinternship (MED 610): Standard programs used for the clerkship in medicine.

Neurology Core Clerkship (NEU 601): The department’s associate chairperson is involved in faculty
development.

Obstetrics & Gynecology Core Clerkship (OBG 601): The Association of Professors of Gynecology web
site has 64 educational objectives which the faculty are encouraged to use. The course director also plans
to institute more inservice trainings of residents (and ideally with faculty) at least once a quarter to
address progress reports, how to work more effectively with students, and how to ensure that students
meet the course objectives. In 2000, Deborah de la Rosa, Ph.D. from Northwestern University facilitated
an inservice retreat for faculty on teaching skills. The department plans to resume inservice retreats in the
near future.

Physical Diagnosis V (PCM 505): This is covered in detail during preceptor orientation. A workshop
portion may be added in the future to this second year course.

Pediatric Core Clerkship (PED 601): These are detailed in the Pediatrics Physician Supervisor’s
Handbook

Pediatric Subinternship (PED 610): See Pediatric Core Clerkship: Physician Supervisor’s Handbook
(copy available from the LCME Coordinator).

Surgery Core Clerkship and Subinternship (SUR 601 & 610): An educational specialist with a Ph.D. in
psychology housed within the surgery department is available daily.

d. Mechanisms for review and sharing of student assessments of their educational experiences and
any other data reflecting the comparability of learning experiences across sites.

Students in the PCM 505 course and in all clerkships complete site and course evaluations for the
Committee on Educational Appraisal (CEA). A member of CEA meets regularly with each
course/clerkship director to review in detail student assessments collected by CEA. This data is provided
for the course as a whole but is also reported for specific sites for clerkships which use more than one site.
CEA data is provided course directors and to the Director, Clinical Curriculum for their attention.

In addition, students in PED 601 and FAM 601 complete a program specific appraisal. Written reports
with information regarding student evaluations are sent to PSY 601 coordinators at the end of each
rotation and to FAM 601 site coordinators semiannually. Student evaluations are discussed at the NEU
601 departmental educational meetings at which site directors are present. The course directors of THE
INTERNAL MEDICINE CLERKSHIP meet regularly to review the evaluations. Students rotate through
the same two inpatient sites to standardize the inpatient portion of training. OBG 601 conducts weekly
meetings with students at all sites. The PED 601 course director meets with students at the end of each
rotation to review their experiences and how they might be improved. The course director of SUR 601
and chairperson of the department of surgery meet semiannually to tabulate and review student
evaluations. Subinterns in FAM 610 give written and verbal feedback to the site coordinator and to the
clerkship director.


LCME Medical Education Database 2004-05               p. 27                             II. Educational Program
Academic Year 2003-2004



Specific examples, by course, follow:

Family Medicine Core Clerkship (FAM 601): Site coordinators receive reports twice a year that contain
information on grades, opinions, and comments made by students at each site. The average grade for
students at the site is compared to all clerkship students along several dimensions. Students complete
anonymous opinion questionnaires during their last week of the clerkship. Information from this survey is
presented along with comparisons to students at all clerkship sites.

Family Medicine Subinternship (FAM 610): Subinterns give written and verbal feedback to the site
coordinator and to the course director.

Internal Medicine Core Clerkship (MED 601): Course directors meet regularly and share all material
received from students regarding their educational experiences. All students rotate through the same two
inpatient clinical sites to standardize the inpatient portion of their training.

Neurology Core Clerkship (NEU 601): Studies have been done comparing the performance of students at
both sites. There are also periodic meetings with a CEA member to review student evaluations from both
sites. Those from the Stroger site are forwarded to the site director and chairperson. Additionally, the data
is discussed at the departmental education meeting.

Obstetrics & Gynecology Core Clerkship (OBG 601): This happens at weekly meetings with students
from all three sites.

Physical Diagnosis V (PCM 505): There are questions on the evaluation forms distributed for the
Committee on Educational Appraisal, which ask students about experiences at each site. The course
director plans to implement an online assessment as well in the near future.

Pediatric Core Clerkship (PED 601): The last week of every rotation, the course director spends about 30
minutes with students specifically reviewing their experiences and how the clerkship might be improved.
In addition, students complete two written evaluations: one the same day for the course director and
another later for the Committee on Educational Appraisal.

Psychiatry Core Clerkship (PSY 601): Reports of student feedback are sent to all three sites after each
six-week rotation.

Surgery Core Clerkship (SUR 601): Each student fills out a tracking instrument as well as site and course
evaluations. These are tabulated and reviewed by the course director and chairperson semiannually.

Surgery Core Clerkship (SUR 610): There is no formal mechanism beyond that provided by the standard
Committee on Educational Appraisal evaluations.




LCME Medical Education Database 2004-05              p. 28                              II. Educational Program
Academic Year 2003-2004


ED-9. The LCME must be notified of plans for major modification of the curriculum.

        Notification should include the explicitly-defined goals of the change, the plans for
        implementation, and the methods that will be used evaluate the results. Planning for curriculum
        change should consider the incremental resources that will be required, including physical
        facilities and space, faculty/resident effort, demands on library facilities and operations,
        information management needs, and computer hardware.

       In view of the increasing pace of discovery of new knowledge and technology in medicine, the
       LCME encourages experimentation that will increase the efficiency and effectiveness of medical
       education.
_____________________________________________________________________________

a. Year of implementation for the last major revision of the curriculum:

                                                      2001

b. Summarize the principal features of that revision, including the reasons for the change and the specific
goals that the change was designed to accomplish.

The last major revision of the curriculum involved the M2 Pathophysiology course (MED 501-503). This
course introduces students to pathophysiological principles of common disease states. It stresses altered
physiology, clinical presentation, and methods of diagnosis. Prior to the revision, the course was
decentralized and course content was determined by separate sub-specialists for each portion of the
course. Material was presented in lecture format and clinical questions were answered in small group
sessions following the lecture. Each small-group numbered approximately 30 students. Students often
complained that the course was disjointed. Many felt that they did not know how different organ systems
interacted with one another in the disease state. Furthermore, they complained that they were
encountering too many instructors, resulting in little faculty accountability. To address these concerns,
and with the goals of reducing overall class time, reducing lecture time, increasing small-group and
independent learning, MED 501-503 was reorganized in Fall, 2001.

Minor revisions include changes in our required pathology course. With a change in course director, the
syllabus was completely changed and lectures were reordered to more closely link them to material being
discussed in pathophysiology. A few hours focusing on evidence-based medicine have been installed into
the curriculum in the form of a series on shared medical decision. This series has not been well received
by students and is being reconceptualized and restructured by the course director.

c. Describe the planning process, including the individuals or groups involved.

These goals were outlined by the Dean at that time, Dr. Larry Goodman.

The new course would reduce lecture hours and increase the number of small group, faculty-moderated
sessions. These small group sessions would be designed around case presentations and resemble the
problem-solving sessions within the Alternative Curriculum. The other system or organ based courses
taught during the M-2 year were invited to sequence the topics of those courses alongside the
Pathophysiology program. The Pathophysiology course is under the leadership of the Internal Medicine
Department. The faculty in this course have their primary appointments in the departments of Internal
Medicine and Pediatrics.

Syed Shah, M.D. and Suja Mathew, M.D. were named as course co-directors. Both individuals are
general internists and had prior experience in teaching this course. Together, and with help of faculty


LCME Medical Education Database 2004-05                p. 29                                II. Educational Program
Academic Year 2003-2004


development and educational experts at our institution, they redesigned the curriculum, with a significant
reduction in lecture hours. The small-group sessions are now the major method for introduction of
material and almost all material is introduced in case-based format. Faculty facilitators are currently all
generalists, and they commit to a minimum of one quarter of teaching per year.

We have completed three years of the newly revised MED 501-503 courses. It has been met with very
positive feedback from the students and teaching faculty. In the two years prior to the restructuring of the
course, students consistently rated the overall course quality around 3.0 (on a 1-5 scale) on the CEA
evaluation (2.85 – 3.1 for various terms). The course was viewed as lacking uniformity and there were
many concerns about the overall organization of the course with some topics given too little attention in
class while students were expected to cover enormous amounts of material given in handouts on their
own. The tests often seemed disjointed to students and not reflective of the material presented. This past
year, for overall quality students rated the course 4.53 in the fall, 3.6 in the winter, and 3.63 in the spring.
They gave the course high ratings on spending sufficient time on important topics, helping to understand
key concepts, and offering well organized workshops and fair tests. Students’ comments were generally
positive with some suggestions to improve the syllabus.

d. Describe any plans for major modification of the present curriculum.

None at present. We are discussing a minor modification to the third year. We may make a change in the
number of weeks of required clerkships in order to be able to require all required clerkships be completed
within a fourteen month period. This will put all students on a level playing field when we are preparing
the MSPE. Proposals for such changes are currently being considered by the Curriculum Committee and
would likely not go into effect before the 2005-2006 academic year.




LCME Medical Education Database 2004-05                p. 30                               II. Educational Program
Academic Year 2003-2004


***ED-10. The curriculum must include behavioral and socioeconomic subjects, in addition to basic science
and clinical disciplines.
_____________________________________________________________________________

a. Indicate whether the following topics are covered in a structured teaching session during a required course or
clerkship (e.g., a lecture, an explicit part of a small group discussion, or a laboratory session) or during a required
clinical experience (e.g., as part of patient care experiences in a clinical clerkship). Check both if appropriate.
Provide the total number of hours the topic is taught in structured sessions during required courses and
clerkships.

                                                   Content Covered During
                Content Area                      Structured         Clinical             Total hours spent on each
                                                    Session         Experience            content area in structured
                                                                                                   sessions
                                                    (check)                (check)
Alternative medicine                               OBG 601               FAM 601                 OBG 601: 1 hr
                                                   PHR 501               MED 601                 PHR 501: 1 hr
                                                   PHR 502                NEU 601                PHR 502: 1 hr
                                                                         OBG 601
                                                                         PED 601*
                                                                         PED 610 *
Biostatistics                                    MED 601                 FAM 601          MED 601: 6 hrs (grand rounds)
                                                 OBG 601                 PED 601*             OBG 601: 1 hr
                                                 PSY 601                 PED 610 *             PSY 601: 1 hr
                                                 PCM 531                                      PCM 531: 1 hr
                                                 PVM 505                                      PVM 505: 3 hrs
Clinical pathology                               MED 501                 FAM 601             MED 501: 40 hrs
                                                 MED 502                 MED 601^            MED 502: 33 hrs
                                                 MED 503                 MED 610             MED 503: 20 hrs
                                                 MED 601                 NEU 601            MED 601: 1 hr/month
                                                 NEU 601                 OBG 601              at Stroger spent in M&M
                                                 OBG 601                 PED 601              NEU 601: 2 hrs
                                                 PED 601                 PED 610*             OBG 601: 3 hrs
                                                 PSY 501                                       PED 601 3 hrs
                                                 PSY 601                                      PSY 501L 6 hrs
                                              PTH 511/512/513                              PTH 511/512/513: 40 hrs
Communication skills                             BHV 481                `FAM 601              BHV 481: 2 hrs
                                                 BHV 482                MED 601               BHV 482: 2 hrs
                                                 MED 601                MED 610            MED 601: 6 (1 hr on eliciting
                                                 OBG 601                 NEU 601            feedback, 5 hrs on counseling
                                                                                            workshops during ambulatory)
                                              PCM 504 & 506              OBG 601
                                                 PCM 511               PCM 521-526            OBG 601: 2.5 hrs
                                                 PCM 514                 PED 601            PCM 504 & 506: 3 hrs.
                                                 PED 601                 PED 610              PCM 511: 20 hrs
                                                 PSY 501                 PSY 501              PCM 514: 20 hrs
                                                 PSY 601                 PSY 601               PED 601: 1 hr
                                                                                               PSY 501: 3 hrs
                                                                                               PSY 601: 1 hr.
Community health                                   BHV 451               FAM601                BHV 451: 5 hrs
                                                   BHV 481              MED 601               BHV 481: 0.5 hr
                                                   BHV 482              MED 610               BHV 482: 0.5 hr
                                                   MED 601               NEU 601               MED 601: ½ hr
                                                   OBG 601               OBG 601               OBG 601: 5 hrs
                                                   PCM 531             PCM 521-526            PCM 531: 2.5 hrs
                                                                        PED 601*
                                                                         PSY 601



LCME Medical Education Database 2004-05                     p. 31                                  II. Educational Program
Academic Year 2003-2004



Diagnostic imaging                         ANA 471 & 472        FAM 601        ANA 471 & 472: 6 hrs
                                             MED 601            MED 610           MED 601: 1
                                             NEU 451            NEU 601          NEU 451: 5 hrs
                                             NEU 601            OBG 601          NEU 601: 2.5 hrs
                                             OBG 601            PED 601           OBG 601: 1 hr
                                             PCM 531            PED 610           PCM 531: 1 hr
                                             PSY 501                             PSY 501: 0.5 hr

Emergency Medicine                             PED 601          MED 601          NEU 601: 2.5 hrs
                                               PHR 501           NEU 601           PED 601: 1 hr
                                               PHR 502           PED 601          PHR 501: 6 hrs
                                               PSY 501           PED 610          PHR 502: 2 hrs
                                                                 PSY 601          PSY 501: 3 hrs
End-of-life care                              BHV 482           MED 610           BHV 482: 7 hrs
                                              MED 601            NEU 601          MED 601: 3 hrs
                                              NEU 451           OBG 601          (on giving bad news)
                                              OBG 601           PED 601*          NEU 451: 1 hr
                                                                PED 610 *        OBG 601: 0.5 hr
Epidemiology                                  MED 601           MED 601           MED 601: 4
                                              NEU 451           MED 610          NEU 451: 1 hr.
                                              OBG 601            NEU 601         OBG 601: 0.5 hr
                                              PSY 601           PED 601*          PSY 601: 6 hrs
                                              PCM 531           PED 610 *         PCM 531: 9 hrs
                                              PSY 501            PSY 601          PSY 501: 6 hrs
                                           PTH 511/512/513                    PTH 511/512/513: 15 hrs
                                              PVM 505                            PVM 505: 8 hrs
Evidence-based medicine                       MED 601            FAM 601         MED 601: 8 hrs
                                              OBG 601           MED 601           OBG 601: 3 hrs
                                              PHR 501           MED 610          PHR 501: 72 hrs
                                              PHR 502            NEU 601         PHR 502: 52 hrs
                                              PSY 501            OBG 601         PSY 501L 15 hrs
                                              PSY 601          PCM 521-526       PSY 601: 10 hrs
                                              PCM 531            PED 601          PCM 531: 2 hrs
                                                                 PED 610
                                                                 PSY 601
Family violence/abuse                         MED 601           MED 601           MED 601: ½ hr
                                              OBG 601           MED 610           OBG 601: 3 hrs
                                              PED 601            OBG 601          PED 601: 1 hr
                                                               PCM 521-526
                                                                PED 601*
                                                                PED 610 *
                                                                 PSY 601
Medical genetics                          BCH 470, 471 & 472    MED 601      BCH 470, 471 & 472: 4 hrs
                                              NEU 451            NEU 601          NEU 451: 1 hr
                                              OBG 601            OBG 601         OBG 601: 4 hrs
                                              PHR 501           PED 601*          PED 601: 1 hr
                                              PHR 502           PED 610 *        PHR 501: 0.5 hr
                                              PED 601            PSY 601         PHR 502: 0.5 hr
                                              PCM 531                           PCM 531: 0.25 hrs
                                              PSY 501                             PSY 501: 1 hr
                                           PTH 511/512/513                    PTH 511/512/513: 5 hrs
Geriatrics                                    BHV 481           FAM 601         BHV 481: 0.5 hrs
                                              BHV 482           MED 601         BHV 482: 0.5 hrs
                                              FAM 601           MED 610         IMM 501: 0.3 hrs



LCME Medical Education Database 2004-05               p. 32                         II. Educational Program
Academic Year 2003-2004


                                             IMM 501          NEU 601         IMM 505: 0.3 hrs
                                             IMM 505          PSY 601          FAM 601: 1 hr
                                             MED 601                            MED 601: 1
                                             NEU 451                           NEU 451: 1 hr.
                                             PHR 501                           PHR 501: 4 hrs
                                             PHR 502                           PHR 502: 5 hrs
Health care systems                          BHV 451           FAM 601        BHV 451: 5 hrs. ??
                                             PCM 531          MED 601         PCM 531: 0.25 hrs
                                                              MED 610
                                                               OBG 601
                                                               PSY 601
Health care quality review                   FAM 601           FAM 601          FAM 601: 1 hr
                                                              MED 601
                                                              MED 610
                                                              PED 601*
                                                               PSY 601
Home health care                              BHV 482          FAM 601         BHV 482: 0.5 hrs
                                                              MED 601
                                                               NEU 601
                                                               OBG 601
                                                             PCM 521-526
                                                              PED 601*
                                                              PED 610 *
Human development/life cycle              NEU 451 (embryo)     OBG 601          NEU 451: 1 hr
                                             OBG 601          PED 610 *        OBG 601: 4 hrs
                                             PCM 543                           PCM 543: 22 hrs
Human sexuality                              OBG 601          MED 601          OBG 601: 5 hrs
                                             PCM 543          OBG 601          PCM 543: 2 hrs
                                                              PED 610 *
Medical ethics                               BHV 481          MED 601        BHV 481: 16 hrs
                                             BHV 482          MED 610        BHV 482: 12 hrs
                                             MED 601           NEU 601     MED 601: giving bad news –
                                             NEU 451          OBG 601             counted above
                                             OBG 601          PED 601*        NEU 451: 1 hr
                                             PED 601          PED 610 *       OBG 601: 1 hr
                                             PSY 601           PSY 601        PED 601: 3 hrs
                                             PCM 531                           PSY 601: 1 hr
                                                                             PCM 531: 0.10 hrs
Medical humanities                           MED 601           NEU 601        MED 601: ½ hr
                                             PCM 500          PED 610 *       PCM 500: 1 hr.
                                           PCM 504 & 506                    PCM 504 & 506: 0.25

Medical jurisprudence                        BHV 482          MED 601         BHV 482: 2 hrs
                                             MED 601          PED 601*     MED 601: giving bad news –
                                             PSY 601          PED 610 *           counted above
                                                                               PSY 601: 1 hr
Medical socioeconomics                       BHV 451          FAM 601        BHV 451: 5 hrs??
                                             BHV 481          MED 601        BHV 481: 0.25 hrs
                                             BHV 482          MED 610        BHV 482: 0.25 hrs
                                             MED 601          NEU 601       MED 601: counted above
                                             PSY 601          PSY 601         PSY 601: 3 hrs
                                             PCM 531          PED 601*         PCM 531: 1 hr
                                             PSY 501                          PSY 501: 6 hrs
Multicultural medicine                       MED 601          MED 601       MED 601: counted above
                                             OBG 601          MED 610          OBG 601: 1 hr
                                             PSY 601          OBG 601         PCM 500: 2 hrs.


LCME Medical Education Database 2004-05              p. 33                        II. Educational Program
Academic Year 2003-2004


                                              PCM 501          PCM 521-526        PCM 531: 1 hr
                                              PCM 531           PED 601*          PSY 601: 1 hr
                                                                PED 610 *
Nutrition                                 BCH 470, 471 & 472    MED 601      BCH 470, 471 & 472: 5 hrs
                                              IMM 501           MED 610         IMM 501: 0.3 hrs
                                              IMM 505            NEU 601        IMM 505: 0.3 hrs
                                              NEU 601            OBG 601        NEU 601: 0.25 hrs
                                              OBG 601          PCM 521-526        OBG 601: 1 hr
                                              PED 601            PED 610          PED 601: 1 hr
                                              PHR 501                             PHR 501: 1 hr
                                              PHR 502                             PHR 502: 1 hr
                                           PTH 511/512/513                    PTH 511/512/513: 3 hrs
Occupational health/medicine                  MED 601            FAM 601         MED 601: 1 hr
                                           PTH 511/512/513       NEU 601      PTH 511/512/513: 3 hrs
Pain management                               BHV 482            FAM 601        BHV 482: 0.5 hrs
                                              PHR 501           MED 601           NEU 601: 1 hr
                                                                MED 610          PHR 502: 4 hrs
                                                                 NEU 601
                                                                 OBG 601
                                                                PED 601*
                                                                 PED 610
                                                                 PSY 601
Palliative care                               BHV 482           MED 601          BHV 482: 0.5 hrs
                                                                MED 610
                                                                 NEU 601
                                                                PED 601 *
                                                                PED 610 *
Patient health education                      BHV 481            FAM 601         BHV 481: 0.5 hr
                                              BHV 482           MED 601          BHV 482: 0.5 hr
                                              MED 601           MED 610        MED 601: counted above
                                              OBG 601            NEU 601         OBG 601: 4 hrs
                                              PSY 501            OBG 601         PSY 501: 2 hrs
                                                               PCM 521-526
                                                                 PED 610
                                                                 PSY 601
Population-based medicine                     MED 601           MED 601           MED 601: 5 hrs
                                              PCM 531            NEU 601          PCM 531: 3 hr
                                                                PED 610 *
Practice management                                              FAM 601
                                                                MED 601
                                                               PCM 521-526
Preventive medicine                           MED 601            FAM 601       MED 601: counted above
                                              OBG 601           MED 601          OBG 601: 4 hrs
                                              PHR 501           MED 610          PHR 501: 3 hrs
                                              PHR 502            NEU 601         PHR 502: 3 hrs
                                              PCM 531            OBG 601          PCM 531: 9 hr
                                           PTH 511/512/513     PCM 521-526    PTH 511/512/513L 3 hrs
                                                                 PED 601
                                                                 PED 610
Rehabilitation/care of the disabled           BHV 451           MED 601           BHV 451: 3 hrs
                                                                 NEU 601
                                                                PED 601 *
                                                                PED 610 *
Research methods                          BCH 470, 471 & 472    MED 601      BCH 470, 471 & 472: 9 hrs
                                              BHV 481                             BHV 481: 1 hr



LCME Medical Education Database 2004-05               p. 34                         II. Educational Program
Academic Year 2003-2004


                                                 IMM501                                      IMM 501 2.0 hrs
                                                 IMM 505                                      IMM 505: 2 hrs
                                                 MED 601                                      MED 601: 6 hrs
                                                 OBG 601                                     OBG 601: 0.5 hr
                                                 PCM 531                                       PCM 531: 1 hr
                                                 PVM 505                                      PVM 505: 3 hrs
Substance abuse                                  MED 601                FAM 601               MED 601: 1 hr
                                                 OBG 601               MED 601                OBG 601: 4 hrs
                                                 PED 601               MED 610                 PED 601: 1 hr.
                                                 PHR 501                NEU 601               PHR 501: 3 hrs
                                                 PHR 502              PCM 521-526             PHR 502: 2 hrs
                                                 PSY 501               PED 601*               PSY 501: 3 hrs
                                                 PSY 601               PED 610 *               PSY 601: 1 hr
                                                                        PSY 601
Women’s health                                  MED 601                 FAM 601           MED 601: counted above
                                                OBG 601                MED 601              OBG 601: 4 hrs
                                              PCM 504 & 506            MED 610               PHR 502: 1 hr
                                                PCM 531                 NEU 601           PCM 504 & 506: 3 hrs
                                                PHR 502                 OBG 601             PCM 531: 0.5 hr
                                                                      PCM 521-526
                                                                        PSY 601
 These categories were written in by course directors under “Other.” They are not pre-specified LCME categories.
Molecular basis of several diseases        BCH 470, 471 & 472                          BCH 470, 471 & 472: 20 hrs
                                             PHYS 451, 452
Sleep; brain-behavior; psychological           BHV 451                                       BHV 451: 12 hrs
testing, behavior change

*Presentation of this content is dependent upon the clinical experiences of a specific student.
^ Students may observe autopsies done on their deceased patients, if possible.

b. Describe steps being taken to improve content coverage in any areas where the school believes more
exposure is needed.

Course and Clerkship Directors, the Curriculum Committee and the Dean’s Office are involved in making
changes to provide increased exposure in needed areas. Examples include:
  1) The neuroanatomy course is adding material on neurogenetics, which include discussion of patient
     counseling;
  2) The neurology clerkship is adding content on terminal illness;
  3) Primary Care Medicine is adding discussions on professionalism and cultural competence to its
     Introduction to the Patient and to Physical Diagnosis courses;
  4) The pediatric clerkship is developing an “Ethics Wednesday” seminar series to expand its ethics
     coverage;
  5) The psychiatry education director is incorporating disaster psychiatry content; and
  6) The new surgery clerkship course co-directors expect to increasing coverage of evidence-based
     medicine using our new patient simulator.

The Dean’s Office and the Curriculum Committee are working on a new core rotation for fourth year
students to further increase their exposure to medical ethics and to add further vertical integration of the
basic sciences to the fourth year of medical school.




LCME Medical Education Database 2004-05                   p. 35                                   II. Educational Program
Academic Year 2003-2004


Specific efforts by course include:

Behavioral Science I & II: Ethics in Medicine (BHV 481 & 482): Based on student feedback, student
performance on term papers, and faculty feedback, the two course directors routinely and frequently
assess content coverage. New content areas are also added or current areas modified based on new
developments in the fields relevant to medical ethics.

Neurobiology (NEU 451): The course directors feel neurogenetics is an increasingly important
component of their basic course material, esp. as it pertains to diagnosis, prognosis, and patient
counseling related to neurologic disease. In the past two years, they introduced a new lecture on
neurogenetics. They also encourage faculty to develop aspects of neurogenetics in their survey lectures
(e.g., Alzheimer’s Disease, Huntington’s Disease, Parkinson’s Disease, stroke, multiple sclerosis) – so
students have some ideas about the pathophysiology and underlying genetics. This is, however, a first-
year course without a direct focus on pathophysiology (where these issues should be covered more
explicitly).

Neurology (NEU 601): Consideration is being given to incorporate additional topics in the lecture series
and to set up an educational workshop, e.g. to discuss terminal disease.

Obstetrics & Gynecology (OBG 601): The course director is making continued efforts to keep abreast of
changes that occur in obstetrics and gynecology in order to increase the emphasis in those areas in which
his course does not currently allocate enough time.

Introduction to Patients (PCM 501): The course directors added lectures on professionalism and cultural
competency for the first time this academic year. The course directors have no current plans to add new
topics but will be refining their coverage of both professionalism and cultural competency.

Preventive Medicine: Health of the Public (PCM 531): The course director updates the syllabus every
year and uses examples from the previous year on the final exam.

Pediatric Core Clerkship (PED 601): The course director recently developed “Ethics Wednesday” during
which the students have a one hour lecture, followed by small group discussions of a real case facilitated
by faculty.

Pediatric Subinternship (PED 610): Students attend the core lecture series for the pediatric residents.

Pharmacology I and II (PHR 501 & 502): The course directors regularly adjust our course topics and
experiences to accommodate such needs.

Psychiatry Core Clerkship (PSY 601): Psychiatry is beginning to incorporate bioterrorism into its
didactics.

Surgery Core Clerkship (SUR 601): The new co-course directors are evaluating curricular changes to take
advantage of recently acquired patient simulators in order to enhance coverage of evidence-based
medicine in the clerkship




LCME Medical Education Database 2004-05              p. 36                             II. Educational Program
Academic Year 2003-2004


ED-11. It [the curriculum] must include the contemporary content of those disciplines that have been
traditionally titled anatomy, biochemistry, genetics, physiology, microbiology and immunology, pathology,
pharmacology and therapeutics, and preventive medicine.
__________________________________________________________________________________

Provide a copy of the most recent NBME graph showing performance in the various subject areas included in
USMLE Steps 1 and 2.

These graphs are provided in the Appendix


See also information for standard ED-5.

With the exception of genetics (see below), the curriculum includes the traditional basic science courses.
The content of each course is kept current (contemporary) by the course directors and their faculty. Our
success is attested to by our students’ performance on the USMLE Step1.

Genetics is not present in the Rush curriculum as a separate course. Rather, genetics is discussed in a
number of basic science courses including biochemistry, pharmacology, and psychology (see ED-10 for a
complete listing of the courses in which genetics appears).




LCME Medical Education Database 2004-05                p. 37                              II. Educational Program
Academic Year 2003-2004


ED-12. Instruction within the basic sciences should include laboratory or other practical exercises that entail
accurate observations of biomedical phenomena and critical analyses of data.
____________________________________________________________________________________

Describe where in the curriculum students participate in required laboratory exercises (real or simulated)
that oblige them to make observations of biomedical phenomena and collect or analyze data.

Histology (ANA 451): Approximately two-thirds of the hours of this course are in a laboratory setting in
which students are required to learn the characteristics that distinguish a large number of normal cell
types, all tissue types, and organs. They must learn to interpret and to analyze visual information that will
allow them to make accurate and correct identifications of histological specimens. These skills serve as a
basis for analysis of pathological specimens.

Pharmacology I and II (PHR 501-502): Autonomic functions are presented via a two-hour demonstration
with data slides and a data workshop.

Physiology (PHY 451): There is one lab in which students measure ECGs, heart sounds and carotid pulse
pressures and use this data to describe the cardiac cycle. There are two other computer labs that do not
involve the collection of data, but do involve analysis of data presented; this is also true of some
workshops.

Physiology II (PHY 452): There are two computer labs that do not involve the collection of data, but do
involve the analysis of data presented; this is also true of the workshops that take place.


See also information for standard ED-5 and the Required Course Forms.




LCME Medical Education Database 2004-05                p. 38                              II. Educational Program
Academic Year 2003-2004


ED-13. Clinical instruction must cover all organ systems, and include the important aspects of preventive,
acute, chronic, continuing, rehabilitative, and end-of-life care.
_____________________________________________________________________________________________________________________________________________________________________________________

How does the school ensure that all the above aspects of clinical medicine are included as part of required clinical
instruction?
Aspects of clinical medicine are addressed in required clerkships and Physical Diagnosis course (PCM 505) through
lecture, supplemental readings, and direct patient contact. The following table details this for each aspect by course.
The Curriculum Committee reviews clinical instruction to make sure it covers all required aspects of care.
Aspects of clinical medicine                                      How addressed in required clerkships
                                                                     and Physical Diagnosis:
all organ systems                                                 FAM 601: In formal lecture/case based sessions, as well as in direct
                                                                    patient contact, and supplemental readings.
                                                                  FAM 610: Direct patient care; teaching rounds; assigned readings and
                                                                    presentations.
                                                                  MED 601: Self study curriculum guide is organized in 10 organ-based
                                                                    units. Students review a case/week in concordance with the unit of the
                                                                    week, for instance, a COPD case is discussed during pulmonary week.
                                                                  PCM 505: Total case discussion occurs in groups sessions at each
                                                                    encounter so that students learn these important aspects of patient care
                                                                  PED 601: Through lectures, case analyses & patient care.
                                                                  PED 610: Addressed through patient care activities
                                                                  SUR 601: Lecture series; hospital/clinic experience
important aspects of preventive care                              FAM 601: In formal lecture/case based sessions, as well as in direct
                                                                    patient contact, and supplemental readings.
                                                                  FAM 610: Initial history/risk factor assessment, discharge planning;
                                                                    teaching rounds.
                                                                  MED 601: Many of the workshops during the ambulatory block
                                                                    emphasize preventive care, including The Healthy Patient, the Cancer
                                                                    Screening Debate and the Counseling workshops.
                                                                  MED 610: Addressed through patient care activities
                                                                  NEU 601: Daily patient care, attending teaching rounds, lectures
                                                                  OBG 601: A major focus, substantial portion of clerkship
                                                                  PCM 505: Total case discussion occurs in groups sessions at each
                                                                    encounter so that students learn these important aspects of patient care
                                                                  PED 601: Through lectures, case analyses & patient care
                                                                  PED 610: Addressed through patient care activities
                                                                  SUR 601: Office/clinic encounters; lecture series
                                                                  SUR 610: Chief resident assigns patients and tasks to subinterns.
important aspects of acute care                                   FAM 601: In formal lecture/case based sessions, as well as in direct
                                                                    patient contact, and supplemental readings.
                                                                  FAM 610: Initial hospital management; review of care given in ED;
                                                                    screening patients in ED prior to admission; teaching rounds.
                                                                  MED: 601: Students participate in the acute care of hospitalized patients
                                                                    for 8 of the 12 weeks during the clerkship
                                                                  MED 610: Addressed through patient care activities
                                                                  NEU 601: Daily patient care, attending teaching rounds, lectures
                                                                  OBG 601: Provide care in the emergency room
                                                                  PCM 505: Total case discussion occurs in groups sessions at each
                                                                    encounter so that students learn these important aspects of patient care
                                                                  PED 601: Through lectures, case analyses & patient care
                                                                  PED 610: Addressed through patient care activities
                                                                  PSY 601: ER while on call & Formal didactic instruction
                                                                  SUR 601: Emergency room patient encounters; surgical consultations in
                                                                  hospital
                                                                  SUR 610: Chief resident assigns patients and tasks to subinterns.


LCME Medical Education Database 2004-05                                                    p. 39                                                      II. Educational Program
Academic Year 2003-2004


important aspects of chronic care          MED: 601: Students participate in the care of outpatients, many with
                                             diseases requiring chronic care, during the ambulatory rotation
                                           NEU 601: Daily patient care, attending teaching rounds, lectures
                                           OBG 601: Through long-term care of patients including those with
                                            chronic conditions.
                                           PED 601: Through lectures, case analyses & patient care
                                           PED 610: Through patient care
                                           PSY 601: Clinical experiences & formal didactic instruction
                                           SUR 601: Office/clinic and hospital experiences
important aspects of continuing care       FAM 601: In formal lecture/case based sessions, as well as in direct
                                             patient contact, and supplemental readings.
                                           FAM 610: Initial assessment; managing co-morbidities; discussion with
                                             attending and consultant physicians; teaching rounds.
                                           MED: 601: In the ambulatory block, students participate in care of
                                             outpatients, who receive continuing care by their primary physicians.
                                           MED 610: Addressed through patient care activities
                                           NEU 601: Daily patient care, attending teaching rounds, lectures
                                           OBG 601: Provide ongoing care to patients with a variety of conditions.
                                           PCM 505: Total case discussion occurs in groups sessions at each
                                             encounter so that students learn these important aspects of patient care
                                           PED 601: Addressed through patient care activities
                                           PED 610: Addressed through patient care activities
                                           PSY 601: Clinical experiences & formal didactic instruction
                                           SUR 601: Office experiences SUR 610: Chief resident assigns patients
                                           and tasks to subinterns
important aspects of rehabilitative care   FAM 601: In formal lecture/case based sessions, as well as in direct
                                             patient contact, and supplemental readings.
                                           FAM 610: Discharge planning; communication with attending
                                             physicians, social services, and home care/family; teaching rounds.
                                           MED: 601: In hospital & outpatient settings, students care for patients
                                             with rehabilitative needs such as strokes, musculoskeletal injuries and
                                             recovery from acute illnesses
                                           MED 610: Addressed through patient care activities
                                           NEU 601: Daily patient care, attending teaching rounds, lectures
                                           PCM 505: Total case discussion occurs in groups sessions at each
                                             encounter so that students learn these important aspects of patient care
                                           PED 601: Addressed through patient care activities
                                           SUR 601: Hospital with discharge to our own rehab. Facility
                                           SUR 610: Chief resident assigns patients and tasks to subinterns.
important aspects of end-of-life care      PCM 505: Total case discussion occurs in groups sessions at each
                                             encounter so that students learn these important aspects of patient care
                                           FAM 601: In formal lecture/case based sessions, as well as in direct
                                             patient contact, and supplemental readings.
                                           FAM 610: Communication with pastoral care, behavioral health, and
                                             hospice professionals; discussions with patient, family, and attending
                                             physicians; teaching rounds.
                                           MED: 601: Students participate in a 3 hour session on Delivering Bad
                                             News in which advance directives and end-of-life care are discussed
                                           MED 610: Addressed through patient care activities
                                           OBG 601: Primarily on the Gynecologic Oncology service
                                           PED 601: Addressed through patient care activities
                                           PSY 601: Formal didactic instruction
                                           SUR 601: Through hospital experience and patient care activities
                                           SUR 610: Chief resident assigns patients and tasks to subinterns.

See also information for standard ED-10 and the Required Clerkship Forms.


LCME Medical Education Database 2004-05                   p. 40                                 II. Educational Program
Academic Year 2003-2004


ED-14. Clinical experience in primary care must be included as part of the curriculum.
________________________________________________________________________________

List each required course and clerkship that provides training in primary care, with the hours or weeks devoted to
the topic in each of them.

Skills Development:

Physical Diagnosis !, IV-VI (PCM 501, 504-506): Our Physical Diagnosis sequence begins in the first year and
continues for most quarters during the first two years. The first year focused on what is needed for the Preceptorship
experience and on the normal physical examination. In the second year, the focus is concerned with advanced
examination techniques and procedures (such as blood drawing). Students examine female gynecologic and male
urogenital associates who stress sensitivity to the individual patient while performing genital examinations.

Interviewing and Communication I & IV (PCM 511 and 514): Our Interviewing and Communication courses focus
on communication skills. This can include video-taped histories, role plays, standardized patients, and direct
feedback from both patients and faculty.

Patient care:

Preceptorship Experiences I, II & III (PCM 521, 522 ,523): Minimum of 24 hours per academic year (usually
completed in half-day experiences in the office of family medicine practitioner)

Preceptorship Experiences IV, V, VI (PCM 524, 525, and 526): Minimum of 28 hours per academic year. (usually
completed in half-day experiences in the office of family medicine practitioner)

Family Medicine Core Clerkship (FAM 601): Six weeks ambulatory completed in the office of family medicine
practitioner

Family Medicine Subinternship (FAM 610): This subinternship consists of four weeks of inpatient care of adult
medical patients with problems commonly encountered in primary care.

Internal Medicine Core Clerkship (MED 601): Four weeks outpatient, eight weeks inpatient (at two sites).

Internal Medicine Subinternship (MED 610): Four weeks inpatient

Pediatrics Core Clerkship (PED 601): For one of the 8 weeks of the clerkship, the student is assigned to the office of
a community pediatrician

Pediatrics Subinternship (PED 610): Four weeks inpatient




LCME Medical Education Database 2004-05                   p. 41                                II. Educational Program
Academic Year 2003-2004


ED-15. The curriculum should include clinical experiences in family medicine, internal medicine, obstetrics
and gynecology, pediatrics, psychiatry, and surgery.

       Schools that do not require clinical experience in one or another of these disciplines must ensure
       that their students possess the knowledge and clinical abilities to enter any field of graduate
       medical education.
________________________________________________________________________________

If the educational program does not include a separate required clinical clerkship in any of the above
disciplines, describe where in the curriculum students acquire the relevant knowledge and skills.

We provide a separate clinical clerkship for each of the above disciplines plus neurology, a required
clerkship in surgical selectives, as well as a subinternship in either Internal Medicine, Pediatrics, Family
Medicine or General Surgery. In addition, numerous electives allow students to garner additional
experience in all of these areas.

See also the Required Clerkship Forms.




LCME Medical Education Database 2004-05                 p. 42                                II. Educational Program
Academic Year 2003-2004


ED-16. Students’ clinical experiences must utilize both outpatient and inpatient settings.
________________________________________________________________________________

Refer to standard ER-6 in Section V: Educational Resources of the database, and to Required Clerkship Forms.

All but one of our required clerkships include an ambulatory component as well as offering experience in
inpatient settings. The family medicine clerkship is completely outpatient. The others, except neurology,
include some ambulatory exposure. Two clerkships (Internal Medicine and Pediatrics) include an
ambulatory block, in addition to inpatient blocks. The time spent on ambulatory blocks for family,
internal medicine and pediatrics alone totals 13 weeks (nearly 25% of our required weeks of clerkships).
Students spend another four to five weeks of time in ambulatory settings across required clerkships which
don’t schedule a separate ambulatory block. Students may also select electives in both outpatient and
inpatient settings to complement their required experiences.




LCME Medical Education Database 2004-05                p. 43                               II. Educational Program
Academic Year 2003-2004


ED-17. Educational opportunities must be available in multidisciplinary content areas, such as emergency
medicine and geriatrics, and in the disciplines that support general medical practice, such as diagnostic
imaging and clinical pathology.
__________________________________________________________________________________

Describe where in the curriculum the following subject areas are covered:

a. Emergency Medicine

Medical students receive clinical and didactic instruction in emergency medicine on their rotations on multiple
rotations and in their didactic program. Medical students evaluate patients in the emergency room on rotations in
neurology, pediatrics, psychiatry, and surgery. Students spend one week in the pediatric emergency room during
their pediatrics rotation. Students rotate for two weeks on the Critical Care/Stroke service during their neurology
core rotation. This experience exposes them to many of the most common neurological emergencies. Students on the
surgery and psychiatry rotations help to evaluate patients in the emergency room while on call. Students routinely
admit patients on their internal medicine and obstetrics and gynecology rotations immediately after they have been
evaluated in the emergency room. They are given ample clinical instruction about the outpatient, emergency room,
and inpatient management of patients from these rotations throughout their clinical experiences.

Students participate in seminars that focus on emergency topics during their pharmacology course and during their
neurology, pediatrics, and psychiatry rotations. On the surgery rotation, faculty lectures and students’ clinical
experiences do not directly focus on Emergency Medicine. The students, however are exposed to topics they would
typically encounter in the ER such as acute abdomen (e.g., appendicitis and cholecystitis), vascular problems, GI
bleeding, or other emergent patients treated in general surgery that typically arrive in the ER. A significant number
of students each year opt to take an elective in emergency medicine at either John H. Stroger Jr. Hospital of Cook
County or at Rush University Medical Center.

Specific example, by course, follow:

Internal Medicine Core Clerkship (MED 601): Students routinely see patients admitted from the emergency room.
Discussion around patient care starts in the outpatient setting, moves through the emergency room into the hospital,
and ends (usually) with follow-up outpatient care.

Neurology Core Clerkship (NEU 601): There is a two-part lecture on Neurologic Emergencies. Students also rotate
on the Critical care/Stroke service for two weeks.

Obstetrics and Gynecology Core Clerkship (OBG 601): Students participate with residents and attending in the care
of women who present to the emergency room with obstetric or gynecologic conditions.

Pediatric Core Clerkship (PED 601): All students spend one week in the pediatric emergency section. In addition,
Dr. Kramer (pediatric emergency medicine physician) lectures for one hour.

Pediatric Subinternship (PED 610): Students regularly receive admissions from the Emergency Department, often
going to the ER to evaluate patients being admitted.

Pharmacology I and II (PHR 501-502): Toxicology is covered in lecture and workshop. The hospital Formulary is
covered in lecture and workshop. Emergency-related course topics include management of acute myocardial
infarction, angina pectoris, hypertension, inflammation-anaphylaxis, asthma, arrhythmias, drug abuse, alcohol
abuse, pain management, anesthesia, adverse drug events, topics in infectious diseases, and topics in autonomics-
cholinergic, anticholinergic, anticholinesterase.

Introduction to Psychopathology (PSY 501): Psychiatric emergencies are discussed in several lecture sessions.

Psychiatry Core Clerkship (PSY 601): Students routinely see patients in the ER while on call




LCME Medical Education Database 2004-05                   p. 44                                II. Educational Program
Academic Year 2003-2004


Surgery Core Clerkship (SUR 601): Each student takes 24-hour call with a junior resident. During that time,
students evaluate surgical consults in the ER. The interval for student call ranges from every five to six nights.

Two electives in this area are offered:

Emergency Medicine (MED 615): Emergency Medicine (offered both at Rush and at John H. Stroger Jr. Hospital of
Cook County). In this elective, students see patients in all areas of the Emergency Room under supervision of an
attending physician. They are expected to take a complaint-oriented history, with attention to pertinent past medical
history, perform a pertinent physical exam, record their findings, and discuss the patient with the attending.
Together, they formulate diagnostic plans, bearing in mind time and cost factors and priorities inherent in various
diagnostic possibilities.

Pediatric Emergency Medicine (PED 622): (offered both at Rush and at John H. Stroger Jr. Hospital of Cook
County). This is a four-week elective experience. Four five-hour shifts per week are spent evaluating patients in the
Emergency Room under supervision of an attending physician. Evening and weekend shifts are included. The
student is required to maintain a log of patients seen and procedures performed, to attend teaching conferences in the
Emergency Department, and to present an informal lecture on a pediatric emergency medicine topic.

b. Geriatrics

Students are given instruction and participate in the care of older adults during multiple rotations and in numerous
classes. Students care for many elderly patients during their rotations on internal medicine, neurology, gynecology,
psychiatry and surgery. Some students spend their outpatient rotation in internal medicine in a geriatric medicine
office. Clinical concepts in geriatrics are discussed during courses in behavioral medicine, immunology, and
pharmacology. Additionally, students attend a didactic seminars on geriatric medicine during their rotation in
internal medicine.

Behavioral Science: Ethics and Medicine I and II (BHV 481 & 482): We often have case discussions in small group
sessions, and discuss how aging affects medical decision-making. We also devote much time to covering end-of-life
issues and advanced directives.

Basic Immunology (IMM 505): Increased risk of autoimmunity and tumor development associated with aging
of the immune system are discussed, along with increased risk of some infections.

Clinical Immunology (IMM 506): Lecture covers effects of aging on the immune system

Internal Medicine Core Clerkship (MED 601): All students attend an hour long didactic session on geriatric
medicine given by one of our geriatricians during their month at Rush. Selected students spend their ambulatory
block month in our faculty geriatrics office.

Internal Medicine Subinternship (MED 610): Population of patients in a general medical Subinternship includes a
substantial number of patients older than seventy.

Neurobiology (NEU 451): This course has at least three lectures that introduce age-related neurologic problems:
aging, Alzheimer’s and dementia, and motor disorders.

Neurology Core Clerkship (NEU 601): Geriatric topics are covered within the context of daily patient care rounds.

Obstetrics & Gynecology Core Clerkship(OBG 601): Students are exposed to significant aspects of gynecologic
care in the geriatric population including preventive care, menopausal care, oncology, and medical and surgical care
of geriatric women with benign gynecologic conditions.

Pharmacology I and II (PHR 501-502): Approximately nine hours of lecture and workshop are devoted to topics
related to the aged patient. Topics include nootropics, anesthesia, general CNS principles, and emphasis on age-




LCME Medical Education Database 2004-05                    p. 45                                 II. Educational Program
Academic Year 2003-2004


related therapeutic outcomes in depression, psychosis, movement disorders and epilepsy. Additional topics include
anti-anginal drugs, hypertension and antihypertensives, congestive heart failure, and hormones.

Psychiatry Core Clerkship (PSY 601): Many psychiatry patients over age 65 are hospitalized on the inpatient psych
unit and are followed by students.

Surgery Core Clerkship (SUR 601): Fifty percent of the surgical population our students see is in the geriatric age
range

Two electives in this area are offered:

Geriatric Psychiatry (PSY 605): The objectives of this elective are: to increase the amount of experience in treating
elderly patients with psychiatric diagnostic skills and the use of psychotherapy and pharmacotherapy with elderly
patients; to learn the psychological changes that accompany the aging process; and to become familiar with normal
and abnormal states and processes in the elderly. These objectives are accomplished via: 1) readings in the field of
Geriatric Psychiatry, and 2) direct treatment of selected patients with supervision by attending psychiatrists, fellows
and residents.

Geriatric Medicine (MED 605): This elective draws upon a number of resources within the Rush system. The
Bowman Health Center, Rush Homecare, Geriatric Care Partners and the Rush Alzheimer’s Disease Center are a
few of the sites of care where students learn about models of care for older adults throughout the continuum of care.
Under supervision of the faculty of the section of Geriatric Medicine, students experience a broad exposure to inter-
disciplinary care, medical ethics, end-of-life care, medical economics and medical care for older adults. Didactic
endeavors complement a variety of clinical experiences.

c. Diagnostic Imaging/Radiology

Diagnostic imaging is integrated into numerous core rotations and into students’ courses. Students participate in the
interpretation of their patients’ radiological studies on rotations in internal medicine, neurology, obstetrics and
gynecology, pediatrics and surgery. Additionally, students attend seminars that include discussions of reading x-rays
and other radiological films during their core rotations in internal medicine and neurology and during their M1 and
M2 courses in human anatomy, neurobiology, and pathophysiology. A significant number of students opt to take one
or more electives in diagnostic imaging or radiology each year, both here and at away sites.

Anatomy I and II (ANA 471 & 472): Includes lectures in Radiology. Students are required to learn radiographs in
lab.

Internal Medicine Core Clerkship (MED 601): All students attend a one-hour workshop on reading chest x-rays
given by one of our pulmonologists. In addition, diagnostic imaging studies are almost universally obtained on
inpatients, and students are expected to review every study ordered on their patients with their team and the
radiologist when needed.

Internal Medicine Subinternship (MED 610): With PACS system, subintern can review films of patients cared for.

Neurobiology (NEU 451): In this course, neuroanatomy is tightly aligned with students decoding MRI and CT scans
in conventional horizontal or coronal sections of the brain. They are exposed to concepts of T1 or T2 weighted
images and are provided with examples of this in their case studies, in lectures, and in case studies. Also,
angiograms and MRA’s are used to demonstrate vascular anatomy. A lecture in neurologic imaging also features
basics on functional imaging techniques, e.g. functional MRI, SPECT, and PET and some of the composite
techniques for overlays of EEG and three dimensional mapping.

Neurology Core Clerkship (NEU 601): Imaging studies pertinent to patient care are reviewed on a regular basis,
including during attending rounds. There is also a weekly CRPC, neuroradiology/pathology conference, and
imaging studies are additionally reviewed within the context of certain lectures (e.g. neurologic emergencies).




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Obstetrics & Gynecology Core Clerkship (OBG 601): Students are exposed to significant educational opportunities
in obstetric and gynecologic ultrasonography. Other imaging procedures are included in students’ educations as the
opportunity and need occurs in patient care.

Pediatric Core Clerkship (PED 601): Discussion of diagnostic imaging is intertwined throughout as the students
work with pediatric patients. In addition, the “case analyses” involve diagnostic testing decisions.

Pediatric Subinternship (PED 610): Students explore imaging options regularly in the diagnostic evaluation of
patients for which they care.

Preventive Medicine: Health of the Public I (PCM 531): The course directors offer an entire session on sensitivity
and specificity that uses some of their own work on interpretation of a medical imaging test as the example
(renovascular hypertension and captopril DTPA renal scan).

Psychopathology (PSY 501): Diagnostic imaging is discussed as it applies to psychiatry in lecture sessions

Surgery Core Clerkship (SUR 601): Once a day, pertinent radiologic tests are reviewed by the surgical team with a
radiologist.

Five electives in this area are offered:

Diagnostic Radiology (RAD 601): Basic radiologic principles are demonstrated and the role of the diagnostic
radiologist in the clinical setting of general patient care, and medical and surgical specialty consultations is
emphasized throughout this elective. Each student prepares one case for the teaching file and gives one oral
presentation. Students complete assigned readings and are tested by a written final examination. Students are also
urged to attend the two daily departmental teaching conferences

Nuclear Medicine (RAD 606): All facets of nuclear medicine are studied in this elective, with particular emphasis
on radionuclide scanning of organ systems for diagnostic and research purposes. Emphasis is on pathophysiologic
correlation and case study. Literature review and individual topics are encouraged to provide in-depth study of this
field.

Interventional Radiology (RAD 611): This elective exposes the student to interventional radiology with emphasis on
patient care. Both non-vascular, as well as vascular, interventional examinations are performed on inpatients and
outpatients. Students complete assigned readings and attend lectures given by the Diagnostic Radiology attending
staff and residents.

Correlative Imaging (RAD 612): This elective covers ultrasound, computed tomography and magnetic resonance
imaging with an emphasis on correlation of radiologic findings. Students will be assigned reading. They spend time
in each imaging section of the Radiology Department.

Radiation Oncology (RAD 621): In this elective, students participate in the normal activities of Radiation Oncology
department, including consultations, treatment planning, and follow-up care of cancer patients. The student will be
assigned to two different services, allowing exposure to different cancer sites.

d. Clinical Pathology

Clinical pathology is covered in most clerkships as well as some basic science courses. In the second year,
pathology is covered in an in-depth, yearlong course. To help make clinical relevance more apparent, the course is
now structured to parallel as much as possible coverage of systems in the pathophysiology course. In the clerkships,
students undertake a variety of approaches to learn about clinical pathology. These include attending autopsies, case
analyses, attendance at Morbidity and Mortality presentations, and specific didactic/lecture training on clinical
pathology concepts most relevant to a particular clerkship.




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Internal Medicine Core Clerkship (MED 601): Students are exposed to clinical pathology during monthly M&Ms at
John H. Stroger Jr. Hospital of Cook County. Cases are presented by Internists, but the pathology is presented by
pathologists.

Internal Medicine Subinternship (MED 610): Subinterns are encouraged to attend autopsies and to follow up on path
specimens on their own patients.

Neurology Core Clerkship (NEU 601): Clinical pathology is discussed pertinent to patient care and the CRPC
conference.

Obstetrics & Gynecology Core Clerkship (OBG 601): Students receive didactic education by a gynecologic
pathologist and by gynecologic oncologists. The students rotate on the gynecologic oncology service, in which
pathology is a major component of the education.

Pathophysiology I, II, and III (MED 501-503): teaches clinical pathology as part of their courses.

Pediatric Core Clerkship (PED 601): This topic is intertwined throughout as the students work with pediatric
patients. In addition, the “case analyses” involve clinical pathology decisions.

Pediatric Subinternship (PED 610): Students regularly discuss clinical pathology with their resident supervisors and
with the faculty.

Introduction to Psychopathology (PSY 501): In lecture sessions, as it applies to psychiatry

Psychiatry Core Clerkship (PSY 601): Pathophysiology is in its infancy as it applies to psychiatry, but the course
director emphasizes what is known during weekly sessions.

Pathology I, II, and III (PTH 511, 512, & 513: This is covered as separate sessions and intermixed with other aspects
of pathology. Special lab sessions are held to introduce and incorporate the concepts of clinical pathology into the
curriculum. We have lab sessions where students are taught the basics of venipuncture, peripheral smear
examination and basic concepts of hematology. Special lectures addressing the utility of lab tests in clinical
management of patients are included. For example, the role of cardiac enzymes, urinalysis, endocrine function tests,
are part of clinical pathology education and training in the pathology course

Surgery Core Clerkship (SUR 601): All students are required to keep a pathology book/record for their team. The
pathology is reviewed and discussed on rounds when the patients’ treatment plans are discussed.

One elective in this area are offered.

Pathology Elective (PTH 601): This elective is aimed at students who are considering post-graduate training in
pathology, and at students who desire to enhance and complement their knowledge of general pathology. The
elective may be tailored to focus on a student’s specialty interest if other than general pathology. During this four to
six week elective, student have hands-on experience in techniques of grossing specimens in surgical pathology,
molecular diagnostic techniques, image analyses, and clinical laboratory procedures. The individual is encouraged to
get involved in the performance of autopsies, including weekends, if so desired. This service usually requires 10-
20% of the student’s time in the elective.

See also information for standard ED-10.




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ED-18. The curriculum must include elective courses to supplement required courses.

       While electives permit students to gain exposure to and deepen their understanding of medical
       specialties reflecting their career interests, they should also provide opportunities for students to
       pursue individual academic interests.
_________________________________________________________________________________

a. Indicate the weeks of elective time available in each year of the curriculum.

                                 Year         Total Weeks of Elective Time
                                  1                         0
                                  2                         0
                                  3                 18 week required
                                  4             Up to 17 additional weeks
                                                        available.


b. Indicate the maximum number of weeks that students may spend taking electives at another institution?

                          10 for credit towards meeting graduation requirements*

          * If a student applies through the Director, Clinical Curriculum and his/her request
          is approved, he or she can take more than ten weeks of away electives if the
          student’s schedule allows. These additional weeks will not, however, meet
          graduation requirements. In special circumstances, a student can request permission
          from both the Curriculum Committee and the Committee on Student Evaluation and
          Promotion to have more than ten weeks of elective credit at other institutions
          applied toward graduation requirements.

c. Provide the average number of weeks that students in the most recent graduating class spent taking
electives at another institution.

                                                     3.87 weeks

         Seventy students (66.6% of 105 graduates) in the class of 2003 took electives at other
         institutions. These seventy students spent an average of 5.8 weeks at such electives.




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ED-19. There must be specific instruction in communication skills as they relate to physician responsibilities,
including communication with patients, families, colleagues, and other health professionals.
________________________________________________________________________________

Describe where in the curriculum (specific course or clerkship) students gain experience in the following areas.
Include the settings in which instruction occurs (e.g., classroom, clinical) and the format(s) used (e.g., lecture, small
group, standardized patient, role play, etc.).

Development of communication skills is an integral part of the pre-clinical curriculum. Students receive specific
instruction and evaluation in diverse formats to expand their inherent speaking and listening abilities. The
interviewing and communications course most directly addresses this topic. Students are taught details of a thorough
medical history; engage in role-playing exercises to practice their interviewing skills; and participate in small group
discussions to explore different methods to handle both routine and difficult professional situations. Communication
is encouraged throughout the pre-clinical curriculum, most commonly through small group interaction. This period
of education at Rush provides our students with the opportunity to adapt their personal styles into effective
approaches to the myriad of social interactions that they will soon face during clinical clerkships and beyond.

During the clinical clerkships, our students frequently are our most effective liaisons between our patients, their
families, and the medical team. Students are expected to conduct a complete history and physical, and then to
present the patient, including an assessment and plan, to the medical team. We encourage the students to discuss the
diagnosis and plan with the patients, frequently under observation by senior house staff. Students also interact with
the other health professionals participating in patient care. This practice provides many opportunities for formal and
informal constructive counseling. Specific instruction is also provided in a more formal lecture or small group
setting during the core clerkships. Students are required to debate the merits of different medical therapies with their
colleagues, discuss the ethics of certain scenarios, and also teach their peers on assigned or selected topics. Feedback
is provided at all levels, both formally and informally, to assist our students as they hone their communication skills
in preparation for their careers in medicine.

In preparation for USMLE Step 2 Clinical Skills exam, a non-graded Clinical Skills Assessment (OSCE) is given to
third year students in late spring. It is conducted at the University of Illinois at Chicago Clinical Performance
Center. Three cases, selected by members of our faculty, are encountered. A second standardized patient experience
with three different cases is planned for the fall of 2004 for the current fourth year students.

The cases are designed to cover some of the basic medical knowledge objectives in the core clerkships:
1) To assess clinical skills though focused histories and patient exams, and
2) To assess communication and interpersonal skills

These three cases are offered to students in half-day sessions and orientation is provided by staff of the Clinical
Performance Center. An attempt was made to use the format of Step 2 CS as much as possible. All encounters are
videotaped. Students are given an orientation presentation to help them anticipate the elements of the experience, to
coach them with tips on a successful encounter, and reminders of what should be included in the documentation
note. The students receive a grade of "satisfactory" or "unsatisfactory" on three components of each case: 1) the
written note; 2) communication/ interpersonal skills; and 3) history/physical exam items. Each student receives
detailed feedback on their performance. This occurs in the following ways:
      each student receives one-on-one feedback directly from the standardized patient immediately after each
          encounter to discuss the student’s communication/interpersonal skills.
      group feedback sessions provided to all the students
      detailed written feedback for each student
      one-on-one feedback from faculty members for those who received unsatisfactory scores
      videotapes are made available for student self-review after the session

a. Communicating with patients and patient families

Behavioral Science: Ethics in Medicine I and II (BHV 481 & 482): In the classroom, we continually discuss
communication skills relevant to medical ethics. For example, we spend approximately 30-60 minutes discussing


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how to initiate conversations with a patient on advanced directives (e.g., how to bring up the topic, how to elicit
patient preferences, how to give medical information the patient may need). We also spend one lecture hour and two
small group hours on the topic of “truth telling / bad news”. We ask students to discuss their own personal
experience interacting with the health care system (e.g., what did they like or not like about how bad news was
delivered to them or their friends/relatives). We discuss strategies and techniques for delivering what may be
perceived as bad news. We also discuss the range of possible reactions patients may have, and how to react as a
caregiver.

Pathophysiology I, II, and III (MED 501-503): This course does not offer exposure to actual patients but all cases
discussed in a problem solving fashion are based on real patients.

Internal Medicine Core Clerkship (MED 601): All students participate in a “Giving Bad News” workshop during
their ambulatory block. During this workshop students interact with a standardized family member, then debrief as a
group. During the debriefing session, students review communication techniques with a faculty member as well as
concepts including DNR, advance directives and living wills.

Internal Medicine Subinternship (MED 610): Clinical experience with patients.

Pediatric Subinternship (PED 610): Clinical experience with patients

Neurology Core Clerkship (NEU 601): Clinical experience is acquired within the context of patient care,
observation of residents and attendings, and verbal instruction.

Obstetrics and Gynecology Core Clerkship (OBG 601): Clinical experience with patients, and with their families (as
part of a treatment team) and in the classroom lecture setting.

Introduction to Patients (PCM 501): Classroom – lecture, small group, role play

Physical Diagnosis IV/VI (PCM 504/506): Lecture on history taking; small group role plays (faculty portrays
patient)

Interviewing and Communication I & IV(PCM 511 & 514): Small group setting – role playing, standardized
patients

Preceptorship I, II, III, IV, V & VI (PCM 521-526): Through direct patient contact

Pediatric Core Clerkship (PED 601): A one-hour lecture is scheduled for the students in addition to a thirty-minute
video. Students’ experiences with patients are critiqued regularly by residents and faculty.

Introduction to Psychopathology (PSY 501): Classroom – formal lectures on communicating.

Psychiatry Core Clerkship (PSY 601): This is an integral part of the inpatient clinical experience. Family meetings
are routine and students attend these sessions.

Surgery Core Clerkship (SUR 601): Students have contact with patient and families in both the private offices and
on the hospital wards. These encounters are supervised by attendings and residents.

b. Communicating with colleagues (e.g., as part of the medical team)

Human Anatomy I & II (ANA 471 & 472): Students interact with each other during the dissections and while
preparing for examinations.

Biochemistry I, II & III (BCH 470, 471 & 472: Course contains small group discussions about molecular
background and subsequent clinical manifestations of several clinical cases.




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Behavioral Science: Ethics in Medicine I & II (BHV 481 & 482): We discuss, in small groups, how to resolve
conflicts between members of the treatment team. This involves organizing the conflicting viewpoints, including the
patient’s preferences, prioritizing goals of treatment, and how to resolve the conflicts.

Pathophysiology I-III (MED 501-503): We do not have actual patients, but all cases discussed in a problem solving
fashion are real. This is highly emphasized. The discussions in our facilitated sessions are a nice introduction to
clinical ward rotations as students are forced to discuss options, diagnostic assessment with each other as if they
were on the floor as a medical team.

Internal Medicine Core Clerkship (MED 601): Students are trained to present patients orally and to practice this with
a faculty member for a total of 8 hours in groups of two or three, in order to improve their communication skills in
this arena. Students also participate in a workshop on eliciting feedback designed to enhance their ability to ask for
and receive feedback on their performances as team members.

Internal Medicine Subinternship (MED 610): Clinical experience

Neurobiology (NEU 451): Problem-based case study work was a tremendous asset for producing a sense of
teamwork and responsibility to the group.

Neurology Core Clerkship (NEU 601): Students gain clinical experience through daily interactions and observation.

Obstetrics & Gynecology Core Clerkship (OBG 601): In clinical setting, as part of a small group.

Introduction to Patients (PCM 501): We teach this to the extent that we have the student document their findings
from the history and physical exam they performed. We review these assignments and provide feedback.

Physical Diagnosis IV/VI (PCM 504/506: homework assignments (students write-up portions of the physical exam)

Preceptorship I-VI (PCM 521-526): During office visits

Pediatric Core Clerkship (PED 601): Communicating with medical team colleagues is experienced throughout the
eight weeks of the clerkship, probably most intensively during the four weeks of inpatient pediatrics.

Pediatric Subinternship (PED 610): Clinical experience requires multiple opportunities to practice these
communication skills with medical team colleagues.

Physiology I/II (PHY 451/452): Many small group sessions are schedule, as well as whole class, problem solving
sessions in which students must communicate with one another in order to solve the problem presented to them.

Psychiatry Core Clerkship (PSY 601): Students discuss their cases with residents and attendings, both informally
and formally (e.g., during Rounds)

Surgery Core Clerkship (SUR 601): Each student is assigned to a surgical team consisting of attendings, residents,
and other students.

c. Communicating with other (non-physician) health professionals

Behavioral Science: Ethics in Medicine I & II (BHV 481 & 482): We discuss, in small groups, how to resolve
conflicts between members of the treatment team. This involves organizing the conflicting viewpoints, including the
patient’s preferences, prioritizing goals of treatment, and how to resolve the conflicts.

Internal Medicine Core Clerkship (MED 601): Students spend three months actively caring for patients in 2 hospital
settings and one ambulatory setting. In all of these settings, there is continuous communication with nurses, physical
therapists, speech pathologists and many others involved in patient care.




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Neurology Core Clerkship (NEU 601): Students gain clinical experience through daily interactions and
observation.

Obstetrics & Gynecology Core Clerkship (OBG 601): In clinical setting, as part of a small group.

Physical Diagnosis IV/VI (PCM 504/506): homework assignments (students write-up portions of the physical exam)

Preceptorship I -VI (PCM 521-526): During office visits

Pediatric Core Clerkship (PED 601): Communicating with other health colleagues is experienced throughout the
eight weeks of the clerkship, probably most intensively during the four weeks of inpatient pediatrics.

Pediatric Subinternship (PED 610): Clinical experience requires multiple opportunities to practice these
communication skills with other health professionals.

Introduction to Psychopathology (PSY 501): Social workers and psychologists are an important part of the treatment
team in psychiatry. Students routinely work with them during their clinical experience.

Surgery Core Clerkship (SUR 601): Students are required to interact with discharge planning nurses and technicians
that take care of their patients.

See also information for standards ED-10 and ED-28.




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Academic Year 2003-2004


ED-20. The curriculum must prepare students for their role in addressing the medical consequences of
common societal problems, for example, providing instruction in the diagnosis, prevention, appropriate
reporting, and treatment of violence and abuse.
____________________________________________________________________________________

Students learn about the medical consequences of common societal problems during small group case
exercises as well as direct patient care. As an urban medical center associated with John H. Stroger Jr.
Hospital of Cook County, students are exposed to a variety of socioeconomic and public health issues
including inadequate immunizations, poor nutrition, substance abuse, domestic violence, lack of
insurance, poverty, and homelessness. In addition to the rich clinical experiences, the internal medicine
clerkship emphasizes preventive medicine and counseling techniques. Physical Diagnosis II (PCM 501)
and Health of the Public I (PCM 531) devote sessions specifically to cultural competence,
professionalism, and “Common Confounders in Causation,” which focuses on the interplay between
society, social factors and healthcare delivery. In addition to their required courses, students have ample
opportunity to see these medical consequences of societal problems during their community volunteer
experiences (especially through the Rush Community Service Initiative Project). Students also can enroll
in elective clerkships at John H. Stroger Jr. Hospital of Cook County if they want additional experience
with underserved populations.

a. Indicate where in the curriculum students learn about the medical consequences of common societal
problems.

Behavioral Science: Ethics in Medicine I & II (BHV 481 & 482): In the small groups, we often have the
topics of poverty, poor access to healthcare, and personal biases that may enter into medical decision-
making.

Immunology Basic Sciences (IMM 505): Covers importance of vaccines in prevention of childhood
infectious diseases.

Pathophysiology I-III (MED 501-503): Alcohol abuse and its impact on liver disease and other GI disease
are incorporated into our case on cirrhosis and pancreatitis.

Internal Medicine Core Clerkship (MED 601): Students see patients in a variety of settings during the
internal medicine clerkship. During the ambulatory block preventive medicine is emphasized as well as
counseling on smoking cessation, nutrition and obesity, and other negative behaviors that affect health.
As part of the course curriculum, we have a lecture on the social determinants of health and another on
smoking cessation. We concentrate on teaching counseling techniques to help students identify the
“stage” (stages of change model) of the patient and the most appropriate advice to offer the patient. The
inpatient setting provides a rich environment in which to witness the consequences of societal problems
such as poverty and homelessness, substance abuse and smoking, and to learn on a case-to-case basis.
They attend didactics on a variety of topics while rotating at John H. Stroger Jr. Hospital of Cook County.

Obstetrics & Gynecology Core Clerkship (OBG 601): Societal problems including poverty, lack of
educational and employment opportunities, substance abuse, poor nutrition, lack of exercise, poor
lifestyle decisions all are common causes of the conditions for which women seek obstetric and
gynecologic care.

Introduction to Patients (PCM 501): We have 2 large-group sessions on Cultural Competence and one
large-group session on Professionalism.




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Shared Medical Decision Making I/II/III (PCM 515/516/517): The course deals intimately with all issues
of diagnosis, prevention, reporting and treatment, as the role of “the patient” is central to these societal
issues.

Preceptorship I - VI (PCM 521, 522, 523, 524, 525, & 526): The Preceptorship Program includes
no “formal” curricular component; however, each office visit certainly provides the opportunity for
addressing the spectrum of societal issues with patients. All primary care practice emphasizes diagnosis,
disease prevention, awareness of chemical/substance abuse, domestic violence, etc.

Health of the Public I (PCM 531): We have an entire session devoted to “Common Confounders in
Causation,” that gives some of the background information about the interplay between society and
societal factors and healthcare delivery.

Pediatric Core Clerkship (PED 601): Social problems play a big role in the practice of pediatrics. Students
are exposed to a variety of patients who demonstrate the medical consequences of societal problems.

Pediatric Subinternship (PED 610): As an urban medical center, many of those admitted to Rush
University Medical Center have social problems with medical consequences.

Pharmacology I-II (PHR 501-502): In three lectures in the CNS section and in one lecture on toxicology,
we indicate outcomes of substance abuse, alcohol abuse, alcoholism, misuse of nutritional supplements,
and abuse of prescription medications. Three hours of clinical case workshop, two in CNS, and one in
toxicology support the lectures.

Introduction to Psychopathology (PSY 501): Psychiatric consequence of alcoholism and other drug abuse
is covered

Psychiatry Core Clerkship (PSY 601): Clinical experience results in exposure to alcoholism/drug abuse,
domestic violence and sexual abuse/rape. These topics are discussed during clinical rounds and formal
didactic sessions. Medical and psychiatric consequences of alcoholism and other drug abuse are also
routinely covered during the clerkship, both in didactic lectures and in patient care experience. Related to
this, psychiatric aspects of HIV infection are covered, both in didactic lectures and (occasionally) patient
care experience.

b. List the required courses and clerkships that cover the following aspects of domestic violence and abuse:

                                Required course(s) where              Required clerkship(s) where topic
          Content area              topic is addressed                          is addressed
          Diagnosis          PCM 515/516/517                          MED 601
                             PCM 524/525/526                          OBG 601#
                                                                      PED 601*
                                                                      PED 610
                                                                      PSY 601
          Prevention         PCM 515/516/517                          OBG 601#
                             PCM 524/525/526                          PED 601*
                                                                      PED 610
          Reporting          PCM 515/516/517                          OBG 601#
                             PCM 524/525/526                          PED 601*
                                                                      PED 610
                                                                      PSY 601
          Treatment          PCM 515/516/517                          OBG 601#
                             PCM 524/525/526                          PED 601*



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                                                                       PED 610
                                                                       PSY 601

    # In Obstetrics & Gynecology, these topics are covered in lecture and clinical care.
    * In Pediatrics clerkship, these topics are covered in a one-hour lecture. In addition, students are exposed to
    abuse issues in their clinical work with patients.
See also information for standard ED-10.




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ED-21. The faculty and students must demonstrate an understanding of the manner in which people of
diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases,
and treatments.

       All instruction should stress the need for students to be concerned with the total medical needs of
       their patients and the effects that social and cultural circumstances have on their health. To
       demonstrate compliance with this standard, schools should be able to document objectives
       relating to the development of skills in cultural competence, indicate where in the curriculum
       students are exposed to such material, and demonstrate the extent to which the objectives are
       being achieved.
________________________________________________________________________________

a. Indicate where in the curriculum students learn about issues relate to cultural competence. Note whether the
instruction occurs through formal teaching or as a result of exposure in the clinical setting.

From the outset of their medical education, Rush students see the patient as a whole and provide their patients a
“medical home” which attends to all their medical needs in the context of their social and cultural circumstances.
The teaching starts early in BHV 481 and 482 which address cultural factors in ethical medical dilemmas, patient
care cases, mock patient interviews and a variety of patient needs. This continues in their physical diagnosis and
general Preceptorship experiences. Specifically, in MED 601, students attend a “social determinants of health”
lecture. During this 3 month clerkship, they are exposed to patients from many cultural backgrounds and learn
cultural competence in the context of direct patient care. The patient population at our urban teaching hospital
combined with the population at John H. Stroger Jr. Hospital of Cook County provides a very diverse and rich
exposure to patients from many socioeconomic and cultural backgrounds. This is seen in all clinical clerkships. PSY
601 and PCM 531 also provide formal didactic sessions on cultural competence. Recently, this has also been the
topic of Obstetrics-Gynecology Grand Rounds.

Co-curricular activities also serve increasing awareness of cultural competence issues. In addition, students work a
variety of underserved populations through the Rush Community Services Initiatives Program (RCSIP). This is a
very popular volunteer co-curricular learning opportunity for students. RCSIP offers exposure to indigent clinics,
which students attend under the supervision of volunteer faculty. Over 80% of RMC students participate with
RCSIP over their four years at Rush. Medical students spend, on average, at least twenty hours engaged in work in
these clinics. Patients at these clinics are from a wide-range of racial and ethnic groups.

Additional examples are provided by course below:

Behavioral Science: Ethics in Medicine (BHV 481 & 482): During all small group discussions, considering
contextual features including cultural factors is a part of the model we use for resolving ethical conflicts.

Internal Medicine Core Clerkship (MED 601): Students are exposed to patients from many cultural backgrounds
during their three-month clerkship, and learn about cultural competence in the context of patient care. The patient
population at an urban teaching hospital combined with the population at John H. Stroger Jr. Hospital of Cook
County provides a very diverse and rich exposure to patients from many backgrounds and cultures.

Internal Medicine Subinternship (MED 610): Exposure in clinical setting

Obstetrics & Gynecology Core Clerkship (OBG 601): Both formal teaching (including grand rounds lectures) and
clinical settings address these issues. The course director plans to increase his coverage of these issues by integrating
it more fully into case discussions.

Introduction to Patients (PCM 501): Occurs via formal teaching (lectures) with clinical vignettes.

Physical Diagnosis IV/VI (PCM 504/506): Students examine each other (which requires some cultural sensitivity).
Students examine gynecologic and male urogenital associates who stress sensitivity to the individual patient.




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Inteviewing & Communication I & IV (PCM 511 & 514): Mock interviews with standardized patients

Pediatric Core Clerkship (PED 601): We expect students will be exposed to issues that related to cultural
competence through their clinical work with patients.

Pediatric Subinternship (PED 610): Through patient care, students are exposed to multicultural issues related to
care/treatment.

Psychiatry Core Clerkship (PSY 601): Cultural differences, as they relate to psychiatry, are very important. Students
are exposed to this concept in their clinical experience and the course director routinely discusses it during formal
didactic sessions.

Health of the Public I (PCM 531): We have a formal teaching session devoted to “Common Confounders in
Causation,” that gives some of the background information about the interplay between society and societal factors
and healthcare delivery. We use some examples of how different cultures view health and disease, as well as how
different cultures are at risk for different diseases (primarily due to different health habits).

Surgery Core Clerkship (SUR 601): Students would learn about cultural competence as a result of exposure in the
clinical settings, depending on site (university hospital vs. public vs. community).

b. Provide evidence that institutional and course or clerkship objectives addressing cultural competence are
being met. How is student attainment of the objectives being evaluated and what are the results?

Evaluations of cultural clinical competence are done primarily by direct observation, personal feedback, and formal
written evaluations. Several courses have added questions to their written and oral examinations to evaluate cultural
competence. Rush’s standard student evaluation form contains a section on professionalism. Residents and attending
faculty are asked to evaluate students on cultural competence. The vast majority of students received good to
superior cultural competence ratings during their clinical clerkships.

Behavioral Science: Ethics in Medicine I & II (BHV 481 & 482): During our many small group sessions, we have
access to students’ voiced opinions and answers to questions. These statements allow us to assess student
understanding of the importance of considering cultural factors relevant to individual patients, groups of patients, or
society as a whole.

Family Medicine Core Clerkship (FAM 601): Students are evaluated on professionalism using CEA forms by
supervising preceptors.

Neurology Core Clerkship (NEU 601): Students are formally evaluated on professionalism using CEA evaluation
form by supervising residents and attendings.

Obstetrics & Gynecology Core Clerkship (OBG 601: Student attainment of these objectives are assessed by
observing students’ clinical competencies in participating in the care of patients. Students are also formally
evaluated on professionalism using the CEA form by supervising residents and attendings.

PCM 500: Questions on cultural competence are included on the final exam (MCQs)

PED 601: Students are formally evaluated on professionalism using the CEA form by supervising residents and
attendings.

PED 610: Through evaluations by the supervising resident and faculty.

PCM 504/506: Students are observed by faculty instructor

PCM 531: We have three questions on the final regarding these issues. There have been no significant differences in
the proportion of students correctly answering these questions compared to the rest of the test.



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PSY 601: Students are exposed to a wide variety of cultural differences during the clerkship. Those are often time
tests (but not always) during the oral proficiency exam. Students are also formally evaluated on professionalism
using the CEA form by supervising residents and attendings.

See also information for standard ED-10.




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ED-22. Medical students must learn to recognize and appropriately address gender and cultural biases in
themselves and others, and in the process of health care delivery.

       The objectives for clinical instruction should include student understanding of demographic influences on
       health care quality and effectiveness, such as racial and ethnic disparities in the diagnosis and treatment of
       diseases. The objectives should also address the need for self-awareness among students regarding any
       personal biases in their approach to health care delivery.
___________________________________________________________________________________

a. Describe where in the curriculum (in formal teaching sessions or indirectly through clinical experiences)
students receive instruction addressing the following:

1. Demographic influences on health care quality and effectiveness (including racial or ethnic disparities in health
care delivery).

Rush students have a unique experience seeing patients and mentors in a variety of clinical settings including an
urban private academic medical center, a county hospital, a community hospital in an ethnic neighborhood, and
several outpatient sites. Through direct clinical experience in these settings, students learn the particular
demographics of that area on how those influence a specific patient’s health care quality and effectiveness. Many of
the classes also have formal didactics (especially in BHV 451, 481, 482, MED 601, and PSY 501).

BHV 451: Lectures cover this topic

BHV 481 & 482: Again, “contextual features,” which includes demographic variables, is one of the four major areas
of the theoretical / practical model we teach students for resolving ethical conflicts.

MED 601: Social determinants of health lecture

NEU 601: Indirect, through clinical experience

OBSTETRICS & GYNECOLOGY (: In both lecture and clinical settings.

PCM 521-526: Through direct patient contact

PCM 531: Formal teaching sessions.

PED 601: This is accomplished through students’ clinical work with patients.

PED 610: Though clinical experiences.

PSY 501: Touched on in formal teaching sessions

PSY 601: Clinical experience

SUR 601: Rotating at a public university hospital in an indigent area, and a community hospital in an ethnic area,
students learn demographics in their clinical settings.

2. Student self-awareness of their own biases.

Rush students first discuss the bases of their own moral systems and biases in BHV 481 and 482. Initially, students
complete various written assignments. They use this as the foundation of an appreciation for “what they bring to the
table” as biases that may influence their actions and how to allow or to protect against this from happening. This
foundation is built upon during direct patient care, direct and indirect feedback from the medical team, and revisited
in many clinical lectures. In MED 601, the students complete a self-reflection writing exercise for one hour with a
faculty member. Specific course examples follow:



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BHV 481 & 482: We spend all of the first 2 small group hours of the year asking the students to complete various
written assignments (prior to class) and to discuss the bases of their own moral systems and biases (in class). We use
this as the foundation of an appreciation for “what they bring to the table” as biases that may influence the actions,
and how to allow or to protect against this from happening.

Internal Medicine Core Clerkship (MED 601): Self-reflection writing exercise for one hour with a faculty member

Neurology Core Clerkship (NEU 601): Indirect, through clinical experience

Obstetrics & Gynecology (OBG 601): In both lecture and clinical settings.

Intro to Patient (PCM 501): This is discussed in our cultural and competency lectures.

Physical Diagnosis IV/VI (PCM 504/506): Though interacting with male GU and Female Gynecologic Teaching
associates.

Interviewing & Communication I & IV (PCM 511 & 514): Small group sessions; taped interviews of mock patients.

Intro to Psychopathology (PSY 501): The course director lectures on this topic during the various didactic sessions

Pediatric Core Clerkship (PED 601): This is incorporated in the one-hour lecture all students receive in clinical
ethics.

Pediatric Subinternship (PED 610): Through clinical experiences.

Psychiatry Core Clerkship (PSY 601): During formal teaching sessions

b. Provide evidence that institutional or course- and clerkship-specific objectives related to gender and
cultural biases on health care are being met.

Small group discussions in many of the classes allow for direct observation and feedback for the students by a
faculty member. Professional and cultural competence is evaluated on clerkship formal evaluations. The vast
majority of students received a rating of good to superior in these areas during their clinical clerkships. The Inernal
Medicine clerkship surveys students after the “Social determinants of health” lecture and the self-reflection exercise
and the students have responded positively to these sessions. Two of the courses are also incorporating cultural
biases questions into their written exams. Specific course examples follow:

Behavioral Science: Ethics in Medicine I & II (BHV 481 & 482): Small group discussions allow the faculty to
assess these factors.

Internal Medicine Core Clerkship (MED 601): We have students fill out surveys at the end of the social
determinants of health lecture and after the self-reflection exercise. Students have responded positively to these
sessions.

Obstetrics and Gynecology (OBG 601): Observations of the students’ clinical performances.

PCM 504/506: Students are evaluated on their professional behavior during sessions with teaching associates while
learning how to perform gynecologic and male urologic exams.

PCM 521-526: Through direct patient contact

PCM 531: We do not have this as a specific objective of our course, but we do have three questions on the final
regarding these issues. There have been no significant differences in the proportion of students correctly answering
these questions compared to the rest of the test.




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Pediatrics Core Clerkship (PED 601): The topic is assessed to a small degree though the NBME Subject Exam for
which the course director receives group results. In addition, faculty evaluate students on these issues as a part of
their completion of the student’s evaluations for the various components of the clerkship.

Psychiatry Core Clerkship (PSY 601): The course director makes it a point to discuss these concepts formally during
each rotation.

Surgery Core Clerkship (SUR 601): We have studied the demographics of patient-student interaction through our
tracking instrument.




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ED-23. A medical school must teach medical ethics and human values, and require its students to exhibit
scrupulous ethical principles in caring for patients, and in relating to patients’ families and to others involved
in patient care.

         Each school should assure that students receive instruction in appropriate medical ethics, human
         values, and communication skills before engaging in patient care activities. As students take on
         increasingly more active roles in patient care during their progression through the curriculum,
         adherence to ethical principles should be observed and evaluated, and reinforced through formal
         instructional efforts.

         In student-patient interactions there should be a means for identifying possible breaches of ethics
         in patient care, either through faculty/resident observation of the encounter, patient reporting, or
         some other appropriate method.

       “Scrupulous ethical principles” imply characteristics like honesty, integrity, maintenance of
       confidentiality, and respect for patients, patients’ families, other students, and other health
       professionals. The school’s educational objectives may identify additional dimensions of ethical
       behavior to be exhibited in patient care settings.
____________________________________________________________________________

a. Identify each course in the pre-clerkship curriculum that requires students to demonstrate understanding
of ethical issues and human values, or to exhibit ethical behaviors.
      BCH 470, 471 & 472
      BHV 481 & 482
      PCM 501
      PCM 504/506
      PCM 515/516/517/524/525/526

b. Provide samples of any evaluation instruments used to assess the acquisition or demonstration of ethical
behavior.

University Statement on Student Conduct:

All Rush Students are required to follow the Rush University Code of Conduct. This is published in the
Rush University Bulletin and on the Rush University website:
Rush University seeks to create a climate that encourages its members to act as responsible adults in an academic
community. Generally, institutional disciplinary measures are invoked only in response to conduct that adversely
affects the University/Medical Center's pursuit of its educational objectives and mission. Penalties may range from a
warning to probation, suspension, or expulsion from the University/Medical Center. A partial list of disruptive
behaviors that would subject a student to disciplinary action includes the following:

         • ALL forms of academic dishonesty.

         • OBSTRUCTION or disruption of teaching, research, administration, or other University/Medical Center
         activities.

         • THEFT of or damage to University/Medical Center property or the property of a member of the
         University/Medical Center community.

         • PHYSICAL abuse of any person or action that threatens or endangers the safety of others.

         • MISREPRESENTATION, falsification, alteration, or misuse of University/ Medical Center documents,
         records or identification.

         • UNAUTHORIZED use or entry of University/Medical Center facilities.



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         • CONDUCT that is inconsistent with the ethical code of the profession the student is preparing to enter.

         • UNLAWFUL use or possession of controlled substances.

         • UNLAWFUL use or possession of firearms or other weapons.


Rush Medical College Honor Code
Rush Medical College’s new Honor Code has been designed and formally adopted by our students and
our Faculty Council. This Code is the culmination of an almost two-year effort led by students, with
broad based student and faculty input. All students have been informed of the new Code and had an
opportunity to review it. We are in a transitional period of developing procedural aspects to address
reports of violations of the Code. The goal is have the Code accepted and followed by all students in all
preclinical courses and clinical clerkships. All incoming students, starting this fall, will be required to
sign it. For students who entered prior to 2004, signing it will be optional but there is an expectation that
students will follow the principles and practices laid out in the Code. The Code did not result in any
changes in the current disciplinary processes of the Medical College. The processes for the Committee on
Student Evaluation and Promotion (COSEP) and the Committee on Student Judiciary Review (SJR)
remain as outlined in the current Rush University Bulletin. The faculty members involved in the effort to
create the Code feel the document is particularly powerful because it was student driven. Our students
recognize early-on their need to be proactive in safeguarding the ethics of the profession.

Implementation of the student initiated Honor Code awaits completion of written statements about the
policies and protections regarding such allegations of a violation against this code.

                                         Rush Medical College Honor Code
Rush Medical College students have instituted this honor code to affirm their commitments to academic and
personal integrity, sound moral character, and respect for the rights and dignity of others. The spirit of this code is in
keeping with our aspirations as future practicing physicians to uphold values of responsible behavior and honesty in
dealing with patients, peers and colleagues.
This commitment confers a shared responsibility of faculty, staff, and students in the Rush University community to
ensure the highest standards of behavior, whether this is in the classroom or in the clinical setting. This
responsibility includes efforts to minimize factors that put individuals at risk for inappropriate action and to keep an
open forum for discussion of ethical and professional issues.
This Honor Code does not specifically address all forms of inappropriate behavior but it does apply to conduct
throughout the undergraduate curriculum. In the pre-clinical curriculum, concerns include security of examination
materials, various forms of cheating on examinations, plagiarism, and respect for intellectual property protection in
reference to syllabus materials, copyrights, and electronic media. In the clinical pre-professional setting, professional
behavior is central to the student’s educational experience.
In recognition of the responsibility to uphold these standards, a student or faculty member who becomes aware of or
suspects inappropriate conduct is bound to consider several options: foremost would be to approach an individual
directly with regard to the particular concern; or, after due consideration, to report the concern to the appropriate
authority for purposes of investigation. Such allegations, which may or may not name (an) individual(s), can be
made to supervisors, program directors or administrators, the Committee on Student Judiciary Review, or to the
Associate Dean of Medical Student Programs.
It is our belief that recognition of these factors, while mostly self-evident, has a significant impact on the fairness
and standards of professionalism at Rush Medical College. It is commitment to these ideals, in addition to the
development of competence as a student to meet the challenges of medical training, that are at the core of our future
as practicing physicians.




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I understand that this signed document becomes part of my permanent record and I am expected to abide by and
uphold the letter and the spirit of this Honor Code throughout my medical education.

         ________________________________ _______________________________
            Signature                                  Printed Name
Unethical behavior:

Any unethical behavior is expected to be immediately addressed by a student’s teacher, preceptor, course
director, and the Dean. Students are required to behave professionally. This is addressed in all practical
courses, such as physical diagnosis, and all clerkships.

Additionally, there is an ethics course in the first year which includes discussion groups and term paper
assignments that require students to demonstrate organized, comprehensive assessments of complex
medical and ethical scenarios. Lastly, in several courses, professionalism and ethical behavior is assessed
during practical and written exams.

Examples from specific courses follow:

BCH 470, 471 & 472: We ask that students follow the Rush Medical College Honor Code. Each student is requested
to sign a reminder that they are expected to follow this Code during each examination.

BHV 481 & 482: This is our entire course. We have written term paper assignments that require the students to
demonstrate organized, comprehensive assessment of complex medical / ethical scenarios. We also engage in case-
based discussions in our small group format that allow faculty members to assess the comprehension of the course
material.

PCM 501: In our course students examine each other in small groups (16 students, 2 faculty, 1 fourth year teaching
assistant). In orientation and in the professionalism session, we explicitly discuss professional behavior with
colleagues. We also discuss professional behavior with patients.

PCM 504/506: Students exhibiting unprofessional behavior fail the course. For the Practical Exam, students perform
a head-to-toe exam on a classmate.

PCM 504: Students are observed during all workshop sessions. Students examine each other in small groups of 10
students and one preceptor. We require professional behavior at all times during these interactions. In the Head-to-
Toe Practical exam, students are scored on introducing themselves in a professional manner to the “patient”
(classmate). MCQ written exam questions cover professional behavior in the physical exam.

PCM 506: Students are observed during all workshop sessions. Students learn pelvic, female breast and male GU
exams on Teaching Associates in small group workshops (3-4 students and one GTA). Professionalism is discussed
explicitly in the Orientation Session. In particular, using inappropriate humor is flagged as being unacceptable in
these workshops. It is explicitly stated students who behave unprofessionally will not receive credit for the
workshops.

PCM 515/516/517: The ethical issues encountered in patient medical decision making, as well as the appropriate
role of the physician in these decisions is the basis for the course.

PCM 521/522/523/524/525/526: Professional behavior is an absolute expectation of the preceptorship experience.
Student behavior/performance is assessed at each office visit, and evaluated by the preceptor via a questionnaire at
the end of the year.

c. Describe the methods used to identify any breaches of ethics in patient care made by medical students.




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Students are monitored for any breach of ethics during patient care by direct supervision by residents,
attendings, and the course director. Students are directly observed during patient encounters and observed
clinical examinations. Moreover, all evaluations include a section on professionalism. In addition, the
nurses and staff are encouraged to contact the attending or course director if they note any lapses in
professionalism. Examples from specific clerkships include:

MED 601: Course directors solicit information from faculty members and housestaff and encourage faculty to
communicate any concerns immediately. Course directors attend senior resident retreats and housestaff conferences
to encourage open communication. All faculty and housestaff working with students are asked to complete a written
evaluation on each student with whom they work that includes a section of professionalism. At the end of one of the
inpatient months, the co-clerkship director meets with all students in groups of 2 or 3 to elicit any additional
information that students felt uncomfortable sharing in written form or in a larger group. In addition, the nurses and
nursing directors at John H. Stroger Jr. Hospital of Cook County and Rush are encouraged to contact the co-
clerkship director/clerkship director if they note any lapses in professionalism.

MED 610: Breaches in ethical patient care are handled thru the Department of Medicine’s internal structure since
the student is part of an entire team. If student specific it is reported to the Dean’s office.

NEU 601: Ethical breaches are identified by resident and attending supervision.

Obstetrics & Gynecology Core Clerkship (OBG 601): Observations by resident and attending staff.

Pediatric Core Clerkship (PED 601): Students are closely supervised by residents and faculty. Any ethical breaches
would be discussed with the student by his/her supervisor.

Pediatric Subinternship (PED 610): Faculty and residents directly supervise the subintern and address any such
breaches directly and personally with the student.

Psychiatry Core Clerkship (PSY 601): Ethical breaches are brought to the course directors’ attention by residents or
fellow students. He then discusses the situation personally with each student.

Surgery Core Clerkship (SUR 601): Any complaint of and ethical breach by a medical student is brought to the
attention of the course director and is reviewed by the course director. The Assistant Director, Clinical Curriculum is
notified of any complaint.

See also information for standard ED-10.




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ED-24. Residents who supervise or teach medical students, as well as graduate students and postdoctoral
fellows in the biomedical sciences who serve as teachers or teaching assistants, must be familiar with the
educational objectives of the course or clerkship and be prepared for their roles in teaching and evaluation.

_________________________________________________________________________________

Describe any institution-level programs to enhance the teaching and evaluation skills of graduate students,
postdoctoral fellows, or residents. If such programs are the same as those provided for faculty, indicate so and refer
to the response for standards FA-4 and FA-11 in Section IV: Faculty.

Residents, graduate students, and post-doctoral fellows are integral pieces to our medical students’ education. In the
clerkships, residents are familiar with students’ rotation objectives, meet with course directors, and are evaluated on
their teaching performance. Specifically, in Internal Medicine, residents attend a day-long retreat in which their roles
as teachers are emphasized. They attend monthly inpatient- service rotation orientation. Residents in both Internal
Medicine and Pediatrics receive handbooks detailing course objectives, teaching objectives, and the importance of
residents as student teachers. Another example of a formal program to enhance teaching skills involves doctoral
students in Anatomy and Cell Biology in conjunction with the Neuroscience graduate program. The doctoral
students and neurology residents are required to teach in the laboratories in histology, gross anatomy and
neurobiology under the supervision and mentoring of a faculty member. Lastly, residents, fellows, and doctoral
students do not teach in a vacuum. They all receive frequent feedback and mentoring from faculty about individual
experiences.

Doctoral students from Anatomy and Cell Biology and from the Neuroscience graduate program have participated in
three laboratories involving gross topography, horizontal and coronal sections in the Medical (M1) Neuroscience
course. Three to four neurology residents also participate directly in these labs or present MRI/CT or angiographic
films in demonstrations. Doctoral graduate students in the Anatomy and Cell Biology program are required to teach
in the laboratories of each of the major anatomy courses for a total of 9 hours credit. This includes formal experience
in histology, gross anatomy, and neurobiology. Research post-doctoral fellows do not serve as teachers or teaching
assistants to medical students. Graduate students in Anatomy & Cell Biology must have previously taken the course
before providing teaching services. They are provided guidance on their particular roles by the supervisors of the
laboratory section to which they are assigned and are evaluated mainly by observation of the supervising faculty
member. Finally, they are graded on their efforts teaching in the gross laboratories.

In the Neurobiology course (ANA 462), there is a pre-course meeting to enlist participants from among the current
neurology residents. These residents are not formally evaluated, but aspects of their presentations are often discussed
with them, particularly if they require improvement. Resident participation is usually handled as a live dialogue
between the faculty supervisor and the resident in front of the students to address specific questions, particularly of a
clinical nature. A premium is placed on helping graduate students develop their presentation, writing and
communications skills, their ability to explain information to their peers or to faculty, and to think critically about
their own efforts. This is an integral subtext of the Anatomy and Cell Biology Graduate Program promoted in
journal club, thesis proposals, and research group discussions in which students have an opportunity to practice
presenting various types of material. Participation in teaching medical students in the medical courses provides a
special venue to develop their understanding of the subject matter.

Biochemistry’s Procedures and Policies state that “The goals of the Graduate Program in the Department of
Biochemistry are to provide high quality education, practical training, and research opportunities to students
interested in practicing basic and applied medical biochemistry at molecular and cellular levels.” Therefore, in this
training program, students are expected to learn concepts of biochemistry and also the application of biochemistry to
causes and treatment of diseases through both their coursework and research experience. Their presentation skills
are critically analyzed during oral examinations and in departmental workshops. Students present lectures in the
graduate classes and some present lectures in the Medical Biochemistry courses (BCH 470, 471, 472). For the past
three years, Biochemistry had one graduate student present the biochemical basis of Addison’s and Cushing’s
Diseases while a second presented Cystic Fibrosis. Such students are asked to contribute examination questions to
cover their lecture topics. In addition, graduate students proctor medical college examinations and monitor the



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course evaluation procedure. Graduate students also are available to tutor medical students in biochemistry. The
Biochemistry Postdoctoral program is unique in that 90% of those that have been trained in this department are
M.D.s and have continued their training for at least 2 years. For ten years, Biochemistry was a World Health
Organization Center with the charge of training physicians to transfer basic science to the clinical setting.
Postdoctoral fellows are encouraged to interact with clinical departments. This interaction is further encouraged
because many members of the department have conjoint appointments in clinical departments. Interactions with
clinicians are supported through our weekly workshops where both basic scientists and physician scientists interact.
In addition, Biochemistry Postdoctoral fellows are assigned to monitor medical college lectures and are expected to
discuss the lecture format and content with the lecturer. Some Postdoctoral fellows lecture to medical students
particularly if their area of expertise has medical application. One postdoctoral fellow with training in molecular
biology lectured for three years to the medical students on Gene Regulation.

Medical Pharmacology (PHR 501): Residents and fellows in relevant clinical areas are invited to present short-case
clinical workshops that support didactic topic areas. These individuals are asked to base their presentations on their
own clinical experience and training. In some cases, the faculty and graduate students and post-docs prepare for
workshops by previewing the cases in a group meeting and by sharing academic background information that
underlies the understanding of each case. We do not include graduate students or post-doctoral trainees that work
outside of the specific clinical area.

Internal Medicine (MED 601 and MED 610): All second-year residents at Rush attend a day-long retreat in which
their roles as teachers are emphasized. They attend a monthly inpatient service rotation orientation. Residents get a
copy of the Internal Medicine Clerkship Curriculum Booklet with the course objectives listed. At John H. Stroger
Jr. Hospital of Cook County, residents participate in a teaching skills workshop and have monthly ward rotation
orientation.

Neurology Clerkship (NEU 601): During orientation of residents at the beginning of the academic year, the
clerkship director explain their roles in teaching and evaluating students.

Systemic Pathology (PTH 511, 512 & 513): Senior residents serve as assistants in the Gross Pathology Lab under
the supervision of the faculty member who generally reviews the educational objectives prior to the assignment.
Student evaluations (written and verbal) are used to assess the teaching skills of the resident.

Psychiatry (PSY 601 and PSY 610): Residents who teach students in a formal manner (i.e., giving lectures on a
specific subject) are provided learning objectives for subjects they are assigned to lecture. The course director
reviews the resident's lecture slides and/or handouts to make sure that the proper material is being covered. Students
fill out evaluations on each resident lecture; this feedback is provided to the resident lecturer and reviewed by the
resident and the course director. There is no formalized training for teaching on the clinical floor. The course
director believes that the best way to acquire teaching skills is to watch faculty members teach and model their style.
Students fill out evaluations on the residents at the end of the rotation, and this includes a section on teaching skills.
Psychiatry residents usually score quite well in this area.

See also the Required Course Forms and Required Clerkship Forms for course-specific and clerkship-specific
programs.




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ED-25. Supervision of student learning experiences must be provided throughout required clerkships by
members of the medical school’s faculty.
____________________________________________________________________________________

Summarize the mechanisms used to assure faculty supervision of student learning experiences in clerkships,
including direct observation of performance, reviews of patient charts or logbooks of patient encounters, etc.

Faculty members are required to provide supervision of all student involvement in patient care. In
addition, faculty review students’ notes and discuss patient care management with both residents and
students. Students in Internal Medicine, Psychiatry, and General Surgery clerkships complete a log-book
of all significant patient encounters. Moreover, several of the clerkships dedicate significant amount of
time to completing required, observed clinical examinations and patient encounters during the rotation.
Lastly, in the Internal Medicine clerkship, students meet with the inpatient preceptors weekly to review,
in detail, patient write-ups and oral presentations.

All clerkship directors communicate with residents and attending faculty on a regular basis to ensure that
they are prepared for their teaching responsibilities. Internal Medicine and Neurology offer periodic
faculty development programs for their faculty. General Surgery has an educational expert available to
faculty on a daily basis. In Pediatrics, faculty responsibilities are outlined in the “Pediatric Physician
Supervisor’s Handbook.” Resident physicians participate in a variety of exercises to prepare them for
teaching, including seminars and retreats. Faculty development opportunities exist in a variety of settings
for volunteer faculty, such as quarterly evening workshops.

Examples from specific courses include:

Internal Medicine Core Clerkship (MED 601): Each student completes a logbook of patient encounters that spans
the three month clerkship, in which they are asked to enter each patient with whom they have significant contact.
Each student completes a clinical examination with a faculty member while at John H. Stroger, Jr. Hospital of Cook
County, and each student completes an observed patient encounter while at Rush. During both inpatient months,
students meet with inpatient preceptors on a weekly basis to review in detail patient write-ups as well as oral
presentations

Neurology Core Clerkship (NEU 601): Faculty members submit student evaluations, review and sign patient log
sheets.

Obstetric & Gynecology Core Clerkship (OBG 601): Through direct observation by the faculty and frequent
feedback between the faculty and the course director either in writing, by phone, or at the monthly departmental
staff meetings.

Pediatric Core Clerkship (PED 601): Faculty are required to provide supervision of all student involvement in
patient care. In addition, faculty review student notes. Students are required to complete one witnessed history and
physical with a faculty supervisor on the wards.

Pediatric Core Clerkship (PED 610): Students are directly supervised by residents and faculty. Faculty members
review charts and personally verify student findings with patients. Faculty and residents both discuss patient care
and management with subinterns daily.

Psychiatry Core Clerkship (PSY 601): All of the above applies to this clerkship: Direct observation during the
proficiency exam; review of student notes by residents and Course Director; student log of patient contact.

Surgery Core Clerkship (SUR 601): All faculty teachers (lecturers) were reviewed by our Ph.D. in education. Our
tracking instrument tabulates patient-student encounters (an electronic logbook). The Asst. Dean, Clinical
Curriculum makes site visits to observe faculty-student–patient contact and to ensure supervision is appropriate.




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ED-26. The medical school faculty must establish a system for the evaluation of student achievement
throughout medical school that employs a variety of measures of knowledge, skills, behaviors, and attitudes.

         Evaluation of student performance should measure not only retention of factual knowledge, but
         also development of the skills, behaviors, and attitudes needed in subsequent medical training and
         practice, and the ability to use data appropriately for solving problems commonly encountered in
         medical practice.

       The LCME urges schools to develop a system of evaluation that fosters self-initiated learning by
       students and disapproves of the use of frequent tests which condition students to memorize details
       for short-term retention only.
___________________________________________________________________________________

a. Describe how the school ensures that the methods used to evaluate student performance are appropriate to achieve
its institutional and course- or clerkship-specific objectives. Note any role played by the curriculum committee or
other central curriculum management group.

Evaluation of student performance in courses and clerkships involves the use of a variety of exams and other
assessment instruments. The appropriateness of these assessment tools in determining whether course/clerkship
objectives and institutional objectives are being met is determined by individual course and clerkship directors.
Feedback from student performance in later Rush courses or clerkships provides one measure of success. Student
performance on the USMLE exam provides another measure of success.

No role is played by the Curriculum Committee in evaluating individual student performance. The committee on
Student Evaluation and Promotions (COSEP) play the central role in this process. [COSEP develops and monitors
the academic policies for the medical college. See Academic policies in the Appendix under MS33 (red binder).]

Examples of the methods chosen by course directors to evaluate student performance include:

Histology (ANA 451): Course faculty members do not evaluate students in this course beyond their ability to master
the factual knowledge and analytical skills taught in the course. This is achieved through course examinations. The
major goal of the course is to prepare students for the second year of the curriculum. Therefore, it is only by
measurement of their performance in the second year that the faculty could determine if their evaluation is a good
indicator of the success of their evaluation. Communication with the pathology course director is the major
mechanism for determining if they are accurately evaluating students.

Pathophysiology I-III (MED 501-503): Final exams are given at the end of each quarter. All exam and quiz
questions are case-based, requiring students to utilize information presented in the case. All exams are cumulative.

Internal Medicine Core Clerkship (MED 601): Faculty are asked to evaluate student performance based on
objectives as listed on the standard CEA evaluation form. These are consistent with the clerkship’s and medical
school’s objectives. In addition, students are paired with preceptors for both inpatient months. Preceptors evaluate
patient write-ups and oral presentation skills using specific criteria developed by the clerkship director that ask
preceptors to evaluate students’ diagnostic reasoning skills. Preceptors are given specific criteria for evaluation.
These criteria are outlined in the Preceptor Handbook.

Internal Medicine Subinternship (MED 610): The subinternship provides the student with the opportunity to
function at the level of a beginning intern with the close supervision of a senior resident. The faculty members’ and
senior residents’ evaluations are specifically directed at the clinical skills of the student including interaction with
patient, data gathering and processing, ability to follow up, interaction with medical and nursing staff, and ability to
mentor more junior students. Faculty and residents receive an evaluation form outlining in detail the evaluation
criteria.

Neurology Core Clerkship (NEU 601): Students are evaluated on their clinical performance by Neurology residents
and faculty. A faculty member is also expected to observe the student performing a neurologic exam. Additionally,
each student’s fund of neurologic knowledge is tested on a standardized NBME written exam.



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Shared Medical Decision Making I/II/III (PCM 515/516/517): Students complete graded assignments.

Preceptorship IV/V/VI (PCM 524/525/526): The preceptorship is an ambulatory care experience. Students submit
assignments (physical exams, progress notes) after each visit on a variety of patients seen. These are reviewed by
faculty. In addition, each preceptor evaluates the students overall performance (knowledge, clinical skills,
professionalism) at the end of each year.

Physiology I & II (PHY 451/452): Student performance is evaluated on the basis of performance on two exams, a
Midterm exam and a Final exam. The exam questions written represent a sampling of the course objectives
(published in our syllabus volumes).

Pharmacology I-II (PHR 501-502): Course objectives include the requirement that students demonstrate an
understanding of drug action as a basis for predictable outcomes, both positive and negative. Quiz & exam
questions, exam reviews, workshops and quiz conferences emphasize the importance of following the factual details
of drugs to logical conclusions about therapeutic expectations and toxic possibilities.

Intro to Psychopathology (PSY 501): Course-specific objectives are distributed during the first day of class. The
lectures and final exam are formatted to cover these objectives.

Psychiatry Core Clerkship (PSY 601): Students write progress notes daily on their patients, and these notes are
reviewed by the residents, attending physician, and course director. Appropriate feedback is given to the student
regarding the quality of the notes. In addition, an oral exam is given at the end of the clerkship to ensure that the
student has a basic grasp of psychiatric interviewing skills, diagnosis, and treatment planning for psychiatric illness.
If, in the opinion of the supervising resident, a student is not performing adequately by the third week of the
clerkship, the course director is informed and a meeting with the student is arranged to discuss the deficiencies.

Epidemiology/Biostatistics (PVM 505): is a review course for second year medical students preparing for the
USMLE Step 1 exam – specifically the portion on epidemiology & biostatistics. This course includes 15 lecture
hours over the course of 5 weeks, with one exam at the end to assess the students’ understanding of the topics
presented. This is the most effective evaluation of student performance for this kind of review course.

b. Include a copy of any standard form(s) used by faculty members or resident physicians to evaluate students during
required clinical clerkships.

The required form is included in the appendix.

See also Required Course Forms and Required Clerkship Forms.




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ED-27. There must be ongoing assessment that assures students have acquired and can demonstrate on direct
observation the core clinical skills, behaviors, and attitudes that have been specified in the school’s
educational objectives.
_____________________________________________________________________________________

a. Is there a core list of clinical skills/behaviors that students must master? (check)

                         X      Yes, as part of the institutional educational objectives
                         X      Yes, as a separate list for each required clinical clerkship
                                No (please explain if checked)

Revised institutional educational objectives have been drafted and are in the process leading to adoption
by Rush Medical College. In addition, each required clinical clerkship has a core list of clinical
skills/behaviors that a student must master:

Yes, as a separate list for each required clinical clerkship:
 Internal Medicine Core Clerkship (MED 601): The Internal Medicine Clerkship Curriculum Handbook has a list
 of core skills/behaviors
 Neurology Core Clerkship (NEU 601): Has a list of core skills/behaviors
 Obstetrics & Gynecology Core Clerkship (OBG 601): Has a list of core skills/behaviors
 Pediatric Core Clerkship (PED 601): The Pediatrics Student Handbook lists the core clinical skills/behaviors for
 this clerkship.
 Pediatric Subinternship (PED 610): Has twelve learning objectives for subinternship
 Psychiatry Core Clerkship (PSY 601): Has a list of core skills/behaviors

b. If one or more comprehensive evaluations of clinical skills (e.g., OSCE or standardized patient evaluations) are
given outside of individual courses or clerkships, describe the evaluation methods and when the evaluations are
administered.

In preparation for USMLE Step 2 Clinical Skills exam, a non-graded OSCE is given to third year students in Spring.
It is conducted at the University of Illinois at Chicago Clinical Performance Center. Three cases, selected by
members of our faculty, are encountered. A second standardized patient experience with three different cases is
planned for the fall of 2004 for the current fourth year students.

The cases are designed to cover some of the basic medical knowledge objectives in the core clerkships. The cases
also highlight the importance of good communication and interpersonal skills. The students receive a grade of
"satisfactory" or "unsatisfactory" on three components of each case: 1) the written note; 2) communication/
interpersonal skills; and 3) history/physical exam items. Each student receives detailed feedback on their
performance. This occurs in the following ways:
      group feedback sessions provided to all the students
      one-on-one feedback from faculty members for those who received unsatisfactory scores
      detailed written feedback for each student
      each student receives one-on-one feedback directly from the standardized patient immediately after each
          encounter to discuss the student’s communication/interpersonal skills.

See also the Required Clerkship Forms.




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ED-28. There must be evaluation of problem solving, clinical reasoning, and communication skills.
__________________________________________________________________________________

Provide a representative sample of the materials (written or oral exam questions, research paper assignments,
problem-based learning cases, etc.) specifically designed to assess student skills in problem solving, clinical
reasoning, and communication. Indicate the courses or clerkships that employ such materials.

Several courses utilize materials to assess student skills in problem solving, clinical reasoning, and
communication. A representative sample is included in the Appendix to this database.

In addition, an OSCE is provided to our third year students (and planned for our fourth-year students)
which specifically assesses communication skills.

Examples by course include:

Human Anatomy I & II (ANA 471 & 472): The dissection portion of these courses is classic problem-solving.
Practical exams are also problem-solving – having to identify an unknown.

Biochemistry I, II, & III (BCH 470, 471 & 472): We use cases from a textbook by Glew and Ninomiya that are
covered in large groups (lecture room) and in small group sessions in order to cover the biochemical basis of disease
that students are expected to discuss.

Behavioral Science: Ethics in Medicine I & II (BHV 481 & 482): Please see attached examples of a term paper
assignment and small group cases for discussion.

Pathophysiology I-III (MED 501-503): We use a standardized multiple choice examination at the end of the quarter
to assess our students; also a progress marker exercise at the end of the second session of every organ system
discussion is utilized.

Physiology I and II (PHY 451 & 452): Copies of this year’s midterm and final exams, plus several workshop
problems (with answers) are provided in the Appendix

Health of the Public I (PCM 531): Written exam questions test students’ skills in problem solving. We use both
multiple-choice questions and short-answer questions (including some with mathematical symbol manipulation,
although no calculations are required).

Interviewing & Communication (PCM 511 & 514): Video taped interviews with mock patient

Intro to Psychopathology (PSY 501): Clinical vignettes are used on the final exam. Students must apply what they
have learned and come up with a diagnosis and/or treatment plan.

Internal Medicine Core Clerkship (MED 601): See written materials on Student Grand Rounds and the IDEA
method (Given to LCME Coordinator)

Internal Medicine Subinternship (MED 610): Subinternship is a totally clinical experience.

Neurology Core Clerkship (NEU 601): Each student is required to evaluate a patient with epilepsy and multiple
sclerosis and present this during weekly attending teaching sessions, separate from daily morning teaching rounds.
Students’ skill in performing the neurological exam is observed. The written exam administered is the standardized
NBME subject test.

Obstetrics & Gynecology Core Clerkship (OBG 601): At weekly meetings, students discuss case presentations. In
the past, essay exams were administered to assess clinical reasoning skills. As the exams were released to students,
this required creating a new valid exam every eight weeks and this became unreasonable in terms of time required.




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The course director may reinstitute the essays as a non-graded but required experience and make variations in the
questions to better reflect the cultural diversity of the patient population seen.

Pediatric Core Clerkship (PED 601): See Pediatric Clerkship Student Handbook

Pediatric Subinternship (PED 610): All the students’ work in this course occurs through actual patient care.

Psychiatry Core Clerkship (PSY 601): Each student undergoes an oral exam based heavily on all three of these areas
(the exam is a patient interview/discussion).

Surgery Core Clerkship (SUR 601): See sample essay (on file with LCME Coordinator)

See also the Required Course and Clerkship Forms and the information for standards ED-6 and ED-19.




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ED-29. The faculty of each discipline should set the standards of achievement in that discipline.
____________________________________________________________________________________

Refer to the responses about student evaluation methods in the Required Course and Clerkship Forms.

In the preclinical curriculum, course directors determine their own objectives and write or select examinations that
correspond to standards they expect the students to meet.

In the preclinical curriculum, faculty members are expected to follow Rush Medical College guidelines for Honors,
Pass, and Fail in their grading. The minimal pass level (MPL) is set by the College as 1.5 SD below the mean with a
maximum of 70% and a minimum of 55%. The system for assigning grades (P/F/H) is basically uniform across the
M1 and M2 curriculum. It is “statistical” in nature and it is based on the mean and SD of the overall performance in
the course. The degree of difficulty of some course exams has changed over the years and aims at keeping the mean
at around 75-80%. Students performing at this level seem to be successful on the USMLE Step 1.

The clerkship directors are expected to use a grading system that includes fail/pass/high pass/honors, following the
RMC guidelines. All clerkships currently use the NBME subject exam as the end of clerkship exam for their
respective clerkships. These exams are used along with the RMC student evaluation forms as the primary evaluation
tools for the clerkships, and correspond with the standards we expect our students to meet. Clerkship directors have
uniformly set a minimal passing level at the 2nd-5th percentage nationally for the NMBE exam.

For example:

Pathophysiology I-III (MED 501-503): Based on mean scores and standard deviation. 1 ½ SD below mean is a
“danger zone” for possible failure.

Internal Medicine Core Clerkship (MED 601): Clerkship standards follow goals/objectives outlined by the Clerkship
Directors in Internal Medicine. All students must demonstrate competence in professionalism, knowledge and skills
articulated in our clinical evaluation form. In addition students must demonstrate competence in patient encounters
and in written and oral presentations. These standards are set by the department of Internal Medicine and the
clerkship director. Finally students must pass a national standardized examination (NBME Internal Medicine exam)
by placing at or above 2 standard deviations below the national mean score for this examination.

Internal Medicine Subinternship (MED 610): Student must be able to effectively evaluate and manage two patients
on each call night. They should show appropriate level of independent thinking.

Neurology Core Clerkship (NEU 601): Students must pass each of three components in order to pass the rotation.
Clinically, students must receive overall passing grades by both faculty and residents indicating that their
performance has been at least “good” and expected for their level of training. On the NBME written exam, students
have been expected to score at or above the 5th percentile. As new norms have been introduced by the NBME, the
minimum passing score may need to be changed.

Obstetrics & Gynecology Core Clerkship (OBG 601): All students must demonstrate competence in
professionalism, knowledge and skills articulated in our clinical evaluation form. Students must pass the NBME
Subject Exam at the required minimum passing score determined by the course director after consultation with the
director of the clinical curriculum. This exam is reviewed at regular intervals by the course director to make sure
that it is a valid test for this educational experience (does it appear to address the APGO objectives) and if the
clerkship experience adequately prepares students for this examination.

Preceptorship I, II, III, IV, V,PCM 521, 522, 523/524/525/526: Students must attend all scheduled visits, and submit
all required assignments in order to receive a Pass grade for the course.

PSY 501: The course director expects students to master 70 % of the material, as tested by multiple-choice
examination, in order to pass the class.




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PSY601: A score of 55% or higher on the final exam (NBME Subject Exam) is required to pass the course. It is
administered during the final two weeks of the clerkship. Successful passing of the oral exam is required; if failed, it
is repeated until a passing grade is earned. The exam consists of a patient interview and case presentation; the
student has thirty minutes to interview the patient, ten minutes to present the case back to the examiner, and twenty
minutes of discussion. The purpose of the exam is NOT to test psychiatric knowledge per se, but rather to test the
student's interviewing skills. Daily notes and participation in rounds, didactic lectures, and other group discussions
are expected; deficiencies in these are brought to the course director’s attention. Standard Rush evaluation forms are
also filled out on each student by residents and attending physicians.




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ED-30. The directors of all courses and clerkships must design and implement a system of formative and
summative evaluation of student achievement in each course and clerkship.
ED-31. Each student should be evaluated early enough during a unit of study to allow time for remediation.

         Those directly responsible for the evaluation of student performance should understand the uses
         and limitations of various test formats, the purposes and benefits of criterion-referenced vs. norm-
         referenced grading, reliability and validity issues, formative vs. summative assessment, etc.
         Courses or clerkships that are extremely short in duration may not have sufficient time to provide
         structured activities for formative evaluation, but should provide some alternate means (such as
         self-testing or teacher consultation) that will allow students to measure their progress in learning.

       The chief academic officer, curriculum leaders, and faculty should understand, or have access to
       individuals who are knowledgeable about, methods for measuring student performance. The
       school should provide opportunities for faculty members to develop their skills in such methods.
____________________________________________________________________________________
Describe how the school ensures that mid-course and mid-clerkship evaluations occur. Include methods (such as
review of test results, formal written comments, oral comments) used to provide formative feedback.
Courses in the first and second years administer mid-term examinations that provide students with both formative
and summative feedback. Computer laboratories and problem solving sessions that occur throughout the quarter
provide the students with formative assessment.
In clerkships, students receive formative feedback at or before the midpoint of the clerkship. Neurology is only four
weeks and routine mid-clerkship evaluations do not occur. If verbal comments or written evaluations are received
after students complete their first 2 weeks, the course director reviews this information with the student. Students at-
risk-to-fail receive feedback and assistance in planning a strategy to improve performance, and are given ample
opportunity to demonstrate an acceptable performance prior to the conclusion of the clerkship. This occurs
differently within each clerkship, depending on the length and venues for the clerkship.
Office of Medical Student Programs staff work closely with students who have been identified as at-risk by course
directors or through the COSEP process. This may include making referrals to staff in the Counseling Center and to
our academic skills specialist for consultation if course performance problems appear to stem from personal
problems or from deficiencies in study skills.
For example:

ANA 451: Students take a required midterm examination. This allows each student to be aware of his/her progress
to that point. Students who are at risk of failure are contacted by the course director and strategies to improve
performance are discussed and implemented. In addition, individual laboratory faculty members have the
opportunity to intervene at any time during the course when they feel a student is not performing at an adequate
level. The faculty may discuss strategies with the student to improve performance or refer the student to the course
director who will consult with the student on improvement of performance.

BCH 470, 471, 472: Students are permitted to review their exams along with individual tutoring by faculty so that
they can understand why they failed to pass the exam.

IMM 505: Ours is a short course – practice questions (with answers) are provided.

MED 501-503: There are weekly progress markers” that are used to gauge understanding of specific topics. Exams
are reviewed by course instructors. All students who score scoring less than 1 ½ SD below the mean meet
individually with a course director to outline a strategy for improvement.

MED 601: Students rotate after 4 and 8 weeks of our 12 week rotation. They receive feedback about their clinical
performance at each juncture. Any student with a marginal or failing clinical performance meets directly with the
clerkship director to develop a plan to address deficiencies, and receives ongoing feedback about his/her
performance towards meeting these improvement goals. Students all complete an observed patient or a mini-CEX



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during their inpatient months and receive immediate feedback on this performance. Any student with a failing
performance is remediated and must successfully complete an observed patient encounter prior to the end of the
clerkship in order to successfully the complete the clerkship requirements.

MED 610: Senior residents meet daily with a chief resident involved with student training. Any problems are
identified and addressed in an ongoing manner.

NEU 601: Given the short duration of the rotation, written evaluations are not sought mid-clerkship. However, if
verbal comments are received or written evaluations received soon after students complete their first 2 weeks (at
Rush, students switch services after 2 weeks), these are reviewed. If there are any problems, these are discussed with
the student contemporaneously.

OBG 601: Students engage in two-week blocks in this clerkship and are evaluated by senior residents and attendings
at the end of each block. The course director reviews the evaluation comments as the clerkship progresses and tries
to discuss any identified weaknesses or problem areas with the students. Faculty and residents are encouraged to
give constructive feedback to students throughout each block so that the student has an opportunity to remediate any
problems/weaknesses.

PCM 501: Students work in small group workshops with 16 students and 1-2 faculty members. They receive
constant feedback on basic history-taking and physical exam skills.

PCM 504/506: Students work in groups of 10 students and 2 faculty members in all workshops where students
receive constant individual attention. Students receive homework scores every week. Interim grades (including
homework and head-to-toe practical exam scores) are posted.

PCM 515/516/517: This is difficult to achieve as the course has been executed as a longitudinal course, with only a
few hours of contact each quarter.

PCM 521/522/523/524/525/526: We only assess student performance within the Preceptorship Program at the end of
each year; however, a student will receive an Incomplete grade for any quarter they have not submitted all required
assignments (i.e. attended all visits).

Pediatrics Core Clerkship (PED 601): The Physician Supervisor’s Handbook for this clerkship includes a mid-
rotation feedback form. Faculty are instructed to complete the form in consulation with housestaff who work with
the student. The form is collected at the end of the second week of a student’s inpatient experience. The form
request specific comments (e.g., physical exam skills, witnessed interactions with patients, procedures, skill working
with difficult patients, etc.). this document is reviewed by the attending physician with and signed by the student.

Pharmacology I and II (PHR 501-502): Exams are scheduled at mid-term and end-term periods during two quarters
(four major exams). Student performance is observed by the faculty and the Office of the Dean, as well as by each
student. All three partners in this process have initiated conversations regarding individual student progress. Quizzes
are scheduled more frequently than are exams and they are also useful early indicators of student performance.
Classroom review of each quiz and exam is designed to provide feedback in a timely way. In addition, some
students ask for individual meetings with faculty for the purpose of gaining feedback and insight into learning
methods.

Physiology I and II (PHY 451/452): There is a Midterm exam. Physiology exams are NOT secured exams so
students can always review their performance on the Midterm at whatever depth they choose. Students doing poorly
are invited to meet with the course director to review their performance and determine if any special assistance is
needed. Unfortunately, not all students needing help actually ask for, or accept, help.

Psychopathology (PSY 501): No mid-term examination or quiz was given in the 2003-2004 academic year. Sample
questions from past exams are distributed, however, and students can gauge their knowledge by looking at the old
questions. In addition, students are highly encouraged to ask questions, either during class or afterwards.




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Psychiatry Core clerkship (PSY 601): As noted under ED-26, deficiencies in student performance are brought to the
course director’s attention by the third week of the clerkship. Intervention is then provided by the course director. In
addition, the course director reviews student daily notes on a regular basis. Also, the course director meets with the
students as a group 6 hours a week during the clerkship in order to gauge student knowledge and mastery of the
material.


See also information for standard ED-26, and the Required Course and Clerkship Forms.




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ED-32. Narrative descriptions of student performance and of non-cognitive achievement should be included
as part of evaluations in all required courses and clerkships where teacher-student interaction permits this
form of assessment.
___________________________________________________________________________________

See information provided on the Required Course and Clerkship Forms.

Narrative descriptions are not solicited nor included as part of student performance in the M1 and M2 years. With
the guidance of COSEP, narrative descriptions could be installed in evaluations of some courses, which have more
extensive teacher-student interaction. These might include our preceptorship course and coursework in ethics and
physical diagnosis. These discussions of narrative descriptions may inform the decision about how to measure and
evaluate aspects of professionalism in our students.

Requests for narrative descriptions are included on the evaluation form for all of the clinical clerkships. Housestaff
and faculty commonly write narratives that describe the aspects of professionalism, knowledge, and clinical skills
demonstrated by their students during their respective clerkships. Clerkship directors provide a summary of
representative housestaff and faculty comments that are included in the final evaluation form for each student.

For example:

Internal Medicine Core Clerkship (MED 610): Evaluations provide a narrative of student’s level of function.
Members of the inpatient teams and outpatient faculty all complete Rush’s standard evaluation form which includes
space for narrative descriptions of student performance and non-cognitive achievement. Housestaff and faculty
routinely write lengthy descriptions as part of this process.

Neurology Core Clerkship (NEU 601): A narrative description of performance, including professional qualities, is
submitted with the final grade for all students.

Obstetrics & Gynecology Core Clerkship OBG 601: Comments are extracted from the course evaluations as well as
the course director’s impressions of the student based on clinical interactions and his weekly sessions with the
students.

Preceptorship IV/V/VI (PCM: 524/525/526): Via an end-of-the-year Preceptorship Program evaluation completed
by preceptors.

Psychiatry Core Clerkship (PSY 601): The course director routinely evaluate students’ professionalism and rapport
with patients. This is done via direct observation of students’ interaction with patients and by evaluation forms filled
out by resident/attending physicians.




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ED-33. There must be integrated institutional responsibility for the overall design, management, and
evaluation of a coherent and coordinated curriculum.

        The phrase “integrated institutional responsibility” implies that an institutional body (commonly
        a curriculum committee) will oversee the educational program as a whole. An effective central
        curriculum authority will exhibit:

         - Faculty, student, and administrative participation.
         - Expertise in curricular design, pedagogy, and evaluation methods.
         - Empowerment, through bylaws or decanal mandate, to work in the best interests of the
        institution without regard for parochial or political influences, or departmental pressures.

        The phrase “coherent and coordinated curriculum” implies that the program as a whole will be
        designed to achieve the school’s overall educational objectives. Evidence of coherence and
        coordination includes:

         - Logical sequencing of the various segments of the curriculum.
         - Content that is coordinated and integrated within and across the academic periods of study
        (horizontal and vertical integration).
         - Methods of pedagogy and student evaluation that are appropriate for the achievement of the
        school’s educational objectives.

        Curriculum management signifies leading, directing, coordinating, controlling, planning,
        evaluating, and reporting. Evidence of effective curriculum management includes:

         - Evaluation of program effectiveness by outcomes analysis, using national norms of
        accomplishment as a frame of reference.
         - Monitoring of content and workload in each discipline, including the identification of omissions
        and unwanted redundancies.
         - Review of the stated objectives of individual courses and clerkships, as well as methods of
        pedagogy and student evaluation, to assure congruence with institutional educational objectives.

        Minutes of the curriculum committee meetings and reports to the faculty governance and deans
        should document that such activities take place and should show the committee’s findings and
        recommendations.

See FA-11.
_________________________________________________________________________________

a. Provide an organizational chart for management of the curriculum that includes the curriculum committee
and its subcommittees, other relevant committees, the chief academic officer, and other individuals or groups
involved in curriculum design, implementation, and evaluation.

An organizational chart is provided in the Appendix.

Solid lines reflect direct oversight. Dotted lines reflect planned communication between entities. This structure is
expected to change in the coming year. The Curriculum Committee and the Committee on Educational Appraisal
plan to disband. A new committee will take its place which combines their functions and responsibilities but which
will be able to carry them out in a more coordinated and integrated manner. A proposed model is now being
considered by both committees. Once a final version is approved, it will need to be approved by the Faculty Council.
The Committee on Committees will then need to recruit and select a slate of members to be ratified by the faculty.

b. Supply the title of the faculty committee with responsibility for the curriculum:

Curriculum Committee




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c. Provide the charge or terms of reference for this committee, and the source of its authority (bylaws,
mandate from the dean or faculty executive committee, etc.).

The Curriculum Committee is constituted as a Standing Committee in accordance with the Policies and Procedures
for Rules for Governance for Rush Medical College. As stated in its Policies and Procedures, the committee is
responsible for (a) the design and content of the medial school curriculum, by recommendation to the Faculty
Council,( b) the assignment of courses in the curriculum to the departments of the medical college, and (c) the
definition of the responsibilities and obligations of the course directors with reference to the courses they conduct.

d. Describe the composition of this committee and mechanisms for selecting its members and chair.

The Curriculum Committee has a Manual of Policies and Procedures (last revised and accepted Feb. 19. 2003). The
members are nominated by the Committee on Committees and approved by the faculty at the last faculty meeting of
the academic year. In addition, the medical students elect three voting student members. Ex-officio (non-voting)
members include representatives of the Office of Medical Student Programs and such consultants or advisors as the
Curriculum Committee may find advantageous to select.

The immediate past-Chairperson convenes a meeting of the Committee in July and holds the election of a new
Chairperson. A Vice-Chairperson is elected at this meeting.

e. Indicate the frequency of regularly scheduled meetings during a typical academic year: (check)

                                              Weekly
                                              Biweekly
                                        X     Monthly
                                              Bimonthly
                                              Other (describe):
                                        X     monthly meeting of each
                                              subcommittee

The chair may cancel and may schedule additional meetings as necessary. Members of the Committee may also
request additional meetings.

f. If there are standing subcommittees, describe their charge or role, membership, and reporting relationship
to the parent committee.

   The chair may designate standing Subcommittees and their members during each academic year for ongoing
   concerns or may appoint members to an Ad Hoc Subcommittee with a specific charge.

   Currently the four subcommittees of the Curriculum Committee are:
       First (M1) year
       Second (M2) year
       Core Clerkships (M3 year)
       Electives

  Each subcommittee is charged to review new course proposals for their area and to coordinate content of current
  courses across their area. Every member of the Curriculum Committee serves on a subcommittee of his/her
  choice. Subcommittees are expected to make monthly reports of their work at each monthly meeting of the full
  committee.

g. Describe the roles of the curriculum committee and any subcommittees, chief academic officer or associate
dean for educational programs, and departments in each of the following:

        Developing and reviewing the institutional objectives for the educational program




LCME Medical Education Database 2004-05                   p. 82                                 II. Educational Program
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        The Associate Dean for Medical Student Programs, along with select faculty members, formed an ad hoc
        task force to update the institutional objectives for the educational program. These revised objectives will
        be presented to the Curriculum Committee and Faculty Council for approval. They are presented earlier in
        this database for review.

       Ensuring use of appropriate teaching methods or instructional formats

        The Curriculum Committee and the Committee on Educational Appraisal are responsible for reviewing
        teaching methods and the instructional format for each individual course. Based on faculty and student
        evaluations, these groups make recommendations to the Associate Dean, as well as to course directors and
        department chairpersons regarding both teaching methods and instructional format.

       Ensuring that content is coordinated and integrated within and across academic periods of study

        There is an active effort underway within both the Curriculum committee and the Committee on
        Educational Appraisal (CEA) to review content across academic periods of study to ensure it is both
        coordinated and integrated. In the M2 year, course directors for pathophysiology, with the support of the
        Dean’s office, led a successful initiative to integrate and coordinate the pathology, pharmacology and
        pathophysiology courses. The CEA has recently constructed a subcommittee structure designed to enhance
        the ability of this committee to review academic periods of study in detail. CEA’s subcommittee on clinical
        courses in the preclinical years recently made recommendations to course directors, department chairs and
        the Dean’s office to increase integration and coordination of some of the courses under their purview. The
        Curriculum Committee subcommittees are also making an active effort to examine redundancy across
        courses to ensure that any redundancy is both planned and desired. The new Director, Clinical Curriculum
        is leading an initiative to identify the unique curriculum for each clerkship as well as redundant curricular
        areas, so that a more coordinated clerkship curriculum can be presented to students in their third year. A
        clerkship orientation course may be added which includes clinical skills that would be useful in multiple
        clerkships (to minimize differences in acquisition of these skills based on the sequence in which a student
        takes the clerkships).

        Perhaps most important is our initiative to form a new standing committee to manage the curriculum as a
        whole, replacing both the Curriculum Committee as well as CEA. The main goal of this committee shall be
        to “strive for a coordinated curriculum carefully designed over 4 years which reflects the mission of RMC
        and measures the competence of RMC students as future physicians.”

       Ensuring use of appropriate methods to evaluate student performance

        Each course or clerkship director works with the Dean’s office and COSEP to ensure the use of appropriate
        methods to evaluate student performance. Faculty development activities are offered periodically both
        within departments and at the college level to improve faculty skills in this area. For example, during
        Spring 2004, the Office of Medical Student Programs sponsored a six-part webcast seminar series (offered
        by IAMSE) on evaluation. Faculty could attend in a group setting or could download handouts and listen to
        the lecture on their office computers. All clerkships are currently using an NBME subject exam as a
        measure of student performance.

       Monitoring the quality of teaching

        The CEA is responsible for monitoring the quality of teaching in each course and clerkship. CEA has four
        subcommittees, 1) M1 basic science, 2) M2 basic science, 3) M1-M2 clinical courses and 4) core
        clerkships. Each member is assigned to a subcommittee as well as to individual courses within the
        subcommittee. That member is responsible for reviewing all course materials and students’ evaluations of
        the course with the course director. Rating of the quality of teaching is part of the students’ evaluation of
        the course. A written course evaluation is completed and reported to the appropriate CEA subcommittee,
        where members discuss the evaluation and offer recommendations as needed. A summary of this evaluation
        is then presented to the committee as a whole, and this summary along with recommendations are sent to



LCME Medical Education Database 2004-05                  p. 83                                II. Educational Program
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        the curriculum committee chair, the course director and the chair of the department responsible for the
        course or clerkship.

The RMC is seeking a new senior associate dean of medical education. Oversight of these five areas will be key
aspects of this new position.




LCME Medical Education Database 2004-05                 p. 84                                II. Educational Program
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ED-34. The program’s faculty must be responsible for the detailed design and implementation of the
components of the curriculum.

       Such responsibilities include, at a minimum, the development of specific course or clerkship objectives,
       selection of pedagogical and evaluation methods appropriate for the achievement of those objectives,
       ongoing review and updating of content, and assessment of course and teacher quality.
___________________________________________________________________________________

a. Provide examples of the types of changes that can be handled at the level of the course or clerkship and the
types of changes that require curriculum committee or other central approval.

Courses or clerkships routinely modify individual course components, such as lecture content, add or delete specific
topics, and update objectives, without the approval of the curriculum committee. Examples from specific courses
include:

  Histology (ANA 451): The course director can determine the nature of the content of the course and the
  mechanism by which this content is presented to students.

  Human Anatomy I & II (ANA 471 & 472): Improving the quality of lectures and lab instruction. Addition of CAI
  materials for learning. Using handouts to direct the students learning.

  Behavioral Science: Ethics in Medicine I & II (BHV 481 & 482): We feel we can alter individual topics for
  discussion as examples of common medical ethics conflicts. For example, we spent an hour this academic year
  discussing the Schiavo case in Florida, due to its timeliness and ability to illustrate conflicts between different
  caregivers, the spouse, other family members, and the legal system. We can also modify cases for discussion in
  the small groups. We also update relevant articles and other reading assignments on an ongoing basis to keep the
  course up to date or as better readings become available (e.g., a special issue of a medical journal comes out,
  devoted to a topic we cover in the course)

  Internal Medicine Core Clerkship (MED 601): We regularly update our curricular objectives by making additions
  and deletions of specific topics. The assignment of students to specific patient care areas changes based on types
  of patients seen and volume of patients available.

  Neurology Core Clerkship (NEU 601): Institution of specific workshops, lectures and conferences.

  Obstetrics & Gynecology Core Clerkship (OBG 601): Increasing education in human sexuality. Increasing
  education in eating disorders.

  Pathophysiology I-III (MED 501-503): We have already modified this course over the last 3 years and continue to
  add/remove subject areas based on clinical relevance and what prepares the students best as they go to the floors
  in their third and fourth years.

  Health of the Public I (PCM 531): Updating the syllabus every year has been done by the course director. He has
  revised the test every year to attempt to reflect the ongoing acquisition of medical knowledge and current practice.

  Pharmacology I-II (PHR 501-502):
  The Course Director has made the following changes in this course during the past 10 years:
       1. Introduced new topics and deleted others.
       2. Introduced new faculty and retired others.
       3. Initiated a toxicology workshop.
       4. Initiated a required attendance hospital formulary workshop.

  Physiology I and II (PHY 451 and 452): No major changes are anticipated, but changes of the type asked about
  include:
        1) Change in textbook
        2) Change in course content (generally to including recent info)



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       3)   Change in lecturers (due to illness, retirement, new hires)
       4)   Changes in workshop problems
       5)   Changes in computer labs
       6)   Minor reallocations of time between different subjects

  Epidemiology/Biostatistics (PVM 505): Reorganization of lectures; additional sample test questions; being
  responsive to student needs.

  Intro to Psychopathology (PSY 501): Specific content areas, such as emphasizing prevalence rates, are being
  down-graded and de-emphasized.

  Psychiatry Core Clerkship (PSY 601): Incorporating more information on bioterrorism/mass disasters and the
  psychiatric sequelae of these.

  Preceptorship I-VI (PCM 521-526): Preceptor or timing conflicts

  Surgery Core Clerkship (SUR 601): Change of lecture topics and change of rotation services

Changes involving the addition or deletion of hours, changing of course format/venue, or a change in the evaluation
of student performance all require the approval of the Curriculum Committee. Some examples of recent changes or
change requests include:

  Biochemistry I, II, & III (BCH 470, 471 & 472): We would like to increase the number of small group sessions to
  encourage student participation and discussions about the cases.

  Introduction to Patients (PCM 501): Changing the small group size to enhance discussion.

  Physical Diagnosis IV/VI (PCM 504/506): Methods for delivering course content in this past year (e.g.: 1) We
  divided the students into groups of 10 instead of groups of 16 as in prior years; and 2) spent less time on lecture
  and more time in small group workshops; and 3) added two lung sounds and heart sounds CD-ROM sessions.

  Pediatric Core Clerkship (PED 601): The following are areas over which the course director has control: lecture
  content, cases used for case analyses, and the time spent in various components of the rotation.

  Pediatric Subinternship (PED 610): The course director is able to make necessary changes in the course.

  Pharmacology I-II (PHR 501-502): The Curriculum Committee is provided the Medical Pharmacology Course
  Plan.
  The Course Director requested this course change: Initiated a quiz/conference series that concludes all topics.

  Surgery Core Clerkship (SUR 601): Time spent in each service or site.

b. Describe the role, if any, of the curriculum committee in the development and review of course- and
clerkship-specific objectives, as well as methods of instruction and student performance assessment.

The Curriculum Committee and Committee on Educational Appraisal (CEA) have responsibilities in these areas.
These groups review course and clerkship-specific objectives, as well as student perceptions of methods of
instruction and student performance assessment. The CEA plays a central role in this process in evaluating courses,
of which student achievement by the class as a whole is considered. A member of CEA is assigned to each course
and clerkship. That member is responsible for reviewing all course materials and students’ evaluations of the course
with the course director. A review of course objectives, the method chosen to measure student performance and the
evaluation of student performance are included as part of each course/clerkship evaluation. A written course
evaluation is completed and reported to the appropriate CEA subcommittee, where members discuss the evaluation
and offer recommendations as needed. A summary of this evaluation is then presented to the committee as a whole,




LCME Medical Education Database 2004-05                   p. 86                                 II. Educational Program
Academic Year 2003-2004


and this summary along with recommendations are sent to the curriculum committee chair, the course director, and
the chairperson of the department responsible for the course or clerkship. See ED-33 for further details about CEA.

c. Describe the kinds of outcome measures routinely available to course and clerkship leaders for evaluating the
quality of instruction, e.g., course evaluation forms, USMLE performance data, results from the AAMC Graduation
Questionnaire, etc.

Course evaluation forms are required for each course and clerkship by the Committee on Educational Appraisal.
Results are provided to course and clerkship directors on a regular basis. For clerkships, NBME Subject Exam
scores are provided to clerkship directors (and are used to partially determine grades on the clerkship).

d. Provide a copy of any standardized institutional course or clerkship evaluation forms.

These are available in the Appendix.

See also the Required Course and Clerkship Forms, and information for standard ED-33.




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Academic Year 2003-2004


ED-35. The objectives, content, and pedagogy of each segment of the curriculum, as well as for the
curriculum as a whole, must be subject to periodic review and revision by the faculty.

       The curriculum committee, working in conjunction with the chief academic officer, should assure
       that each academic period of the curriculum maintains common standards for content. Such
       standards should address the depth and breadth of knowledge required for a general professional
       education, currency and relevance of content, and the extent of redundancy needed to reinforce
       learning of complex topics. The final year should complement and supplement the curriculum so
       that each student will acquire appropriate competence in general medical care regardless of
       subsequent career specialty.
________________________________________________________________________________

Describe the process of formal review for each of the listed curriculum elements. Include in the description how
often such reviews are conducted, how they are conducted, and under what auspices (e.g., the department, the
curriculum committee) they are undertaken.

       Required courses and clerkships

        The Committee on Educational Appraisal (CEA) is responsible for formally reviewing each course and
        clerkship. CEA has four subcommittees, 1) M1 basic science, 2) M2 basic science, 3) M1-M2 clinical
        courses and 4)core clerkships. Each member is assigned to a subcommittee, as well as given responsibility
        to review specific individual courses for that subcommittee. That member is responsible for reviewing all
        course materials and students’ evaluations of the course with the course director. A formal written course
        review is completed and reported to the appropriate CEA subcommittee, where members discuss the review
        and offer recommendations as needed. A summary of this review is then presented to the committee as a
        whole. This summary, along with recommendations, are sent to the Curriculum Committee chair, the
        course director and the chairperson of the department responsible for the course or clerkship.

       Individual years or academic periods of the curriculum

        In addition to reviewing individual courses, each CEA subcommittee is responsible for evaluating the
        curriculum under its purview as a whole, and making recommendations to the Curriculum Committee
        chair, the course director and the chairperson of the department responsible for the course or clerkship. The
        Curriculum Committee subcommittees are charged with coordinating content of courses within each
        academic period.

        The LCME Medical Students Task Force and Student Council included questions about all required
        courses in their jointly conducted student survey. Members of the Task Force used this data to prepare
        more detailed analyses of the M1 and M3 years. These are included in an Appendix to this database (see
        pages 95-117). This type of integrated review will be utilized by the CEA and Curriculum Committee for
        their analysis of our educational program. We hope this will lead to a formal review of all four years of
        medical education at Rush.

       The entire curriculum

        The Sub-Committees of the Curriculum Committee (M1, M2, Core Clerkships, and Elective Sub-
        Committees) are responsible for oversight and review of the curriculum as it relates to the courses covered
        by their respective sub-committees. The sub-committee chairs bring recommendations to the Curriculum
        Committee which then votes on recommended changes. These subcommittees review new course
        proposals, receive reports from course directors regarding any significant change to existing courses, and
        are made aware of concerns raised by CEA reviews. The subcommittees are currently involved in a review
        of the curriculum as it relates to the courses under their jurisdiction. In addition, the Curriculum Committee
        periodically reviews the entire curriculum as specific issues arise. An illustrative example is the recent
        request from members of the faculty of the College of Nursing to include medical students in a new
        program addressing patient care issues at the end of life. This sparked an examination of where in the



LCME Medical Education Database 2004-05                  p. 88                                 II. Educational Program
Academic Year 2003-2004


        curriculum these concepts were taught. Other examples include an examination of the issue of attendance
        as a requirement for some courses but not others and the educational impacts of this requirement.

        With the recruiting of the Senior Associate Dean for Educational Affairs and the creation of a new
        committee that combines the Curriculum Committee and the Committee on Educational Appraisal, active
        management of the curriculum will more readily occur.




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Academic Year 2003-2004


ED-36. The chief academic officer must have sufficient resources and authority to fulfill the responsibility for
the management and evaluation of the curriculum.

         The dean often serves as the chief academic officer, with ultimate individual responsibility for the
         design and management of the educational program as a whole. He or she may, however, delegate
         operational responsibility for curriculum oversight to a vice dean or associate dean.

         The kinds of resources needed by the chief academic officer to assure effective delivery of the
         educational program include:

          - Adequate numbers of teachers who have the time and training necessary to achieve the
         program’s objectives.
          - Appropriate teaching space for the methods of pedagogy employed in the educational program.
          - Appropriate educational infrastructure (computers, audiovisual aids, laboratories, etc.).
          - Educational support services, such as examination grading, classroom scheduling, and faculty
         training in methods of teaching and evaluation.
          - Support and services for the efforts of the curriculum management body and for any
         interdisciplinary teaching efforts that are not supported at a departmental level.

       The chief academic officer must have explicit authority to ensure the implementation and
       management of the educational program, and to facilitate change when modifications to the
       curriculum are determined to be necessary.
_______________________________________________________________________________

a. Provide the name and title of the chief academic officer responsible for the medical education program. If
the dean functions as the chief academic officer but has delegated responsibility for medical student
education to an associate dean or other individual, provide the name and title of the latter.

Name:      Dr. Thomas A. Deutsch
Title:     Dean and Senior Vice President, Rush Medical College

b. Provide a position description for the individual responsible for the medical educational program leading
to the M.D. degree, if not the dean.


See also information for standard ED-33.




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Academic Year 2003-2004


ED-37. The faculty committee responsible for the curriculum must monitor the content provided in each
discipline so that the school’s educational objectives will be achieved.

__________________________________________________________________________________

Describe how the curriculum committee monitors the content of required courses and clerkships, and how gaps and
unwanted redundancies are identified.

The Curriculm Committee and the Committee on Educational Appraisal (CEA) are responsible for formally
reviewing each course and clerkship.

CEA has four subcommittees: 1) M1 basic science, 2) M2 basic science, 3) M1-M2 clinical courses and 4) core
clerkships. Each member is assigned to a subcommittee as well as to individual courses within the subcommittee.
That member is responsible for reviewing all course materials and students’ evaluations of the course with the
course director. A written course evaluation is completed and reported to the appropriate CEA subcommittee, where
members discuss the evaluation and offer recommendations as needed. The evaluation sheet contains a section for
comments on horizontal and vertical integration. Discussion occurs at the subcommittee level when gaps or
redundancies are identified, and recommendations are made. A summary of this evaluation is then presented to the
committee as a whole, and this summary along with recommendations are sent to the curriculum committee chair,
the course director, and the chairperson of the department responsible for the course or clerkship.

The subcommittees of the Curriculum Committee meet regularly and examine issues including vertical and
horizontal integration of courses. Curriculum Committee subcommittees are currently working to identify gaps and
redundancies within the curriculum.

See also information for standard ED-33.




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Academic Year 2003-2004


ED-38. The committee [responsible for the curriculum] should give careful attention to the impact on
students of the amount of work required, including the frequency of examinations and their scheduling.
_____________________________________________________________________________________

a. Provide the average number of unscheduled hours per week during each of the first two years of the
curriculum, and the number of for-credit examinations in each year.

The table below indicates the average number of hours medical students are scheduled during their first two years.
Based on a 40 hour workweek, our unscheduled hours average 14.4 - 21.7 hours/week for the M1 students and 17.1
– 19.5 hours/week for the M2 students (across the three academic quarters). The table gives a breakdown by quarter
and an average for each year.The actual schedule varies each week in order to accommodate students’ Preceptorship
experiences, small group experiences and protected study time for examinations. The numbers were calculated
based on a student assigned to Group A using our quarterly Timetable schedules.

M1 students take 22 exams and M2 students take 26 exams over the course of the academic year.

                      M1 CLASS 2003-2004                    M2 CLASS 2003-2004
                             Fall Quarter                          Fall Quarter
     Total            359 hours         8 exams             305 hours        10 exams
    average          25.6 hrs/wk                          20.33 hrs/wk
                           Winter Quarter                         Winter Quarter
     Total            251 hours         7 exams             226 hours        10 exams
    average          22.8 hrs/wk                         20.5 hrs/wk
                            Spring Quarter                        Spring Quarter
     Total            226 hours         7 exams             156 hours         6 exams
    average          18.3 hrs/wk                           22.3 hrs/wk

 Grand total          836 hours          22 exams           687 hours          26 exams
 Average for         22.6 hrs/wk                           20.8 hrs/wk
      year


b. Describe how the curriculum committee or the relevant subcommittee(s), as well as course and clerkship
leaders, monitor the workload of students within and across individual courses and clerkships.

The Curriculum Committee will address these issues if they arise as a result of the review of the course. Otherwise,
this is left to the discretion of the course director. Should students bring workload as a concern to the Dean or staff
in the Office of Medical Student Programs, the concerns are brought to the attention of the course director, and if
appropriate, to the Curriculum Committee.

The functions of the Curriculum Committee and the Committee on Educational Appraisal are planned to be merged
into a new committee. This committee will monitor workload of students within and across courses and clerkships.
It will receive regular reports on efforts to coordinate examinations by OMSP.

c. Describe the process, including the roles of relevant committees and the central medical school
administration, for coordinating major examinations during the first two years.

Dr. Susan Jacob, Associate Dean, Medical Student Programs, is responsible for coordinating major examinations.
She reports regularly on this to both Curriculum Committee and the Committee on Student Evaluation and
Promotion.

See also information for standard ED-5.




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Academic Year 2003-2004



Note: Questions for standards ED-39 through ED-45 should be completed only by schools that operate geographically separate campuses, as
defined in the instructions for completing the database. These questions do not apply to Rush Medical College.

ED-46. To guide program improvement, medical schools must evaluate the effectiveness of the educational
program by documenting the extent to which its objectives have been met.

ED-47. In assessing program quality, schools must consider student evaluations of their courses and teachers,
and an appropriate variety of outcome measures.

       Among the kinds of outcome measures that serve this purpose are data on student performance,
       academic progress and program completion rates, acceptance into residency programs,
       postgraduate performance, and practice characteristics of graduates.
_________________________________________________________________________________

a. Check all indicators used by the medical school to evaluate educational program effectiveness.

                   X     Results of USMLE/MCC or other national examinations
                   X     Student scores on internally developed examinations
                   X     Performance-based assessment of clinical skills (e.g., OSCEs)
                   X     Student responses on AAMC Medical School Graduation Questionnaire
                   X     Student evaluation of courses and clerkships
                   X     Student advancement and graduation rates
                   X     NRMP results
                   X     Specialty choice of graduates
                         Assessment of residency performance of graduates
                         Licensure rates of graduates
                         Specialty certification rates
                         Practice location of graduates
                         Practice type of graduates
                         Other (specify)


b. For each checked item, indicate

     1.   How the data are collected (including response rates for questionnaires)?

     Students are required to take and pass USMLE Step 1 for promotion to the third year and to qualify for
     graduation. They must also take USMLE Step 2 to qualify for graduation.

     Most basic science courses develop their own written exam for evaluation of the students. Pathology has
     included the NBME Subject exam as part of its evaluation.

     The clerkships use the NBME Subject exam for their area as well as some in-house exams as evaluation tools.

     AAMC Graduation Questionnaire (GQ) is coordinated by the Office of Medical Student Programs. Response
     rates to the GQ have hovered in the high 90s to 100% completion rates until this year (average 97.2% for the
     previous past six years). With national concerns over the GQ regarding Institutional Review requirements, our
     local IRB required us to seek approval for our use of the GQ for the first time this year. The AAMC failed to
     provide materials we needed in a timely manner. This delayed our approval and eventual launch of the survey.
     Our response rate this year is almost 80% (we attribute the decline from past years to the delayed launch date,
     as well as to the restriction that we cannot say participation is required to avoid students feeling coerced to
     complete the survey). We, nonetheless, managed to achieve a response rate over 10% higher than the national
     sample though our frequent and gentle reminders to our seniors inviting them to complete the survey.




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    Student evaluations of courses and clerkships are monitored by the Committee on Educational Appraisal. This
    committee submits summary reports based on student course ratings, course director comments, and committee
    recommendations to the Curriculum Committee, the course director, and to the Dean’s Office.

    The Office of Medical Student Programs oversees student advancement, graduation rates, the NRMP process
    and tracks specialty choice of our graduates in the Match.

    A new alumni survey is being undertaken which will allow us to look at both practice location and types, as
    well as to get feedback on the effectiveness of our curriculum. The original intention was to conduct the survey
    electronically but an insufficient percentage of alumni email addresses have been identified so a more
    traditional paper-and-pencil survey was distributed in July through a mailing to our alumni. Reports on this data
    will be available for the site visit in November.

    The Office of Medical Student Programs also plans to launch a survey of PGY-1 and PGY-2 students and their
    residency directors, beginning with the graduating class of 2005. This will allow us to better assess the
    adequacy of preparation for residency of our graduates.

    2.   What groups or individuals review the data (e.g., curriculum committee, department chairs)?

    The Committee on Student Affairs reviews data from the GQ regarding student services. Appropriate RMC
    committees are included in discussion of the students’ perceptions from this survey (most notably, the
    Committee on Student Affairs). GQ data is also shared with Curriculum Committee and CEA regarding
    feedback on courses.

    USMLE data is also reviewed by Office of Medical Student Programs and by the Curriculum Committee and
    the Committee on Student Evaluation and Promotion, as well as by the clinical course directors and the Dean.

    Student scores on internally developed exams are reviewed by the course director. He or she may also review
    the scores with departmental colleagues and may seek consultation with the Office of Medical Student
    Programs. Clerkship faculty were invited to review the NBME Subject exams that are used for all of our core
    clerkships. Many faculty members took the opportunity to assess for themselves how well the examination
    matched the course goals and knowledge expectations for their students.

    Student advancement data, graduate rates, the NRMP process and tracking of the specialty choices of our
    graduates are reviewed by staff in the Office of Medical Student Programs and discussed with the Dean and
    with interested faculty members.

    3.   How is the information used for curriculum review and change?

    The Curriculum Committee subcommittees are responsible to review available data and to meet with course
    directors, as necessary, to discuss needs for change in courses. Course directors may independently make minor
    changes in their courses as a response to data from examinations, the GQ, etc.

c. Provide evidence that the educational program objectives in the domains of knowledge, skills, behaviors, and
attitudes are being achieved.


See also information for standard ED-1.




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Academic Year 2003-2004


ED-48. Medical schools must evaluate the performance of their students and graduates in the framework of
national norms of accomplishment.
____________________________________________________________________________________

If available, provide summary data on the performance of your graduates in the following:

        USMLE Step 3 or MCCQE Part II
        Graduate medical education (e.g., from surveys of graduates or residency program directors)

For U.S. Medical Schools only:

a. Indicate if students at your institution are required to take or required to pass USMLE Steps 1 and 2. (check)

                                                          Take      Pass
                                              Step 1       X         X
                                              Step 2       X

b. Supply graphs provided by the National Board of Medical Examiners comparing national and school first-time
takers for USMLE Steps 1 and 2.

c. For each of the past three years, provide USMLE results for repeat (not first-time) takers.

                                                       STEP 1
                         Number Examined                                                             National Mean
Year                                               Percent Passing         Mean Total Score           Total Score
2003                              5                      40                      180                      187
2002                              3                     100                      189                      186
2001                              4                     100                      NR                       NR


                                                       STEP 2
                         Number Examined                                                             National Mean
Year                                               Percent Passing         Mean Total Score           Total Score
2003                              3                      66                      189                      188
2002                              2                     100                      195                      187
2001                              2                     100                      191                      185

See also Part A, item (b.), information for standard ED-47, and Required Course and Clerkship Forms.

                                               END OF SECTION II




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Academic Year 2003-2004


                                                                      APPENDIX

                       Summary of LCME Student Survey Responses
          Preclinical Courses for M1s as reviewed by M1-M4 students, Spring 2004

For all questions the value for each class is given as well as the mean + standard deviation [S.D.]) of the
values for all four classes. While the percentage varied slightly among the M1-M4 classes, the mean of
all students was 52%.

Gender
                                                   M1          M2          M3       M4     mean     S.D.
% Female                                           60.2        47.6        53.8     47.1   52.18    0.15

                                                                Gender

                                             100
                                              90
                     expressed as % female




                                              80
                                              70
                                              60
                                              50
                                              40
                                              30
                                              20
                                              10
                                               0
                                                   M1     M2          M3       M4   mean




Faculty
                                                   M1          M2          M3       M4      mean      S.D.
Availability                                       4.56        4.25        4.25      4.3    4.34      0.15
Receptiveness                                      4.47        4.26        4.19     4.31    4.31      0.12
Responsiveness                                     4.46        4.16        4.09     4.11    4.21      0.17

Respondents: M1 (n=109); M2 (n=114); M3 (n=119); M4 (n=108)

Summary of Student Comments:
M1 (n=40) 32 comments were positive; the remaining 8 contained negative comments as well as positive
 ones.
M2 (n=29) 17 comments were positive; the remainder primarily centered on Pathology which is now an
 M2 course with a new course director and faculty.
 M3 (n=16) 10 comments were positive and addressed both preclinical and clinical faculty.
M4 (n=17) 11 comments were positive.

Summary and Recommendations: The faculty was evaluated highly. The majority of positive
comments about the faculty were favorable in general describing their caring, availability, openness and
willingness to help. Negative comments concerned quality of lecture presentation for some faculty as
well as integration of the lectures between courses.




LCME Medical Education Database 2004-05                                    p. 96                   II. Educational Program
Academic Year 2003-2004


                                                           Faculty

                                          Availability   Receptiveness    Responsiveness

                   5

                  4.5

                   4

                  3.5

                   3
                  2.5

                   2

                  1.5

                   1
                           M1              M2                    M3                  M4                mean




 Office of Medical Student Programs
                            M1                    M2                   M3                 M4                  mean      S.D.
 Receptiveness              4.36                  4.35                 4.07               4.13                4.23      0.15
 Responsiveness             4.36                  4.38                 4.06               4.16                4.24      0.16
 Satisfaction with services 4.32                  4.28                 4.02               4.13                4.19      0.14
Respondents: M1 (n=109); m2 (n=112); M3 (n=116); M4 (108)
Summary of Student Comments :
M1 (n=17) 13 comments were strongly positive; while the remainder were mixed positive and negative.
M2 (n=15) 9 comments were positive; the remainder were mostly mixed positive and negative with
 several comments on communication between the office and individual students.
M3 (n=17) 9 comments were positive with the others referring specifically to members of the office or
 the difficulty in communicating.
M4 (n=13) 7 comments were positive with several negative comments about specific staff members or
 support.
Summary and Recommendations: The Office of Medical Student Programs was ranked as excellent.
Comments were mostly positive especially in the overall description of the staff. The most frequent
suggestion for improvement was being more prompt with replies to inquiries or requests.

                                       Office of Medical Student Programs
                                       Receptiveness     Responsiveness   Satisfaction with services

                    5

                  4.5

                    4

                  3.5

                    3
                  2.5

                    2

                  1.5

                    1
                           M1                M2                   M3                    M4               mean


 Evaluation/Appraisal
                                M1          M2                    M3                   M4              mean           S.D.
 Adequacy of course
 evaluation methods             3.54        3.58                  3.11                 3.12            3.34           0.26
 Responsiveness and
 incorporation of change        3.39        3.83                  3.13                 3.07            3.36           0.35


LCME Medical Education Database 2004-05                               p. 97                                          II. Educational Program
Academic Year 2003-2004


Respondents: M1(n=109); M2 (n=111); M3 (n=118) ; M4 (n=106)
Summary of Student Comments :
M1 (n=21) Only 2 comments were entirely positive; 7 students felt that as M1s they did not know
 enough, especially about responses to change to make comments. 12 students expressed dissatisfaction
 with the process and had suggestions for change.
M2 (n=21) Seven comments were positive, especially regarding the responsiveness to Shared Medical
 Decision Making and Pathology; the remainder were a mixture of suggestions for changing the
 evaluation process and responsiveness to suggestions for change.
M3 (n=27) Only one comment was entirely positive. Others were mixed, with most commenting on
 suggestions for changing ways evaluations are done.
M4 (n=26) The majority of the comments were concerned with evaluations students receive from
 residents (in the clinical years) & faculty. Two comments on preclinical evaluations were positive.
Summary and Recommendations: In response to questions regarding adequacy of course evaluations
and responsiveness to and incorporation of change, the students rated as very good; however, the majority
of the written comments were either negative or suggested change. Their suggestions included electronic
course evaluations that would provide greater anonymity and allow the students to complete the
evaluation at a time other than the final exam. The students appeared frustrated with either the pace of
changes or not being informed that changes had been implemented. These comments should be shared
with the Committee on Education Appraisal for considering change with not only the system of
evaluation but communicating with students how their recommendations are implemented.

                                                   Evaluation/Appraisal

                             Adequacy of course eval methods   Responsiveness and incorporation of change

                      5

                     4.5

                      4

                     3.5

                      3

                     2.5

                      2

                     1.5

                      1
                             M1               M2                M3                M4               mean




Curriculum
A total of 15 courses that have been taught in the M1 year were evaluated. Students from all four classes
of the medical school rated all but 3 of the courses. Of these, one is no longer taught in the M1 year –
General Pathology. The Shared Medical Decision Making Course has been significantly modified
because of student evaluations (2.10/5), and several topics were considered redundant with Ethics. (It
should be noted that the M-2 Shared Medical Decision Making course which was designed as an
extension of the topics in the M-1 course was removed from the M-2 curriculum following the fall quarter
2003.) Pathology was a highly rated course (4.39) that has been moved to the M2 year. The third course
is Immunology: Basic Science that has been taught in the M1 year for only one year. Immunology
received a score of 4.73 – the highest rating of any class for the M1 year.

Except for Anatomy, students were asked to rate each course on 1) overall teaching quality, 2) content of
syllabus/course materials, 3) organization of the course, and 4) overall course quality. For Anatomy, one
additional question asked the students about the adequacy of changing space for Gross Anatomy.



LCME Medical Education Database 2004-05                          p. 98                                      II. Educational Program
Academic Year 2003-2004


Anatomy
                                     M1     M2             M3     M4        Mean          SD
Overall Teaching Quality             4.44   4.15           4.22   4.31      4.28          0.13
Content                               4     3.66           3.8    3.93      3.85          0.15
Organization                         4.16   4.03           4.05   4.09      4.08          0.06
Overall Course Quality               4.34   4.15           4.07   4.16      4.18          0.11
Adequacy of Changing Space           3.32    3             3.15   3.26      3.18          0.14
Respondents: M1 (n=106); M2 (n=106); M3 (n=113); M4 (n=101)
Summary of Student Comments:
M1 (n=39) Generally good comments with some comments regarding overlap with Physical Diagnosis
M2 (n=28) Generally good comments
M3 (n=19) Generally good comments
M4 (n=20) Generally good comments
Summary and Recommendation: The Anatomy course is evaluated very highly by the students. Two
common concerns include a lack of changing space for students and teaching embryology as a separate
course. It is highly recommended that the students be provided some changing room other that the
hallway and that embryology lectures be presented separately rather than as a component of other
anatomy lectures.

Behavioral Science: Behavior in Life Cycle (only M2-M4 data were collected)
                                M1         M2       M3        M4         Mean             SD
Overall Teaching Quality                   3.43     3.35      3.34       3.37             0.05
Content                                    3.14     3.18      3.29       3.20             0.08
Organization                               3.33     3.24      3.27       3.28             0.05
Overall Course Quality                     3.24     3.24      3.27       3.25             0.02
Respondents: M2 (n=106); M3 (n=111); M4 (n=98)
Summary of Student Comments:
M2 (n=14) Generally well received with some concerns about testing and syllabus
M3 (n=9) Generally well received with some concerns about testing and syllabus
M4 (n=8) Generally well received with some concerns about testing and syllabus
Summary and Recommendation: The positive comments on this class were on the faculty and small
groups. The students comments were primarily concerned that the syllabus did not match lecture
material.

Behavioral Science: Fundamentals of Behavior (only M2-M4 data were collected)
                              M1         M2         M3      M4        Mean                SD
Overall Teaching Quality                 3.4       3.33     3.33       3.35               0.04
Content                                 3.17       3.24     3.29       3.23               0.06
Organization                            3.22       3.25      3.3       3.26               0.04
Overall Course Quality                  3.25       3.29     3.32       3.29               0.04
Respondents: M2 (n=106); M3 (n=112); M4 (n=97)
Summary of Student Comments:
 M2 (n=8) Generally well received with some concerns about testing and syllabus
 M3 (n=8) Generally well received with some concerns about testing and syllabus
 M4 (n=4) Generally well received with some concerns about testing and syllabus



LCME Medical Education Database 2004-05            p. 99                          II. Educational Program
Academic Year 2003-2004


Summary and Recommendation: The comments were primarily focused on the content of the syllabus
and whether it reflected lecture material.

Biochemistry
                                     M1       M2              M3      M4         Mean         SD
Overall Teaching Quality             2.99     3.04            3.07    3.02       3.03         0.03
Content                              3.3      3.41            3.05    3.15       3.23         0.16
Organization                         3.19     3.37            3.18    3.2        3.24         0.09
Overall Course Quality               3.01     3.19            3.05    3.02       3.07         0.08
Respondents: M1 (n=106); M2 (n=106); M3 (n=111); M4 (n=98)
Summary of Student Comments:
M1 (n=42) Seen as an average course with comments on the need for small groups, too much material
 presented, the need to revise the syllabus and learning guide, the need for clinical relevance. Variations
 among lecturers were seen as a problem.
M2 (n=29) The majority of comments centered on the syllabus/lecture guide.
M3 (n=23) The majority of comments centered on the syllabus/lecture guide
M4 (n=20) The majority of comments centered on the syllabus/lecture guide.
Summary and Recommendation: While some comments were positive regarding both lecturers and
syllabus, the majority of the students felt that the material was too extensive and that the
syllabus/learning guide should be changed.

Ethics in Medicine
                                     M1       M2              M3      M4         Mean         SD
Overall Teaching Quality             3.29     3.18            3.1     3.03       3.15         0.11
Content                               3       3.02            2.93    2.99       2.99         0.04
Organization                         3.05     3.1             2.98    3.06       3.05         0.05
Overall Course Quality               3.13     3.1             3.06    3.01       3.08         0.05

Respondents: M1 (n=105); M2 (n=106); M3 (n=111); M4 (n=98)

Summary of Student Comments:
M1 (n=42) A range of comments from a waste of time to excellent were noted. Many comments were
 made with respect to the syllabus/learning guide and use of small group.
M2 (n=23) Comments were similar to those of the M1 students.
M3 (n=8) Comments were similar to those of the M1 students.
M4 (n=20) Comments were similar to those of the M1 students.

Summary and Recommendation: Student comments were both positive and negative regarding the
small group sessions and the syllabus/learning guide.

Histology
                                     M1       M2              M3      M4         Mean         SD
Overall Teaching Quality             3.57     3.58            3.71    3.74       3.65         0.09
Content                              3.68     3.54            3.59    3.68       3.62         0.07
Organization                         3.66     3.66            3.7     3.73       3.69         0.03
Overall Course Quality               3.59     3.55            3.69    3.73       3.64         0.08

Respondents: M1 (n=106); M2 (n=106); M3 (n=111); M4 (n=99)



LCME Medical Education Database 2004-05              p. 100                           II. Educational Program
Academic Year 2003-2004


Summary of Student Comments:
M1 (n=36) Generally well received with comments ranging from good to poor with respect to the
 syllabus/learning guide and quality of instructors.
M2 (n=23) Generally well liked course with high praise for Dr. Hughes. There were also
 recommendations for syllabus/learning guide revisions.
M3 (n=9) Some comments regarding the syllabus/learning guide.
M4 (n=12) Mostly numerous positive comments.

Summary and Recommendation: While most students evaluated faculty, lectures and laboratories as
positive, there were numerous suggestions regarding laboratory rotations, syllabus organization and
uniformity of faculty.

Interviewing and Communication
                             M1              M2              M3     M4        Mean         SD
Overall Teaching Quality     3.82            3.92            3.74   3.72      3.80         0.09
Content                      3.36            3.61            3.49   3.64      3.53         0.13
Organization                 3.49            3.82            3.6    3.64      3.64         0.14
Overall Course Quality       3.63            3.8             3.59   3.67      3.67         0.09

Respondents: M1 (n=106); M2 (n=105); M3 (n=111); M4 (n=98)

Summary of Student Comments:
M1 (n=28) Generally good comments with some regarding overlap with Physical Diagnosis.
M2 (n=17) Generally good comments
M3 (n=10) Generally good comments.
M4 (n=9) Generally good comments.

Summary and Recommendation: This course was well received by the students with a number of
suggestions that Interviewing and Communication, Physical Diagnosis, Preceptorship and Ethics be
better coordinated.

Neurobiology (only M2-M4 data available)
                              M1         M2                  M3     M4        Mean         SD
Overall Teaching Quality                 4.07                3.84   3.96      3.96         0.12
Content                                  3.82                3.64   3.8       3.75         0.10
Organization                             3.87                3.72   3.68      3.76         0.10
Overall Course Quality                    4                  3.79   3.94      3.91         0.11

Respondents: M2 (n=106); M3 (n=110); M4 (n=99)

Summary of Student Comments:
M2 (n=33) Generally high praise for faculty with suggestions for improving the syllabus/learning guide.
M3 (n=17) Well received by the students with comments regarding the organization of the course.
M4 (n=19) Well received by the students with comments regarding the organization of the course.

Summary and Recommendation: Overall the students were very positive about faculty and content of
this course.




LCME Medical Education Database 2004-05             p. 101                         II. Educational Program
Academic Year 2003-2004


Physical Diagnosis
                                     M1       M2              M3      M4        Mean         SD
Overall Teaching Quality             3.8      3.74            3.61    3.6       3.69         0.10
Content                              3.65     3.48            3.47    3.52      3.53         0.08
Organization                         3.59     3.61            3.54    3.57      3.58         0.03
Overall Course Quality               3.66     3.65            3.57    3.57      3.61         0.05
Respondents: M1 (n=105); M2 (n=106); M3 (n=110); M4 (n=98)
Summary of Student Comments:
M1 (n=34) Generally well received with comments regarding additional time for the course, more
 instructors and more overlap with Interviewing and Communication.
M2 (n=24) Generally well received
M3 (n=19) Generally well received
M4 (n=17) Generally well received
Summary and Recommendation: Overall the students asked for additional time for this course and
overlap with other M1 courses such as Interviewing and Communication.
Physiology
                                     M1       M2              M3      M4        Mean         SD
Overall Teaching Quality             3.65     4.1             3.67    3.85      3.82         0.21
Content                              4.08     4.47            3.87    3.96      4.10         0.26
Organization                         3.96     4.35            3.82    3.91      4.01         0.23
Overall Course Quality               3.83     4.3             3.79    3.93      3.96         0.23
Respondents: M1 (n=106); M2 (n=106); M3 (n=112); M4 (n=98)
Summary of Student Comments:
M1 (n=30) A very well received course with high praise for the Fall quarter course director, Dr. Levis.
 Comments about the Winter quarter were not as favorable.
M2 (n=23) A well received class with high praise for Dr. Levis
M3 (n=11) A well received class with high praise for Dr. Levis
M4 (n=14) A well received class with high praise for Dr. Levis
Summary and Recommendation: Students identified a number of differences between the two
quarters of this course. While the Fall quarter was highly rated, there were a number of suggestions for
improving the Winter quarter, particularly by the faculty.

Preventive Medicine
                                     M1       M2              M3      M4        Mean         SD
Overall Teaching Quality             3.87     4.03            3.64    3.89      3.86         0.16
Content                              3.88     3.96            3.48    3.72      3.76         0.21
Organization                         3.79     3.98            3.5     3.68      3.74         0.20
Overall Course Quality               3.82     3.98            3.52    3.72      3.76         0.19
Respondents: M1 (n=106); M2 (n=106); M3 (n=110); M4 (n=98)
Summary of Student Comments:
M1 (n=16) Generally well received with high praise for Dr. Elliott.
M2 (n=14) Generally well received with high praise for Dr. Elliott.
M3 (n=6) Generally well received with high praise for Dr. Elliott.
M4 (n=9) Generally well received.
Summary and Recommendation: The course was highly considered with very good faculty.


LCME Medical Education Database 2004-05              p. 102                          II. Educational Program
Academic Year 2003-2004


Preceptorship
                                     M1     M2              M3     M4      Mean         SD
Overall Teaching Quality              4     3.89            3.83   3.91    3.91         0.07
Content                              3.88   3.63            3.62   3.69    3.71         0.12
Organization                         3.88   3.77            3.72   3.86    3.81         0.08
Overall Course Quality               3.96   3.86            3.79   3.9     3.88         0.07

Respondents: M1 (n=106); M2 (n=106); M3 (n=111); M4 (n=96)

Summary of Student Comments:
M1 (n=24) Generally well received with mostly positive comments.
M2 (n=22) Generally well received with mostly positive comments.
M3 (n=21) Generally well received with mostly positive comments.
M4 (n=20) Generally well received with mostly positive comments.

Summary and Recommendation: The course was well received by the students.

Shared Medical Decision Making
                              M1            M2              M3     M4      Mean         SD
Overall Teaching Quality     2.94           1.65                              2.3       0.91
Content                      2.47           1.55                             2.01       0.65
Organization                 2.57           1.51                             2.04       0.75
Overall Course Quality       2.55           1.52                             2.04       0.73

Respondents: M1 (n=106); M2 (n=106)

Summary of Student Comments:
M1 (n=35) Not received well by the students, with numerous comments regarding the amount of time,
 difficulty understanding the material, and overlap with other courses.
M2 (n=30) Comments were very similar to those from the M1 students.

Summary and Recommendation: This course has been discontinued.




LCME Medical Education Database 2004-05            p. 103                       II. Educational Program
Academic Year 2003-2004


Overall Teaching Quality
                                                                                                                                                                                      Mean                                                  SD
Anatomy                                                                                                                                                                               4.28                                                  0.13
Behavioral Science: Behavior in Life Cycle                                                                                                                                            3.37                                                  0.05
Behavioral Science: Fundamentals of Behavior                                                                                                                                          3.35                                                  0.04
Biochemistry                                                                                                                                                                          3.03                                                  0.03
Ethics in Medicine                                                                                                                                                                    3.15                                                  0.11
Histology                                                                                                                                                                             3.65                                                  0.09
Interviewing and Communication                                                                                                                                                        3.80                                                  0.09
Neurobiology                                                                                                                                                                          3.96                                                  0.12
Physical Diagnosis                                                                                                                                                                    3.69                                                  0.10
Physiology                                                                                                                                                                            3.82                                                  0.21
Preventive Medicine                                                                                                                                                                   3.86                                                  0.16
Preceptorship                                                                                                                                                                         3.91                                                  0.07
Shared Medical Decision Making                                                                                                                                                        2.30                                                  0.91

                                                                                                                           Overall Teaching Quality

         5.0

         4.5

         4.0

         3.5

         3.0

         2.5

         2.0

         1.5

         1.0
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 Content (Mean ± S.D. from M1-M4 classes)
                                                                                                                                                                                           Mean                                      SD
 Anatomy                                                                                                                                                                                   3.85                                      0.15
 Behavioral Science: Behavior in Life Cycle                                                                                                                                                3.20                                      0.08
 Behavioral Science: Fundamentals of Behavior                                                                                                                                              3.23                                      0.06
 Biochemistry                                                                                                                                                                              3.23                                      0.16
 Ethics in Medicine                                                                                                                                                                        2.99                                      0.04
 Histology                                                                                                                                                                                 3.62                                      0.07
 Interviewing and Communication                                                                                                                                                            3.53                                      0.13
 Neurobiology                                                                                                                                                                              3.75                                      0.10
 Physical Diagnosis                                                                                                                                                                        3.53                                      0.08
 Physiology                                                                                                                                                                                4.10                                      0.26
 Preventive Medicine                                                                                                                                                                       3.76                                      0.21
 Preceptorship                                                                                                                                                                             3.71                                      0.12
 Shared Medical Decision Making                                                                                                                                                            2.01                                      0.65




LCME Medical Education Database 2004-05                                                                                                                          p. 104                                                                                                      II. Educational Program
Academic Year 2003-2004



                                                                                              Content

          5.0

          4.5

          4.0

          3.5

          3.0

          2.5

          2.0

          1.5

          1.0




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 Organization (Mean ± S.D. from M1-M4 classes)
                                                                                                                                                         Mean                        SD
 Anatomy                                                                                                                                                 4.08                        0.06
 Behavioral Science: Behavior in Life Cycle                                                                                                              3.28                        0.05
 Behavioral Science: Fundamentals of Behavior                                                                                                            3.26                        0.04
 Biochemistry                                                                                                                                            3.24                        0.09
 Ethics in Medicine                                                                                                                                      3.05                        0.05
 Histology                                                                                                                                               3.69                        0.03
 Interviewing and Communication                                                                                                                          3.64                        0.14
 Neurobiology                                                                                                                                            3.76                        0.10
 Physical Diagnosis                                                                                                                                      3.58                        0.03
 Physiology                                                                                                                                              4.01                        0.23
 Preventive Medicine                                                                                                                                     3.74                        0.20
 Preceptorship                                                                                                                                           3.81                        0.08
 Shared Medical Decision Making                                                                                                                          2.04                        0.75

                                                                                          Organization

          5.0

          4.5

          4.0

          3.5

          3.0

          2.5

          2.0

          1.5

          1.0
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LCME Medical Education Database 2004-05                                                                  p. 105                                                                                    II. Educational Program
Academic Year 2003-2004


 Overall Course Quality (Mean ± S.D. from M1-M4 classes)
                                                                                                                                                         Mean                        SD
 Anatomy                                                                                                                                                 4.18                        0.11
 Behavioral Science: Behavior in Life Cycle                                                                                                              3.25                        0.02
 Behavioral Science: Fundamentals of Behavior                                                                                                            3.29                        0.04
 Biochemistry                                                                                                                                            3.07                        0.08
 Ethics in Medicine                                                                                                                                      3.08                        0.05
 Histology                                                                                                                                               3.64                        0.08
 Interviewing and Communication                                                                                                                          3.67                        0.09
 Neurobiology                                                                                                                                            3.91                        0.11
 Physical Diagnosis                                                                                                                                      3.61                        0.05
 Physiology                                                                                                                                              3.96                        0.23
 Preventive Medicine                                                                                                                                     3.76                        0.19
 Preceptorship                                                                                                                                           3.88                        0.07
 Shared Medical Decision Making                                                                                                                          2.04                        0.73

                                                                                 Overall Course Quality

          5.0

          4.5

          4.0

          3.5

          3.0

          2.5

          2.0

          1.5

          1.0
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Overall Opinion on 1st year
                                                                                 M1                          M2                              M3                           M4                          mean
Overall Quality of courses                                                       3.84                        3.87                            3.75                         3.87                        3.83            0.06
Overall adequacy of syllabi/course                                               3.91                         3.9                            3.71                         3.85                        3.84            0.09
materials

Overall Summary and Recommendations for M1 Courses: The courses were rated as excellent or
very good with the exception of Shared Medical Decision Making which underwent modification during
the 03-04 calendar year. Changes were implemented because of student input and the fact that it had
significant overlap with other courses and did not add material needed for the M1 curriculum. Although
there were suggestions for improvement of all the courses, none of the other courses appeared to have
serious problems.

Comments by the students were primarily centered on faculty and the course learning guide. Almost
without exception, the students feel that the learning guides should be improved. Comments for faculty
ranked from high praise to criticism of lecture styles and content. The rating for each course by M1-M4
students were consistent suggesting that their opinions of the courses do not change significantly even


LCME Medical Education Database 2004-05                                                                  p. 106                                                                                   II. Educational Program
Academic Year 2003-2004


into their fourth year. There was no evidence that their opinion of the M1 courses changed for the better
or worse after taking their board examinations. Some of the courses have undergone considerable
changes that are not reflected in the student evaluations. This may be due, in part, to the fact that the
students either are not aware of the changes or that these changes do not change their perception of how
the course is delivered.

Our recommendation is that results of the student survey provide a highly valuable tool that should be
shared with the Committee on Education Appraisal, the Curriculum Committee, Course Directors and
their Chairmen. While the individual course reviews are routinely provided for the Committee on
Education Appraisal, Course Directors and their Chairmen, the reviews by students from all four classes
should provide new insight into how the courses are viewed as part of the whole curriculum.




LCME Medical Education Database 2004-05           p. 107                             II. Educational Program
Academic Year 2003-2004


                     Summary of LCME Student Survey Responses
                        Clinical Curriculum for M3s and M4s

FAMILY PRACTICE

The Family Practice Core Clerkship is a 6-week ambulatory rotation. Students rotate over 10 different
sites with the majority of students at LaGrange, Hinsdale, Rush Copley, Cook County, University Family
SW, and McNeal. A large number of students postpone this core clerkship to their M4 year. The table
below depicts student ratings of teaching, grading, clinical experience, and clerkship quality.

                                           Poor/ Below                Very Good/
                                            Average         Average    Excellent
Quality of lectures & conferences             15%            40%         45%
Quality of resident teaching                  12%            36%         53%
Involvement in patient care                    7%            15%         78%
Quality of attending teaching                  5%            19%         76%
Grading/evaluation system                     16%            38%         46%
Patient volume                                 4%            17%         79%
Variety of patient conditions & diseases      11%            26%         64%
Overall quality of this clerkship              8%            24%         68%
  * N = 150 respondents (58 M3s, 92 M4s)

Additionally, respondents made 103 comments about the strengths and weaknesses of the Family
Medicine Core Clerkship. A thematic content analysis yielded the following:
    56% of comments addressed faculty and resident teaching. Of these, 83% were positive
       comments about the quality of teaching by residents, faculty, and specifically identified mentors.
    35% of comments addressed the quality of clinical experiences, and 72% of these comments were
       positive.
    14% of comments were made about the curriculum, and 79% of these were negative.
    8% of comments referenced the grading and/or evaluation process, and 70% of these were
       negative.

Summary and Recommendation:

Student ratings and comments point toward several strengths including 1) teaching excellence, especially
attending teaching, and 2) clinical experiences, especially the patient volume and student involvement in
patient care. Identified areas needing improvement include the grading and evaluation processes, and the
quality and relevance of the curriculum imparted in lectures and conferences. It would be beneficial to
review the content of the lectures and conferences and the grading and evaluation process to determine
the sources of student dissatisfaction.




LCME Medical Education Database 2004-05                  p. 108                      II. Educational Program
Academic Year 2003-2004



INTERNAL MEDICINE

The Internal Medicine Core Clerkship is 12 weeks, which includes 4 weeks of in-patient experience at
Rush, 4 weeks of ambulatory experience with a preceptor, and 4 weeks at John H. Stroger Jr. Hospital of
Cook County. More than 25 faculty members serve as preceptors, a list of that includes 19 individuals, 2
small practices, and 1 large practice. The table below depicts student ratings of teaching, grading, clinical
experience, and clerkship quality.

                                           Poor/ Below                Very Good/
                                            Average         Average    Excellent
Quality of lectures & conferences              6%            30%         64%
Quality of resident teaching                   4%            23%         73%
Involvement in patient care                    2%            18%         80%
Quality of attending teaching                  5%            19%         76%
Grading/evaluation system                     19%            37%         44%
Patient volume                                 2%            19%         79%
Variety of patient conditions & diseases       3%            10%         87%
Quality of ambulatory experiences              9%            12%         79%
Overall quality of this clerkship              2%            18%         79%
  * N=171 respondents (77 M3s, 94 M4s)

Additionally, respondents made 123 comments about the strengths and weaknesses of the Internal
Medicine Core Clerkship. A thematic content analysis yielded the following:
    76% of comments addressed faculty and resident teaching. Of these, 78% were positive
       comments about the quality of teaching by residents, faculty, and specifically identified mentors.
    17% of comments were specific to site, and 76% of these comments were positive.
    15% of comments referenced students’ clinical experiences, and 79% of these were positive.
    10% of comments were made about the ambulatory experience, and 75% of these were positive.
    20% of comments referenced the feedback, grading and evaluation process, and all of these were
       negative.


Summary and Recommendation:

Student ratings and comments emphasized several strengths including 1) teaching excellence by residents
and attending physicians, 2) clinical experiences, especially patient volume, student involvement, and
variety of patient diseases and conditions, 3) the quality of ambulatory experiences and preceptors, and 4)
the overall quality of the clerkship. One area that may need improvement is the grading and evaluation
process. It would be beneficial to review and address the potential sources of student dissatisfaction with
the grading and evaluation processes.




LCME Medical Education Database 2004-05                  p. 109                         II. Educational Program
Academic Year 2003-2004



NEUROLOGY

The Neurology Core Clerkship is a 4-week rotation. Approximately 70% of students rotate at Rush and
approximately 30% of students rotate at John H. Stroger Jr. Hospital of Cook County. A large number of
students postpone this core clerkship to their M4 year. The table below depicts student ratings of teaching,
grading, clinical experience, and clerkship quality.

                                           Poor/ Below                Very Good/
                                            Average         Average    Excellent
Quality of lectures & conferences             11%            24%         65%
Quality of resident teaching                   4%            25%         71%
Involvement in patient care                    7%            26%         68%
Quality of attending teaching                  4%            21%         75%
Grading/evaluation system                      7%            31%         62%
Patient volume                                 6%            28%         66%
Variety of patient conditions & diseases       9%            18%         73%
Quality of ambulatory experiences             16%            25%         59%
Overall quality of this clerkship              6%            24%         71%
  * N=105 respondents (20 M3s, 85 M4s)

Additionally, respondents made 48 comments about the strengths and weaknesses of the Neurology Core
Clerkship. A thematic content analysis yielded the following:
     71% of comments addressed faculty and resident teaching. Of these, 79% were very positive
        comments about the quality of teaching by residents and faculty.
     15% of comments were specific to lectures and conferences, and 86% of these were positive.
     13% of comments referenced students’ clinical experiences, and all of these were negative.
     10% of comments expressed a need for an ambulatory experience.


Summary and Recommendation:

Student ratings and comments emphasized the strength of faculty and resident teaching and the quality of
lectures provided, especially those given at the Rush site. Five respondents suggested an ambulatory
experience be added and 6 respondents made negative comments about their clinical experiences. The
quality of teaching should be maintained at the Rush site and enhanced at the Stroger site. It may be
beneficial to review and address the potential sources of student dissatisfaction with their clinical
experiences.




LCME Medical Education Database 2004-05                  p. 110                       II. Educational Program
Academic Year 2003-2004



Obstetrics and Gynecology

The Obstetrics and Gynecology Core Clerkship is an 8-week rotation. Students take their OB/Gyn core
clerkship at Rush (55%), John H. Stroger Jr. Hospital of Cook County (30%), or West Suburban Hospital
(15%). The table below depicts student ratings of teaching, grading, clinical experience, and clerkship
quality.

                                           Poor/ Below                Very Good/
                                            Average         Average    Excellent
Quality of lectures & conferences             22%            43%         35%
Quality of resident teaching                  20%            38%         41%
Involvement in patient care                   18%            41%         41%
Quality of attending teaching                 21%            29%         50%
Grading/evaluation system                     23%            48%         29%
Patient volume                                10%            39%         51%
Variety of patient conditions & diseases       9%            29%         62%
Quality of ambulatory experiences             15%            37%         48%
Overall quality of this clerkship             21%            37%         42%
  * N=149 respondents (58 M3s, 91 M4s)

Additionally, respondents made 96 comments about the strengths and weaknesses of the Ob/Gyn Core
Clerkship. A thematic content analysis yielded the following:
     69% of comments addressed faculty and resident teaching. Of these, 65% were negative
        comments about the quantity and quality of teaching by residents and faculty.
     13% of comments were specific to lectures and conferences, and 92% of these were negative with
        frequent references to cancellations.
     23% of comments referenced feedback, grading, evaluation processes, and 82% of these were
        negative.
     27% of comments were regarding an aspect of the students’ clinical experience. orty-six percent
        of these were negative with frequent references to lack of opportunity to observe and/or perform
        common ob/gyn procedures, especially pap smears and deliveries.
     14% of comments included a general critique of the rotation, and 69% of these were negative.
     Four of 96 comments contained a description of student mistreatment, which included verbal
        abuse and running errands.

Summary and Recommendation:

The strength of this clerkship lies in the variety of patient conditions and diseases that comprise students’
clinical experiences. However, the results of the student survey reveal a range of issues that emphasize
the need for faculty development programs for ob/gyn attending physicians and residents. It is
recommended that the curriculum design, instruction, and student evaluation processes for this clerkship
be reviewed and enhanced.




LCME Medical Education Database 2004-05                  p. 111                         II. Educational Program
Academic Year 2003-2004



Pediatrics

The Pediatrics Core Clerkship is an 8-week rotation. Students rotate at Rush or John H. Stroger Jr.
Hospital of Cook County in addition to a subspecialty rotation that includes a Rush ambulatory
experience or a Shriner’s Hospital experience. The table below depicts student ratings of teaching,
grading, clinical experience, and clerkship quality.

                                           Poor/ Below                Very Good/
                                            Average         Average    Excellent
Quality of lectures & conferences              5%            24%         70%
Quality of resident teaching                  17%            23%         60%
Involvement in patient care                   11%            27%         61%
Quality of attending teaching                 12%            23%         65%
Grading/evaluation system                     13%            42%         45%
Patient volume                                 7%            30%         63%
Variety of patient conditions & diseases       8%            25%         67%
Quality of ambulatory experiences             11%            27%         61%
Overall quality of this clerkship             11%            27%         61%
  * N=149 respondents (57 M3s, 92 M4s)


Additionally, respondents made 87 comments about the strengths and weaknesses of the Pediatrics Core
Clerkship. A thematic content analysis yielded the following:
     57% of comments addressed faculty and resident teaching. Of these, 64% were very positive
        comments about the quality of teaching by residents and faculty.
     18% of comments referenced students’ clinical experiences, and 75% of these were positive.
     13% of comments were general critiques of the rotation, and 82% of these were positive.
     9% of comments were specific to lectures and conferences, and all of these were positive.
     9% of comments were made about the grading and evaluation process, and all of these were
        negative.


Summary and Recommendation:

Student ratings and comments about faculty teaching and lectures were generally positive. However,
ratings and comments about resident teaching were disparate, with concerns raised about resident
teaching at Stroger Hospital. Resident teaching and the clinical experience at Stroger Hospital should be
reviewed for the purpose of enhancing student experience. It would also be beneficial to review and
address the potential sources of student dissatisfaction with the grading and evaluation processes.




LCME Medical Education Database 2004-05                  p. 112                       II. Educational Program
Academic Year 2003-2004


Psychiatry

The Psychiatry Core Clerkship is a 6-week rotation. Approximately 45% of students rotate at Rush, 5%
rotate at John H. Stroger Jr. Hospital of Cook County, and approximately 50% complete a combined
rotation of Rush and Stroger Hospital. A large number of students postpone this core clerkship to their
M4 year. The table below depicts student ratings of teaching, grading, clinical experience, and clerkship
quality.

                                           Poor/ Below                Very Good/
                                            Average         Average    Excellent
Quality of lectures & conferences              3%            26%         71%
Quality of resident teaching                  14%            33%         53%
Involvement in patient care                    3%            35%         62%
Quality of attending teaching                  5%            25%         70%
Grading/evaluation system                      6%            47%         47%
Patient volume                                 2%            37%         61%
Variety of patient conditions & diseases       2%            27%         71%
Quality of ambulatory experiences             10%            29%         62%
Overall quality of this clerkship              2%            31%         67%
  * N=145 respondents (58 M3s, 87 M4s)


Additionally, respondents made 65 comments about the strengths and weaknesses of the Psychiatry Core
Clerkship. A thematic content analysis yielded the following:
     55% of comments addressed faculty and resident teaching. Of these, 58% were very positive
        comments about the quality of teaching by residents and faculty.
     42% of comments referenced students’ clinical experiences, and 74% of these were positive.
     23% of comments described the clerkship director, and ALL of these were positive.
     14% of comments addressed lectures and conferences, with those comments divided between half
        positive and half negative.


Summary and Recommendation:

Student ratings and comments emphasized several strengths including the teaching quality provided by
residents and attending physicians, and the clinical experiences. Resident teaching and the clinical
experience at John H. Stroger Jr. Hospital of Cook County should be reviewed for the purpose of
enhancing student experience. It would be beneficial to review and address the potential sources of
student dissatisfaction with the grading and evaluation processes.




LCME Medical Education Database 2004-05                  p. 113                       II. Educational Program
Academic Year 2003-2004




Surgery

The surgery core clerkship is an 8-week rotation. Students rotate at Rush, John H. Stroger Jr. Hospital of
Cook County or combined RUMC/Rush North Shore Hospital. The table below depicts student ratings of
teaching, grading, clinical experience, and clerkship quality.

                                           Poor/ Below                Very Good/
                                            Average         Average    Excellent
Quality of lectures & conferences              4%            24%         72%
Quality of resident teaching                  12%            25%         64%
Involvement in patient care                    6%            30%         64%
Quality of attending teaching                  7%            25%         68%
Grading/evaluation system                     13%            41%         46%
Patient volume                                 3%            20%         78%
Variety of patient conditions & diseases       4%            21%         75%
Quality of ambulatory experiences             12%            33%         54%
Overall quality of this clerkship              4%            34%         63%
 * N=161 respondents (69 M3s, 92 M4s)

Additionally, respondents made 72 comments about the strengths and weaknesses of the Surgery Core
Clerkship. A thematic content analysis yielded the following:
     65% of comments addressed faculty and resident teaching. Of these, 64% were positive
        comments about the quality of teaching by residents and faulty.
     19% of comments referenced students’ clinical experiences. 57% of these were positive.
     13% of comments addressed lectures and conferences, and 66% of these were positive.
     10% of comments mentioned the surgical technique course (“Dog Lab”) and all were positive.
     17% of comments referenced the grading and evaluation process, and 66% of these were
        negative.
     5 respondents (7%) expressed that they need more ambulatory experiences.
     4 respondents (6%) commented on the workload, stating that it was too extensive.

Summary and Recommendation:

Student ratings and comments emphasized several strengths including 1) teaching excellence by residents
and attending physicians, 2) lectures and the surgical technique course, and 3) the clinical experience,
especially patient volume and breadth of patient disease and conditions. One area that may need
improvement is the grading and evaluation process. It would be beneficial to review and address the
potential sources of student dissatisfaction with the workload, and the grading and evaluation processes.




LCME Medical Education Database 2004-05                  p. 114                      II. Educational Program
Academic Year 2003-2004


Surgical Selectives

The Surgical Selectives are considered part of the core requirements for surgery. Students are required to
take two 2-week electives in one 4-week block after completing 8 weeks of surgery during either the 3rd
or 4th year to complete the core clerkship in surgery. The table below depicts student ratings of teaching,
grading, clinical experience, and clerkship quality.

                                            Poor/ Below                 Very Good/
                                             Average          Average    Excellent
 Quality of lectures & conferences              9%             42%         49%
 Quality of resident teaching                   8%             24%         68%
 Involvement in patient care                   18%             32%         49%
 Quality of attending teaching                 11%             31%         58%
 Grading/evaluation system                      7%             41%         51%
 Patient volume                                 7%             24%         69%
 Variety of patient conditions & diseases       7%             23%         70%
 Overall quality of this clerkship              6%             31%         63%
 * N=72 respondents (6 M3s, 66 M4s)

Additionally, respondents made 22 comments about the strengths and weaknesses of the Surgical
Selectives. A thematic content analysis yielded the following:
     77% of comments addressed faculty and resident teaching. Of these, 76% were positive
        comments about the quality of teaching by residents and faculty, and 24% were negative.
     68% of all responses included a specific reference to a subspecialty. Of these, 75% were positive
        comments, and 25% of them were negative comments.
     23% of comments referenced students’ clinical experiences and 80% of these were positive.
     9% of comments (2 of 22) referenced the grading and evaluation process, and both of these
        comments were negative.

Summary and Recommendation:

Student ratings and comments reflect a need for a review of rotation objectives and expectations,
especially as they pertain to student involvement in patient care, and faculty and resident teaching
expectations for the surgical selectives.




LCME Medical Education Database 2004-05              p. 115                            II. Educational Program
Academic Year 2003-2004


M4 Subinternship

The M4 students choose Internal Medicine (74%), Pediatrics (15%), Family Medicine (7%) or Surgery
(4%) for their Subinternship requirement.

                                            Poor/ Below                  Very Good/
                                             Average          Average     Excellent
 Quality of lectures & conferences              4%             25%          71%
 Quality of resident teaching                   5%             14%          80%
 Involvement in patient care                    0%              9%          91%
 Quality of attending teaching                  4%             16%          80%
 Grading/evaluation system                      4%             21%          75%
 Patient volume                                 1%             17%          81%
 Variety of patient conditions & diseases       1%              8%          91%
 Overall quality of this clerkship              3%             11%          87%
 * N=76 respondents (all M4s; M3s are not allowed to take Subinternships)

Summary and Recommendation:

The subinternship experience is rated very positively. It may be beneficial to review the opportunities to
create a more even distribution of students among the four departments that offer subinternships.




LCME Medical Education Database 2004-05              p. 116                           II. Educational Program
Academic Year 2003-2004


Electives

Approximately 80 M4 students responded to the questions about their elective clerkships. Their
responses to questions about scheduling and availability of electives are included below, with frequencies
reported in parentheses.

Respondents indicated that their TOTAL weeks of electives scheduled were:
 Less than 18:    2.5% (2)
           18:    50.6% (41)
        19-21:    28.4% (23)
   22 or more:    18.5% (15)


Respondents indicated that their total weeks of AWAY electives scheduled were:
         Zero: 23.2% (19)
    1-3 weeks: 6% (5)
    4-6 weeks: 44% (36)
      8 weeks: 17% (14)
   10+ weeks : 10% (8)



                                                              Poor/ Below                  Very Good/
                                                               Average       Average        Excellent

 Availability of information about opportunities for away
 electives provided by OMSP                                      11%          45%              45%

 Overall variety of electives available                           3%          14%              84%


 Overall adequacy of required 18 weeks of elective
 clerkships to graduate as a physician                            4%          19%              77%

 Adequacy of allotted time for away electives (10 weeks)          9%          16%              75%


Summary and Recommendation:

Students report satisfaction with elective requirements and variety. It may be beneficial to provide
students with more information about away electives and to make this information available to students in
     rd
the 3 year.




LCME Medical Education Database 2004-05              p. 117                            II. Educational Program
Academic Year 2003-2004



Overall Opinions on Clinical Curriculum

The table below depicts overall student ratings of the clinical curriculum.

                                              Poor/ Below                     Very Good/
                                               Average          Average        Excellent
 Adequacy of first and second year
 courses in preparation for clerkships            3%             27%             70%
 Satisfaction with scheduling system for
 required clerkships                             11%             17%             71%
 Adequacy of exposure to a variety of
 patient demographics                             2%              9%             89%
 Adequacy of clerkships in preparing for
 USMLE Step 2 (M4s only)                          6%             15%             79%
  * N=179 respondents (87 M3s, 92 M4s)

Additionally, 28 students responded to a question about the clerkship sites that expanded their exposure
to a wider variety of patient demographics. A thematic content analysis yielded the following:
      86% of responses were positive references to the variety of patient demographics and diseases.
      75% of all responses included a specific, positive reference to the wide variety of patients that
        comprise students’ clinical experiences at Stroger Hospital of Cook County.

Summary and Recommendation:

Students expressed a high degree of satisfaction with their M1 and M2 preparation for clerkships.
Additionally, M4 students perceived the clerkships to have adequately prepared them for the USMLE
Step 2. Individual comments on clerkship sites which broadened students’ exposure to a variety of
patient demographics were overwhelmingly positive and specific to Cook County Hospital.

Committee Recommendation:

Upon review, The LCME Committee for Medical Students has recommended that this report, completed
for the purposes of LCME self-study, be provided to the Office of Medical Student Programs for
distribution to standing committees on curriculum and evaluation and course directors in clinical
curriculum.


Respectfully submitted on June 14, 2004 by Linnea S. Hauge, PhD, Committee Member, and Keith W.
Millikan, MD, Chair of the LCME Committee for Medical Students
         (Report revised on June 23, 2004 to include Committee recommendations for distribution and
         data summaries on surgical selectives, subinternships, electives, and clinical curriculum).




LCME Medical Education Database 2004-05                p. 118                              II. Educational Program

				
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