M.D. graduating class achieves 100 percent match rate for the second year in a row

Originally published on the OHSU News hub

March 15, 2019

At 8:52 a.m., they snagged their envelopes from the long row of tables and pulled close to their family members, friends and classmates amid nervous chatter.

Then, at 9 a.m., the cavernous learning studio at the Robertson Life Sciences Center at OHSU went silent. Save for the ripping of envelopes.

The next sound was a shriek.

Then a woot!

Then shouts, tears, hugs and jumps of joy rippled and escalated across the room as the OHSU School of Medicine M.D. Class of 2019 absorbed where they will spend the next several years of their lives in residency programs at OHSU and across the country.

Match rate recognizes students, program

For the second year in a row, the school posted a 100 percent match, continued affirmation of OHSU students’ excellence and their attractiveness in the fifth year of the school’s transformed, competency-based, personalized curriculum that favors active learning, including moving to clinical rotations sooner.

“The excitement and pride we feel for our students just pumps through us at this moment when their incredible dedication is affirmed,” said Ben Schneider, M.D., assistant dean for undergraduate medical education student affairs, OHSU School of Medicine, and master of ceremonies for the event. “The White Coat Ceremony at the start of medical school is about looking forward and commencement will be about reflection. Match Day is a little of both.”

All 126 graduating M.D. students matched in 27 specialties at 106 programs in 36 states with a total of 44 percent matching in primary care – internal medicine, family medicine or pediatrics; 17 percent are staying at OHSU and 70 percent are in the western U.S., including Oregon. View more program statistics

Dreams realized

Fourth-year medical student Nattaly Greene arrived in America from Columbia at the age of 19 with two 55-pound bags and the drive to become a physician. Friday, surrounded by a wealth of family and friends, she became what she described as the first woman in her lineage to accomplish her life-long dream: she matched in orthopaedic surgery - at Harvard Medical School.

“Out of every surgical specialty, orthopaedic surgery combines my strengths and passions,” Greene said, noting the intersection of mechanics and physics, and creative problem-solving. “Most of all, I love our results. I love this unique privilege to give someone back their mobility and improve their capacity to more easily and productively navigate the world.” 

Mackenzie Deane and Ryan Nesbit, both from Portland suburbs, met on their first day of medical school at OHSU.

They’ve since tackled all aspects of their medical education, from examinations to clinical rotations -- and today -- the residency match process, together as a couple. And they will stay together. Both matched to OHSU residency programs, she in pediatrics, and he in family medicine. 

Ian Coe, who grew up in Corvallis, experienced the fulfillment that comes from being of service as he learned to advocate for his parents who navigate without the benefit of sight.

Family medicine resonates with him because physicians are called to do what’s needed. In rural Oregon communities where he did rotations, he felt the strongest opportunity for impact. Now he will do both: he’s headed to Montana Family Medicine in Billings.

Read their stories

The OHSU School of Medicine Alumni Association put a bow on this breathless morning with a tribute and an invitation to begin envisioning their journey as OHSU alumni.

“From the White Coat ceremony through Medical Specialty Speed Dating, Transition to Clinical Practice and your residency interviews, the Alumni Association has been with you and wished you well,” said Mark Kemball, director of OHSU Alumni Relations. “Wherever the match may take you, please don’t forget the way home.”

March 13, 2019

The Robertson Life Sciences Building classrooms looked like a conference-style exhibit hall on March 8. Students, staff and faculty mentors were there to celebrate this year’s YOUR M.D. Scholarly Projects:

• 126 presentations this year
• 112 students from M.D. Class of 2019
• 14 students from M.D. Class of 2020

Medical students – including those in the combined M.D./M.P.H. and M.D./Ph.D. programs – work on scholarly projects over the entire course of their undergraduate medical education through YOUR M.D. The capstone event is the culmination of years of their research, investigation and analysis.

Students get creative when it comes to scholarly work, producing a children’s book, clinical surveys, and even a provisional patent and draft legislation for the state of Oregon. Faculty members and health care leaders provide essential mentoring to students through the process. Former Oregon governor John Kitzhaber, M.D. ’73, provided guidance for one student this year.

From the archive: Read about Scholarly Projects and the 2018 capstone event

Awards go to…

Student Awards (all M.D. Class of 2019)

• Group A, Law, business and health policy: Mackenzie Deane, “Redesigning testosterone prescribing in the Doernbecher Gender Clinic: Interdisciplinary process improvement results in enhanced patient experience”
• Group B, Education, quality improvement and ethics: Maria Chuop, “Teaching suicide risk assessment and management: A standardized model curriculum for second-year medical students”
• Group C, Clinical research II: Omar Fares, “Examining the utility of the routine daily chest X-ray in a pediatric ICU”
• Group D, Basic science and biomedical engineering: Ellen McCleery, “Population-based screening for neurocysticosis using a novel urine antigen test”
• Group E, Clinical research I: Haley Calcagno, “Integrated otolaryngology and anesthesiology simulation model for crisis management of cavernous carotid injury”
• Group F, Epidemiology, community and global health: Minhazur Sarker, “Impact of delayed initiation of prenatal care on maternal outcomes”

Faculty Mentor Awards

• Whitney Black, M.D., assistant professor of psychiatry, OHSU School of Medicine
• Allison Lindauer, Ph.D., NP, assistant professor of neurology, OHSU School of Medicine
• William Messer, M.D., Ph.D., assistant professor of molecular microbiology and immunology and medicine, OHSU School of Medicine
• Lisa Miura, M.D., associate professor of medicine, OHSU School of Medicine
• Ali S. Olyaei, Pharm.D., professor of medicine and surgery, OHSU School of Medicine
• Alex Ortega Loayza, M.D., assistant professor of dermatology, OHSU School of Medicine
• Craig Warden, M.D., professor of emergency medicine and pediatrics, OHSU School of Medicine

OHSU School of Medicine’s pain intersession stands out among medical schools nationwide

Originally published on the OHSU News hub

January 15, 2019

Around 50 aspiring physicians spent the first part of December with what at first glance might appear to be a getaway to a spa: getting a massage, being treated with acupuncture needles, perusing a marijuana dispensary.

In fact, the OHSU School of Medicine students were taking part in a comprehensive program of pain education that stands out among medical schools nationwide. The goal is to ensure the next generation of health care providers understand there are multiple approaches to help patients manage pain apart from opioids, says Philippe Thuillier, Ph.D., who organizes and directs the pain management coursework at OHSU.

“We start to talk right away that this is a pain management issue,” Thuillier said. “It’s not just opioids.”

Three times a year, the OHSU School of Medicine organizes the two-week “intersession,” bringing together OHSU specialists, national experts and patients who understand pain. The School of Medicine began requiring the focused intersession in 2016 as a fundamental aspect of students’ education: Diving deep into pain so that they will be able to help their patients understand and manage their pain.

Plenty of medical schools offer elective coursework in pain management, but OHSU requires the two-week pain intersession of all its medical students – whether they aspire to be a surgeon, obstetrician or primary care physician. 

“Pain tends to be this nebulous concept,” said Hannah Dischinger, a third-year medical student who intends to go into internal medicine. “Some injuries, like a broken arm, are fairly straightforward because it’s easy to see what needs to be remedied. Pain’s different. Historically, it’s been really hard to tackle pain in a way that helps patients feel heard and cared for.”

In light of the nation’s opioid epidemic, it may be surprising that pain management has traditionally been a secondary point of emphasis in America’s medical schools. However, experts say it’s the exception rather than the rule to find pain management integrated into the curriculum, as it is at OHSU. One set of curriculum recommendations cited a study that found the average American medical student received less than 10 hours of education specifically about pain, compared with 80 hours of training for people studying to be veterinarians in Canada.

OHSU stands out

Beth Hogans, M.D., Ph.D., studies curricula of medical schools across the country. An associate professor of neurology in the Johns Hopkins School of Medicine, Hogans created a four-day pain course for medical students at Johns Hopkins. She said training in pain management has not historically been considered a primary part of medical practice, but rather “a nice sideline for the most accomplished doctors.”

That changed dramatically beginning in the 1990s with a heightened focus on pain management.

In the mid-1990, the American Pain Society began to advance the concept of pain as the “fifth vital sign,” in addition to pulse rate, temperature, respiration rate and blood pressure. At the same time, pharmaceutical companies began heavily marketing opioids beyond their traditional use in cancer treatment and end-of-life care. Widespread use of prescription opioids led to misuse, addiction and overdoses. In 2017 alone, more than 72,000 people died from drug overdoses in the United States – more than the number of U.S. soldiers killed during the entire Vietnam War.

Hogans said OHSU stands out for the quality of its medical education around pain.

Although data about pain education across the nation is imprecise, Hogans estimates OHSU is in the top 10 percent among medical schools nationwide.

“They’re doing some really innovative stuff,” she said.

The school’s focus on pain reflects the reality that future physicians will experience in their clinics, said Catriona Buist, Psy.D., assistant professor of anesthesiology and perioperative medicine in the OHSU School of Medicine. Buist, a past chair of the Oregon Pain Management Commission, estimates that 80 percent of visits to primary care clinics relate to some aspect of pain.

The school integrates pain management for all four years of medical education, but the pain intersession takes it a step further. It includes 65 hours of class time (compared with 10 hours or less at most medical schools), followed by case studies requiring students to address aspects of pain management concerning clinical practice, basic science and the overall health system.

Taking the stress out of Step 1 preparation: Nourish provides a space for positive, nourishing experiences to support students

Dec. 31, 2018

Merely mention the U.S. Medical Licensing Examination Step 1 to a medical student, and their heart rate might increase. Debate exists around how residency programs use the scores to select applicants and the unintended consequences of a “Step 1 climate” on student learning and wellness. (See this Dec. 18 Academic Medicine commentary, co-authored by Kelsey Priest, M.P.H., an OHSU M.D./Ph.D. student.)

Standardized exams are hard enough without all the unintended pressure of doing well to secure a residency slot. School of Medicine leaders and medical students are taking some of the well-intentioned energy around Step 1 preparation and putting it into a new, opt-in support program for second-year medical students studying for the test in the Portland metro area.

Nourish began in mid-December and is the brainchild of Megan Furnari, M.D., M.S., assistant professor of pediatrics, OHSU School of Medicine, and Nishad Sathe, a student in the M.D. Class of 2020. The program aims to build community, promote regular exercise, reduce stress and give students access to tutoring. Fifty students – about a third of the Class of 2021 – have gotten involved.

“We are not aware of any other school doing a Step 1 support program like this,” said Dr. Furnari, who is also director of medical student wellness and leadership development in the School of Medicine. “I’m proud to offer this and believe it is an essential part of our overall approach to creating a collaborative, rich, and nourishing experience for students to prepare them for residency and beyond.”

Mentoring and peer support for Nourish comes from within the existing student community. Sathe held one-on-one planning sessions with students, and will lead tutoring sessions every Sunday between Jan. 6 and Feb. 3. Grace Clark, member of the M.D. Class of 2022 and a CorePower teacher, teaches yoga each week. Dr. Furnari leads runs and relaxation, sends daily morning affirmation emails, and helps organize a Friday evening gratitude event online.

At OHSU, students must pass Step 1 before moving on to the clinical experiences part of the YOUR M.D. curriculum. With the active learning and intentional self-care absorbed through Nourish, this requirement may get a little less stressful.

M.D. class of 2018 celebrates 100 percent match amid tears, hugs

Originally published on the OHSU News hub

March 16, 2018

Shira Einstein survived Hodgkin’s lymphoma at age 15 with the support of an excellent medical team at OHSU Doernbecher Children’s Hospital.

On March 16, this now fourth-year OHSU medical student joined her classmates in opening their Match Day envelopes to learn that she will become a member of the extended team that saved her life a decade ago, as a pediatrics resident at Doernbecher. 

As her classmates’ shrieks, cheers and tears erupted across the third-floor learning studio at the Collaborative Life Sciences Building, Einstein’s father picked up his now healthy and grown little girl and twirled her around in celebration.

“It seems like just yesterday that she was a patient here,” Josh Einstein said.

“It’s closing the circle for her from patient to doctor at the same facility, the same place,” said her mom, Elana Einstein. “What a journey.”

OHSU’s 100 percent match bodes well for new curriculum

Run by the National Resident Matching Program, Match Day is when, all across the country at exactly the same time (9 a.m. Pacific Standard Time), fourth-year medical students learn where they will spend the next three to seven years as resident-physicians – and where many of them will ultimately stay on to practice medicine.

This year’s match was especially significant for OHSU because the M.D. class of 2018 is the first full group to experience the YOUR M.D. curriculum, a more personalized, integrated learning experience that favors active learning and allows students to demonstrate competency in core areas, in some cases graduating sooner than the standard four years.

By Friday, OHSU learned that 100 percent of the class of 2018 had matched to a residency program, a key indicator that the curriculum is generating desirable, well-prepared emerging physicians. The national average for matching is 93 percent.

“Match Day is a celebration of our medical students' incredibly hard work to master the skills and knowledge to become physicians and to identify the areas in which they wish to begin to specialize,” said OHSU School of Medicine Dean Sharon Anderson, M.D., who came to the celebration to congratulate students and families.

“That the match is experienced by all fourth-year medical students across the country at the exact same time makes it not only a rite of passage, but a day when we as a profession focus on, and commit to meeting, the physician workforce needs in communities large and small to fulfill our obligation to society,” Anderson said.

A computer algorithm determines which graduate medical education, or residency, program students will join, based on their application, interview and program preferences and the preferences of the programs to which they have applied.

This year’s group of 147 soon-to-be-minted OHSU School of Medicine physicians matched in 25 different disciplines at 76 institutions across the nation. Destinations include:

• 38 (26 percent) will train in Oregon – 34 at OHSU in one of more than 80 graduate medical education programs.
• 100 will stay in the western region; 23 will head to the northeast; 13 to the central region; and 11 to the south.

By specialty, 60 students, or 41 percent of the class, chose primary care residencies (internal medicine, family medicine and pediatrics). While some will end up in subspecialties, the trend bodes well for meeting the demand for primary care physicians.

A medical community moment

Match Day is a labor of love and a communal moment for the medical school leaders, staff, faculty and alumni. The staff arranged a buffet breakfast and laid out the envelopes containing each student’s match information across a long table, while a slide show of student snapshots from their medical school years looped on a big screen. Teaching faculty roamed the room sharing handshakes and hugs with students and their families.

The OHSU School of Medicine Alumni Association handed out shirt-shaped cookies frosted in blue to resemble doctors’ scrubs and sponsored a photo booth.

Joanne Jene, M.D., OHSU School of Medicine Class of 1960, an anesthesiologist and emeritus member of the Alumni Association Council, shared her Match Day experience in the pre-smart phone/internet days. She called the OHSU registrar from a payphone amid a road trip to learn she matched to Philadelphia General Hospital.

“Remember that you will forever be an ambassador for OHSU,” Jene said. “And we will cherish the fact that soon you will be a forever alum of this fine institution.”

The emcee role is played by Student Affairs Assistant Deans Nicole Deiorio, M.D., professor of emergency medicine, and Ben Schneider, M.D., assistant professor of family medicine, OHSU School of Medicine. At 8:55 a.m., Schneider invited students to come get their envelopes. At exactly 9 a.m., the envelope opening began.

Medicine as an avocation

Soon after, fourth-year med student Skender Najibi, a first-generation college student from an Afghani immigrant family, was jumping for joy with his wife, brother and parents who came up from California.

Najibi earned a spot in the family medicine residency at Contra Costa Regional Medical Center in California, where his patients will include the underserved families he is most passionate about supporting.

“As a minority, the health disparities that I witnessed within my own family, empowered me and created a sense of responsibility for me to enter this profession,” Najibi said.

Fourth-year student Liz Kinsey cried tears of happiness with her mom and stepfather upon learning she matched to Mt. Sinai St. Luke’s in New York where she will be surrounded by family. Raised in San Antonio, Texas, Kinsey’s grandmother, from a Mexican migrant worker family of nine children, told her: “Study hard, mija, and you can have a better life one day.”

Kinsey went on to create her own major in global health entrepreneurship as a Harvard University undergrad and a rotation in Oaxaca, Mexico, while in med school at OHSU. She will serve in obstetrics and gynecology at Mt. Sinai.

For Shira Einstein, the happiness of staying at OHSU was all the sweeter because her classmate and best friend, Margo Roemeling, matched in Oregon too.

Roemeling, who along with Einstein, was featured in an inspirational video series created by the American Medical Association, grew up on a farm outside Albany, Oregon. Roemeling matched to the OHSU Cascades East Family Medicine Residency in Klamath Falls, which specializes in training residents as rural physicians.

“I’m going to move back to a rural area. That’s where I feel at home. Those are my people,” Roemeling said. “I want to serve where I can have the biggest impact, with the people who need me most.”

First YOUR M.D. cohort presents their scholarly projects

Originally published on School of Medicine News

March 13, 2018

Fourth-year – and some third-year – M.D. students gathered March 9 for the first Scholarly Project Capstone Event, a culminating moment in the maturation of the first cohort of students to complete the YOUR M.D. curriculum. Students presented 118 projects, including eight projects presented by third-year students, in the M.D. class of 2019.

Undergraduate medical education staff transformed the Collaborative Life Sciences Building third-floor classrooms into an exhibit hall for the day, with aisles of posters grouped by concentration area.

The event design is key to understanding the goals of the curriculum, explained Heidi Nelson, M.D., M.P.H., M.A.C.P., research professor and vice chair of medical informatics and clinical epidemiology and medicine, and director of scholarly projects, OHSU School of Medicine.

"We're trying to replicate what students might see at a national meeting, such as the American College of Physicians, which will be a part of their continuing medical education across their entire careers," Dr. Nelson said. "They may not all become researchers, but they're all going to be physicians who need to understand the implications of new research."

Scholarly Projects is a three-course curriculum within YOUR M.D. – a competency-based, time-variable approach to medical education. These competencies include skills that haven't traditionally been evaluated for a medical degree, such as communication, presentation and critical analysis of information. Designing and performing a research project, and then presenting the findings at a meeting, demonstrates all of these skills.

Dr. Nelson emphasized that while the scholarly element of the program is narrowly defined, the interpretation of "project" is broader. This flexibility is meant to mirror the scientific process overall, where even a well-designed inquiry may not result in the expected outcome. It also encourages the development of new ideas and products, as demonstrated by scholarly projects resulting in a children's book about dealing with serious health problems and a method for developing personalized aortic valves.

"Research is always messy," she said. "It's a learning experience similar to students rotating through a clinical ward. In this case, all the patients don't miraculously recover and go home … but that doesn't mean they failed the course. The process may not be linear and the outcomes may be unexpected."

Planning the curriculum: concentration areas

The Scholarly Project curriculum is organized into concentration areas that students helped to choose, allowing administrators to then identify faculty leads and mentors who can guide and support student interests.

Mark Baskerville, M.D., J.D., MBA, assistant professor of anesthesiology and perioperative medicine, OHSU School of Medicine, is the concentration lead for Law, Business and Health Policy. It's a broad category that includes projects beyond direct legal and policy inquiries.

"We all have lives beyond whatever our concentration is. Yes, I'm a lawyer but I also work in an ICU, so if there's anyone that's doing critical care or anything else in my background, I'll get those students as well," said Dr. Baskerville.

Dr. Baskerville described his role as "the matchmaker and wedding coordinator," meaning he helps connect students with mentors in their specific areas of interest, track their progress and troubleshoot problems. He's also a backup to support students directly if someone's mentor leaves OHSU.

Hands-on experience with global health

Kaitlyn "Katie" Main and Shira Einstein, both M.D. class of 2018, collaborated on an 11-week trip to Lima, Peru, to work with Health Bridges International. Main is pursuing emergency medicine and Einstein plans to go into pediatrics, but they share a passion for global health.

"We both knew that we wanted to have a global health experience, and this project sounded like a really sustainable, ethical way to learn and give back," said Einstein.

They created a standardized manual as a resource for health ambassadors advocating for children and families who live in extreme poverty, to help navigate a complex health care system and overcome barriers to access.

"With the scholarly project, when we heard we were all expected to do some kind of research project, we all thought bench or lab research," Einstein said. "It didn't speak to me in the same way that doing some kind of advocacy, patient-centered work did. I think it's really cool that we could make evidence-based, scholarly contributions to the field of global health."

Main credited the scholarly project requirement for helping her learn what's needed when presenting at a major conference. She said the larger YOUR M.D. curriculum schedule – and supportive M.D. program leaders – provided the flexibility and time to pursue the project, including their international travel.

Peter Engdall, M.D. class of 2018, examined social determinants and global health closer to home. Partnering with Winding Waters clinic in Enterprise, Ore., Engdall identified circumstances that impact health that are not traditionally part of a doctor-patient discussion –such as housing, food insecurity, access to transportation or a phone.

"The more that your care team knows about these [circumstances], and can help tailor specific treatments, the better the outcomes. My project simply asks, 'why aren't we asking everybody?'," said Engdall. "We can give you all the medicine for whatever ails you, but if you don't have a home, you're not going to be healthy."

Analysis with clinical impact

Joel McLouth, M.D. class of 2018, plans to pursue radiology, so his research focused on how image analysis can benefit patient care – specifically "the association of sarcopenia as it related to adverse outcomes following liver-directed treatment in patients with unresectable hepatocellular carcinoma."

"From obtaining IRB approval to statistical analysis, there is a lot more that goes into a successful project than I initially anticipated," said McLouth. "This was an eye-opening experience and I certainly feel that I am more prepared to present research findings than I was at the start."

Dacey Brooke, M.D. class of 2018, already has a master's degree and some experience with conducting and presenting research. However, the clinical focus she pursued with her scholarly project was a new direction for her. She explored the efficacy of imaging options to detect shunt failure in children with hydrocephalus, primarily comparing shunt series (X-rays) and shuntograms, which require exposing children to radiation.

She said she hopes the research will illuminate the limits of these tests and better support emergency department physicians and neurosurgeons needing to decide which tests to use on children with concern for shunt failure.

"The fewer tests that we can do on these patients, while still keeping them safe and providing them medical care, the better," she said.

Brooke presented this research at a regional meeting of the Society for Academic Emergency Medicine, and has been accepted for the national meeting. She will also share her findings at the Pediatric Academic Society in Toronto.

Recognizing student work and contributions to medical knowledge

The capstone event closed with a gathering to celebrate all of the work and the award winners.

"It's a proud moment for the curriculum and the program with your work coming to light, and this event brings it all home – back at CLSB where you all started," said Tracy Bumsted, M.D., M.P.H., associate dean for undergraduate medical education, OHSU School of Medicine. "You've created a lot of new knowledge with your projects. I can't thank you enough for your perseverance, your creativity, your passion for the projects that you have created to change and improve human health."

2018 capstone event award winners

• Group A, Clinical Research I: Derrick L. Tao, Mutational Testing in Advanced Prostate Cancer and its Impact on Clinical Decision-Making
• Group B, Clinical Research II: Harrison M. Mooers, CRC Screening in Women age 50-59 years: A Risk-based, Tiered Approach with Fecal Occult Blood Test
• Group C, Basic Science and Biomedical Engineering: Qiuying "Selena" Liu, Midostaurin Improves AML Patient Survival by Targeting the Microenvironment
• Group D, Law, Business and Health Policy: Peter A. Engdall, Social Determinants of Health Survey Prior to Clinical Visit: An Intervention to Improve Healthcare Delivery
• Group E, Education, Quality Improvement and Ethics: Joel D. McLouth, Association of Sarcopenia with Adverse Outcomes after Liver-directed Treatment for Unresectable Hepatocellular Carcinoma
• Group F, Epidemiology, Community and Global Health: Kaitlyn "Katie" Main and Shira Einstein, Health Advocacy Curriculum Development for Health Care Ambassadors and Families of Medically Fragile Children in Lima's Urban Slums

March 7, 2018

As the first cohort of students to use the OHSU School of Medicine's YOUR M.D.curriculum approaches Match Day and graduation, Academic Medicine, the journal of the Association of American Medical Colleges, has published an article reviewing OHSU's process, including factors that helped and hindered change.

"Describing the Journey and Lessons Learned Implementing a Competency-Based, Time-Variable Undergraduate Medical Education Curriculum," by George Mejicano, M.D., M.S., senior associate dean for education, and Tracy Bumsted, M.D., M.P.H., associate dean for undergraduate medical education, describes the forces driving change and how OHSU tailored the new curriculum to respond.

Drs. Mejicano and Bumsted cite among the driving factors the "explosion of medical knowledge," new disciplines and educational methods, and "the profound economic pressures borne by health care delivery systems and payers." Another key factor is that incoming medical students are now overwhelmingly digital natives.

"The goal of the new curriculum was to effectively prepare graduates for residency training and professional practice to best serve and meet the needs of society in the 21st century," they wrote.

A more active, competency-based approach

For these reasons, the YOUR M.D. curriculum, launched in August 2014, moves away from a one-size-fits-all, lock-step curriculum to a more personalized, interactive curriculum that emphasizes the demonstration of competency in core areas.

The YOUR M.D. curriculum allows students to begin the clinical phase of the curriculum in February of their second year, earlier than before. The curriculum also favors active learning – through simulation, transition courses, creative clinical experiences, reflective writing and scholarly projects. The latter requires students to do a "deep dive" about a topic or issue of their choosing. The work of the graduating class will be showcased on March 9 when the students present their project capstone posters.

"A real moment of pride for me has been to see our students in clinical settings so much earlier than before," said Dr. Bumsted. "After mastering the essence of the skills required, they go on to learn by doing, allowing experience to be the best teacher."

In addition, every student is assigned a coach for the entire program. Together, they design an individualized learning plan that can take into account previously attained knowledge and skills. The idea is that students will be able to graduate whenever they can demonstrate that they can perform at a predetermined level across each of the 43 competencies selected by the school's faculty.

Although some students may take longer than four years to graduate, many more should finish earlier than scheduled. Indeed, 31 students from the M.D. class of 2018 will graduate at the end of winter term (i.e., three months ahead of schedule). This has the added advantage of decreasing student debt.

Challenges and learnings

Drs. Mejicano and Bumsted reflect in the article on challenges during the transformation, including resistance to change and regulatory barriers.

They note, however, that students who were going to benefit from the new curriculum were largely supportive. A hallmark of the transformation has been to empower students to give feedback on how to improve the curriculum. As a result, the article notes, "multiple new feedback systems are now in place, such as town halls, surveys and meetings with student leaders, to give input."

Indeed, Drs. Mejicano and Bumsted credit the dialogue with the M.D. class of 2018 and the opportunity to learn from their experience with the new curriculum as key to what will eventually become its full implementation. "Their overall progress, both in terms of time to and ease of achieving the intended outcomes, has helped us better understand this process and make ongoing innovative curricular changes in real time," the authors wrote.

As they prepare to celebrate Match Day and graduation with the class, both expressed a sense of determination to complete the work as well as gratitude.

"When you're making significant change in order to meet a demonstrated need, it is not always easy, but it is necessary, to persevere," Dr. Mejicano said. "We know that many aspects of this change have been challenging. And we appreciate and are grateful to our faculty and students because they have been integral to the successful transformation of the curriculum. Most importantly, however, is that we believe that our students will be better prepared to enter residency and practice medicine."

• Sooner. Faster. Better. OHSU changes its medical school curriculum (The Oregonian)
• Our participation in AAMC pilot to test core entrustable professional activities (EPAs)
• Q&A with Dr. George Mejicano (Quality Matters)
• OHSU restructuring approach to medical school (The Scribe) 
• How OHSU plans to make health care more compassionate (Portland Business Journal)
• Transformation of medical education relies heavily on students (Hospitals & Health Networks)
• Three-year curriculum: the cure for med-ed's ills? (MedPage Today)
• Q&A: Tailoring coursework to the strengths and weaknesses of students (Commonwealth Fund)
• OHSU gets $1M to find new ways to educate doctors (OPB)

What will society need from physicians and health care professionals over the next 20 to 30 years?

In 1994, the OHSU School of Medicine answered that question by implementing a redesign of our M.D. curriculum. Our focus on what was then a cutting-edge approach to education earned us a national reputation, and helped support Oregon's physician workforce needs.

Over the past two decades, the health care landscape has evolved and now is doing so at an ever-faster pace, making now the right time to ask the same question: What will society need from physicians over the next 20 to 30 years?

To answer the question, the OHSU School of Medicine created YOUR M.D., a curriculum to prepare physicians to be leaders in a health care delivery and discovery environment that is rapidly changing – and likely to continue evolving under any future scenario.

The YOUR M.D. curriculum builds on and expands the strengths of our current curriculum, enhances our commitment to Oregon's rural and underserved communities, and ensures OHSU continues to educate and graduate the types of physicians most needed by Oregon.

The curriculum embraces innovative new teaching methods, emphasizing 21st century skills related to health care quality, genetics, interprofessional teamwork, data interpretation, technology, costs and more. In time, our students will advance through customized learning plans, allowing some students to complete medical school at an accelerated pace.

The future health care landscape is interprofessional, patient-centered, focused on prevention, technology-smart, evidence-based, and able to rapidly integrate new discoveries into treatments. The practice environment of the future physician will be different than it is today.

The M.D. Curriculum Transformation initiative is answering this question: What will society need from physicians and health care professionals over the next 20 to 30 years?

Throughout our transformation process, our commitment to excellence in primary care education and enhancing student understanding of the needs of rural Oregon and underserved communities is unshakable. A transformed M.D. curriculum has the potential to enhance and strengthen that commitment by identifying new and innovative educational opportunities for students to focus on these areas.

Principles associated with future rural community-based curriculum

• A purpose of the M.D. Curriculum Transformation process is ensuring that OHSU continues to educate and graduate the types of physicians needed by Oregon – across discipline, geography, patient population, cultural competency, and attributes linked to an ability to provide high quality health care and community leadership in the evolving future health care landscape. 
• Reflecting our commitment to supplying a diverse physician workforce for Oregon, as part of the curriculum transformation, we expect that the rural and community-based curriculum, as well as instruction focused on other underserved areas/populations, will be expanded. 
• Among other goals, we want to provide enhanced opportunities to introduce students to community-based practice, community leadership and problem solving, population and public health and systems-based competencies. 
• Multiple ideas for expansion are being discussed, but under any scenario, a rural clerkship will remain a requirement for our M.D. students. Rural in this context is defined by the Oregon Office of Rural Health as "geographic areas 10 or more miles from the centroid of a population center of 40,000 or more." 
• The rural curriculum expansion now being discussed focuses on increasing the menu of options for fulfilling the rural requirement – options such as adding new sites, more specialties, exploring the creative use of technology (such as telemedicine), creating rotations for teams of students (M.D., PA, Nursing) to reinforce collaborative team-based practice, and others. 
• Currently, all third-year medical students participate in a required Rural and Community Health Clerkship primarily in Family Medicine. This clerkship was established as part of our 1994 curriculum redesign. This same clinical experience will remain available to all of our students as one of the options (an elective) in an expanded, required rural and community-based curriculum. 
• In addition to the specific discipline which may be its clinical focus (e.g., Surgery, Obstetrics and Gynecology, Family Medicine, Pediatrics, Psychiatry, Internal Medicine, etc.), all options to fulfill the required rural rotation will also include attributes that focus on unique aspects of the health care needs of rural Oregon communities. 
• The first cohort to participate in the expanded third-year rural curriculum will be 2016 (the transformed curriculum will be introduced with the entering class of 2014, and will be phased in each year after that). 
• The OHSU faculty is the responsible entity for ensuring the excellence of the M.D. curriculum and ensuring its accordance with accreditation standards. A faculty and student work group is currently charged with reconsidering all M.D. clinical educational experiences and will make recommendations to the School of Medicine across all specialties.

Approved and posted March 2013

Foundational philosophy of curriculum transformation

The purpose of the undergraduate medical curriculum is to foster transformation of the learner into a physician. In addition to transferring information and skills, medical education should prepare the student for lifelong learning and scholarship; synthesis of information, critical reasoning and problem solving; self-assessment and reflection; and collaborative clinical practice. The OHSU School of Medicine curriculum explicitly integrates the scientific basis of medicine with relevant clinical experiences within and across each year of learning. It offers students progressive patient care responsibilities, fosters independent learning, and allows individualization of educational experiences. Students learn in an integrated system model, in which scientific principles of normal and abnormal human structure and function are woven throughout, and other important themes are incorporated as threads.

The curriculum is guided by the following tenets:

• Integration of foundational and clinical sciences throughout the curriculum promotes comprehension and retention.
• Learner-centered teaching modalities are selected according to the desired educational outcomes and may include: didactic presentations, team-based learning, problem-based learning, case discussions, simulation, online modules, service learning and clinical experiences.
• Competency-based assessment evaluates student mastery of knowledge, skills and attitudes.
• Training is aligned with the institutional missions addressing health care needs of the state and region.
• The curriculum embraces the principles of diversity and inclusion, scientific discovery and innovation.
• All physicians need a foundational core of knowledge, skills and attitudes, which the curriculum provides while maintaining the flexibility to allow the development of expertise in specific areas of concentration.
• Clinical experiences beginning in the first year and continuing throughout the medical curriculum reinforce integration and application of new knowledge, enhance clinical and communication skills, and foster development of professional identity.
• Clinical experiences in rural, medically underserved, and other community settings provide perspective as well as exposure to the key role of social determinants of individual patient and population health.
• Carefully designed shared learning experiences foster the knowledge, skills and attitudes needed for practicing as part of an interprofessional care team that operates within a larger system of care.
• The curriculum effectively prepares the M.D. graduate for transition to the next phase of training as a resident.

Student, Faculty and Administrative Expectations

• Students are expected to engage fully in all aspects of the medical education program, and to contribute to the learning of their classmates.
• The faculty are responsible for defining the specific content and learning modalities of each course and clerkship. Faculty are expected to participate in and support the education mission of the School of Medicine. In recognition of the importance of this mission, achievement as an educator will be an important component for faculty academic advancement.
• The Associate Dean for Undergraduate Medical Education, under the supervision of the Senior Associate Dean for Education, is responsible for maintaining the quality and effectiveness of the curriculum and all other aspects of the undergraduate medical education program. The Curriculum Committee and subcommittees assist with this work, and facilitate input of the faculty into the curriculum structure and function.

Structure

• An optional self-assessment and learning opportunity is offered prior to matriculation to help prepare students for success in the undergraduate medical curriculum.
• A required introductory block familiarizes the student with general concepts of the foundational sciences, and promotes the knowledge, skills and attitudes necessary for the professional development of the physician.
• The foundational science curriculum is organized into integrated, multidisciplinary units, relating normal and abnormal structure, function and behavior with the epidemiology, pathophysiology, prevention and treatment of disease, together with emerging disciplines such as informatics and quality improvement science.
• Required clinical clerkships follow the foundational science curriculum to provide a broad experience in clinical medicine.
• Electives, selectives, and mentored scholarly activity leading to a capstone project are provided to enhance the educational value of the curriculum, allow increased breadth and depth in specific areas, and permit individualization of each student's educational experiences.
• Intersession courses are provided to facilitate the progression from undergraduate to professional school, from the foundational curriculum to the core clinical experiences, and from medical student to resident physician. They are also used to reinforce foundational sciences.

Evaluation of Performance

• The evaluation of student performance includes the following core competencies: medical knowledge, patient care and procedural skills, professionalism, interpersonal and communication skills, practice-based learning and improvement, and systems-based practice.
• The evaluation of student performance applies both traditional approaches and performance-based assessment of the acquisition of clinical skills, knowledge and attitudes.
• Evaluation of student performance is timely, includes formative and summative feedback, and is provided by faculty who are familiar with the performance of the student.

Evaluation of Curriculum

• The content, teaching methodologies and assessment tools used in the foundational and clinical sciences curricula are continuously scrutinized for appropriate depth, breadth, integration and relevance.
• The curriculum is evaluated by how well our students perform, both at OHSU and following graduation. This evaluation includes what students do, in terms of specialty and career choices and practice location, and what impact they have, as measured by quality of clinical care, research productivity, leadership positions, awards and other recognition. This information is continuously reviewed and changes incorporated to meet the educational mission of the School of Medicine.
• The Curriculum Committee is responsible for implementation, coordination, evaluation and continuous improvement of the UME curriculum.

Approved by OHSU UME Curriculum Committee March 14, 2013

Approved by SOM Faculty Council May 2, 2013

Guiding principles drive innovation

1. Involvement and communication

• Maintain close engagement with faculty, students and other constituencies
• Communicate openly and transparently with the OHSU academic community
• Leverage OHSU’s position as a top-ranked research institution

2. Curriculum design

• Begin with the end product in mind – the ideal physician of the mid-21^st century – and reverse engineer the curriculum to achieve that goal
• Prepare graduates of the MD program for rigorous residency program
• Consider the entire curriculum holistically, with deliberate horizontal and vertical integration
• Balance innovation and experimentation with more traditional approaches
• Integrate clinical and foundational sciences across all four years
• Guide curriculum development through best practices in both undergraduate and medical education
• Develop curricular content based on competency-based learning objectives
• Examine the most effective means of promoting interprofessional education
• Acknowledge and incorporate curricular elements that OHSU SoM does well
• Make an honest appraisal of areas in which OHSU needs to improve

3. Learner-centered approach

• Acknowledge the different learning styles among our students and that no one pedagogy is right for all
• Emphasize student-centered instruction, active learning over passive learning, and application and synthesis of knowledge in critical reasoning over memorization
• Help students develop a sense of responsibility for their own learning, with the goal of creating self-directed, lifelong learners
• Assure student readiness for success through interventions prior to matriculation

4. Assessment and evaluation

• Enhance the assessment and evaluation of students through central monitoring of objective-driven performance across all four years, while incorporating feedback as an integral part of teaching
• Implement purposeful, ongoing system for curriculum evaluation

5. Integration of technologies

• Enhance the use of technology in the delivery of content and assessment of performance
• Assure proficiency with the electronic health record, medical informatics and management of information technologies

6. Faculty development

• Encourage central support of faculty development to assure success of the new curriculum
• Educate both faculty and students on principles of adult learning

Why transform our M.D. curriculum? 

The health care landscape is changing. Our goal is to boldly and innovatively bridge the growing divide between how physicians are trained and the needs of society in this future landscape.

How is the health care landscape changing? 

Reform, changing delivery models, integration of new treatments (such as those stemming from genetics advances), the push to contain costs and a new focus on prevention and wellness are among several accelerating trends. Simultaneously, an explosion of information technology and tools is transforming both health care and education at all levels.

At its broadest level, what is the purpose of the initiative? 

The M.D. Curriculum Transformation process is ensuring that OHSU continues to educate and graduate the types of physicians needed by Oregon – across discipline, geography, patient population, cultural competency, and attributes linked to an ability to provide high quality health care and community leadership in the evolving future health care landscape.

Is there something wrong with the existing M.D. curriculum? 

No. The current curriculum is strong and produces exceptional graduates. However, in this rapidly changing environment, our responsibility is to look forward and ask what society will need from us in the future, to imagine the future, and to help create it. This initiative builds on our existing strong curriculum and ensures our graduates are aligned with the health care trajectory.

Has OHSU ever undertaken this type of curriculum revision before? 

Yes. In 1994, the School of Medicine created and implemented a revision of our M.D. curriculum. At that time, we took unique aspects of OHSU and Oregon and made them part of the then-new curriculum. We are taking those same steps now.

Are other medical schools doing this too? 

Many, if not most, medical schools across the country are in some phase of curriculum transformation. Like OHSU, the community of academic medicine acknowledges and embraces its leadership role on this topic.

What do our students think of this initiative? 

Students – like all of us – understand that our health care systems are changing. Student input is being provided through a number of channels. We're also seeking input from recent graduates, who provide a unique and timely perspective on their educational experience.

OHSU is nationally known for primary care education. Will that change? 

No. Throughout this change process, our commitment to primary care, rural Oregon and underserved communities will be – as it has always been – unshakable. A transformed M.D. curriculum will enhance that commitment by identifying new and innovative educational opportunities for students to focus on underserved communities.

Have themes already emerged that are guiding the transformation initiative? 

Yes. Three themes have emerged that permeate most aspects of the curriculum.

First, the new curriculum will be competency-based, not time-based, with an educational program customized to each student. This means some students – such as a student who is already a physician assistant – may complete medical school in less than four years.

Second, the health care landscape of the future will be data-driven (patient panel/population analyses, genetic sequencing, costs control, for example) and the new curriculum will include a focus on related skills sets, such as informatics.

Third, the new curriculum will produce graduates skilled at self-assessment and able to continually advance their own expertise, allowing them to lead health care into a new era of continuous improvement.