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The fall of 2010 marked a major turning point for medical education at the University of Virginia. An institution known for its Jeffersonian tradition welcomed an expanded class into a new education building and moved from a discipline-based pre-clerkship curriculum to a systems-based curriculum with a focus on team-based learning.
Larger class size, variable schedules and rotation sites for students and demands on faculty created a challenge for continuity of student-faculty relationships as well as a barrier to effective oversight of professional development, academic progress and career advising. Lack of a system to guide the medical school experience inhibited efforts to improve the process.
The University of Virginia School of Medicine Class of 2014 was the first class to be part of a new College System. Four colleges were formed, each headed by a Dean for Student Affairs and named after a prominent physician associated with the School of Medicine:
Robley Dunglison College: As the first professor of anatomy and medicine at the UVA, Dr. Dunglison was also Thomas Jefferson’s personal physician. He is known as the “Father of American Physiology,” largely because of his textbook Human Physiology (1832).
Thomas Hunter College: A pioneer in bioethics, Dr. Hunter was Dean of the University of Virginia School of Medicine 1953 -1965 and subsequently served as Vice President for Medical Affairs. He returned to the faculty and headed a nationally recognized program in bioethics.
Vivian Pinn College: Dr. Pinn was both the only African American and the only woman in the UVA School of Medicine class of 1967. A pathologist and the recently retired director of the NIH’s Office of Research on Women’s Health, Dr. Pinn is also known as a firm advocate for women and underrepresented minorities in medicine.
Walter Reed College: In 1869, at age 18, Walter Reed became the youngest graduate of the School of Medicine. Reed joined the Army Medical Corps in 1875 and is most well known for leading the team that made the discovery that a mosquito was responsible for the transmission of yellow fever.
Our aim was to unify our educational and student support efforts utilizing the framework of learning communities. Using intentionally created groups that acknowledge the social context for learning, this program is enabling us to provide consistent, longitudinal oversight of clinical performance and professional development. These learning communities also foster continuous relationships with faculty and peers and encourage vertical integration of students for mentoring.
Student support services have been restructured into four colleges. Each is headed by a Dean for Student Affairs who works with individual students and the college as a whole to provide career counseling, address personal well-being, oversee academic progress, identify professionalism concerns, and advocate for students in all aspects of their medical education. The Deans organize and oversee major events and transitions. They place the white coats on their students during the first week of medical school and hood the students in their college at graduation.
In our “Next Generation” curriculum, we have committed to a four-year course of Clinical Performance Development (CPD). In the first 18 months six-member student groups meet weekly with two mentors, one physician and one non-physician, in order to learn fundamental clinical skills, interview and examine patients, and work through cases together. We have laid the foundation for our hybrid learning communities by forming each college from 6 or 7 of these small groups. In this way, the small group mentors become college affiliated faculty and are encouraged to identify and communicate concerns directly to the Deans thereby providing broader support for students as well as longitudinal oversight of each student’s clinical development. The CPD mentors start with a new small group every other year.
Each college now rotates through the clerkship year on the same schedule. This facilitates group and individual meetings with the Deans, allows delivery of a cohesive clerkship year curriculum to be learned within the CPD groups, simplifies faculty feedback to the Deans, and enhances supervision of clinical skill development by the CPD mentors. In addition, students continue their relationships with their peers as they function together in patient care settings.
In the post-clerkship period, the CPD mentors continue to monitor professional and skill development and will be integral as we address competencies and entrustable professional activities of students. The Deans and CPD mentors together work with students to address any concerns. Plans are evolving to have each CPD group carry out a quality improvement project and to have fourth year students participate in teaching their mentor’s second year small group as another opportunity for vertical college integration.
- Associate Dean for Admissions and Student Affairs, Dean of Hunter College: John Densmore MD, PhD
- Assistant Dean for Student Affairs, Dean of Reed College: Rasheed Balogun MD
- Assistant Dean for Student Affairs, Dean of Dunglison College: Meg Keeley MD
- Assistant Dean for Student Affairs, Dean of Pinn College: Christine Peterson MD
- Director, Clinical Performance Development: Nancy McDaniel MD
- Director, Clinical Performance Development-1: James Moak MD
- Director, Clinical Performance Development-2: Linda Waggoner-Fountain MD, MEd
- Director, Clinical Performance Development-3: Meg Keeley MD
- Program Manager, Clinical Performance Development: Eva Casola MBA
Dunglison College Mentors:Ashley Blurton MD Jennifer Beard PhD Earl Bracker MD Karen Knight MSLS Tabor Flickinger MD Ruby Ford MSN RN Sim Galazka MD Evangeline Calland MTS Owen Hendley MD Ellen Longmoore D Min Jennifer Kirby MD Richard Fontaine MBA Chuck Thornsvard MD Hillary Barry MS Roger Burket MD Morgan Taylor MSW Thomas Hartka MD Kristen Heinan MD James Moak MD Christina Leftwich BSN Ionut Mosteanu MD Tonya Showalter RN Rahul Mehta MD Ellen Longmoore D Min Hunter College Mentors: Joe Chance MD Marie Perucci-Bailey RPh Lisa Christianson MD Richard Fontaine MBA Mark Mendelsohn MD Kim Mechling RN James Moak MD Tonya Showalter CEN Van Nguyen MD Jeffrey Ciucias RN Brian Uthlaut Anne Fishwick RN Alan Binder MD Judith Sanford RN Matthew Goodman MD Elizabeth Bradley PhD Diane Pappas MD Evangaline Calland MTS Margaret Plews-Ogan MD Annemarie Clemente LCSW Robert Reiser MD Joseph Moffett RN Lara Veber, MD Elizabeth Glover SLP Andrew Wolf MD Yvonne Newberry FNP-BC
Pinn College Mentors:Jamison Bourque MD Judi Sanford RN Megan Bray MD Eugene Locke D Min Lein Dame MD Julie Pitti Med Ira Helenius MD Deborah Childs RN Erik Hewlett MD Carolyn Engelhard MPA Mohan Nadkarni MD Elizabeth Jaeger-Landis ACNP Theresa Schlager MD Elizabeth Lyons MD Nancy McDaniel M Moses Woode PhD Glenn Moulder MD Jacqueline Salaway MSW Mary Preston MD Joel Schectman MD Donna White, RPh Claudia Sussdorf, MD
Reed College Mentors:Heather Streich MD Mary Stack FNP Sue McCoy MD Ian Marks PA Chris Moore MD Mildred Best M DIv Kenneth Ballew MD Barbara Maling NP Ben Sneed MD Ina Stephens MD Moses Woode MD Joshua Barclay, MD Kevin Boyd M Div Eve Bargmann MD Gordon Putnam M Div Blake Garmon MD Miriam Halpern MD Karen Boyle BSN Martha Hellems MD Sean Reed MD Jonathan Schorling MD Elizabeth Jaeger-Landis ACNP
- Big Sib/Families vertical integration of student mentoring organized by colleges
- Iron Med Fitness program with college affiliation competition
- Classroom review activities with college affiliation competition
- Summer opportunities and career counseling organized by colleges
- Events: Orientation, Field Day, Gateway Dinner, White Coat Ceremony, Family Day, Summer Opportunities, Summer Send Off, Transition Course, Student Clinician Ceremony, Reception with the Dean, Match Day, Graduation
- Keeley M, “Longitudinal and Multifaceted Support: The Evolution of Learning Communities at the University of Virginia School of Medicine” Harvard Macy Institute Innovations Poster Session, Association of American Medical Colleges Annual Meeting, Philadelphia, PA, November 4, 2013
- Keeley M, “Learning Communities in the Clerkship Year”, Platform Presentation, Learning Communities Institute Annual Meeting, Philadelphia, PA, November 1, 2013
- Keeley M, Peterson C, “Longitudinal and Multi-Faceted Support: The Evolution of Hybrid Learning Communities at the University of Virginia” Learning Communities Institute Annual Meeting, Platform presentation, Palo Alto, CA, November 3, 2012
- Students and faculty have responded very positively to the innovation. Both find continued relationships with their learning community on the clerkships rewarding and supportive. Communication among mentors and Deans has been enhanced.
- Students in learning communities describe faculty as more accessible, feel an increased sense of community, and place increased value on relationships and activities with classmates and faculty members.
- This hybrid learning community model provides longitudinal support across domains. Oversight of skill development, vertical integration of peer mentoring and individualized student support from white coat ceremony at orientation to hooding at graduation has enhanced and helped to guide the medical school experience.
- The challenges have been to generate acceptance of the learning community concept and to develop expectations for four-year faculty mentoring of clinical skill development as well as to ensure appropriate support for teaching time and faculty development.