• Jed Gonzalo, MD, MSc
    Senior Associate Dean, Medical Education
    Professor, Internal Medicine and Health Systems & Implementation Science, VTCSOM


Upon completion of this activity, participants will be able to:

  • Explain the social accountability framework for academic medicine.
  • Illustrate several different pedagogical approaches to pre-clerkship curriculum used in both the US and Canada (inclusive of the patient case presentation model).
  • Describe the approach to curricular change and evolution at VTCSOM.
  • Highlight the future work in Phase 2-3 of the curriculum.

*The Medical Society of Virginia is a member of the Southern States CME Collaborative, an ACCME Recognized Accreditor.
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Southern States CME Collaborative (SSCC) through the joint providership of Carilion Clinic's CME Program and Carilion Clinic Office of Continuing Professional Development. Carilion Clinic's CME Program is accredited by the SSCC to provide continuing medical education for physicians. Carilion Clinic's CME Program designates this enduring material activity for a maximum of 1 AMA PRA Category 1 CreditTM
Physicians should claim only the credit commensurate with the extent of their participation in the activity.

And thank you Sherry thank you to the team for setting this up and um thanks everybody for joining so it's a it's a pleasure to be here and being asked to provide some of the updates on the curriculum which I'm excited about I know um the educators are extremely excited about it as well so the time is really yours so if you have questions get it in the chat Sher is helping with the chat just in case I can't see it or just interrupt me because I'm more focused on helping everybody understand about the curricular changes than um even some of the covering content if you will so so I came up with the title honoring Our Heritage and forging forward into the future partly because I think when you go through curricular change you might be concerned about holding on to the identity of of a school or what's been in place and I think one of the most remarkable things about VTC has been the past the origin story of the school itself um this is a picture um when I came here Dr Paul Dallas was helping me we communicated several times about the origin of the school and I think he or somebody sent me this picture and he was walking me through the the story this is the early 2000s of the whole plot of land on on where the school sits now there's a there was a tire plant and I think a flower factory and uh a flooring a set of flooring stores and tile it's just a remarkable story at least for me to think about in such a short amount of time what's happened with the school of medicine that I think we're all proud of um and there's a lot of features of the school of medicine the values the the focus on the curriculum that um will remain I think even when I was applying for the job several years ago there was a lot of tenants on the origin of the school that I thought was preent on where medical education needed to be in 2024 and 2034 and 2044 so um many of those facets and features you will see remain in the curriculum so I will talk about some of the evolutionary um changes that will be happening here so here's the objectives I do want to start with the social accountability framework um this is something that I I kind of view in medical education um through my set of lenses when you're going through curriculum change well illustrates several pedagogical approaches to pre-clerkship curriculum as one example when we go through several of the changes I'll highlight four changes going on in the curriculum even though there's many more just trying to highlight the big ones um describe the approach of the curricular change I'll just comment on our our processes that we've put in place all the way up to this point and I'll just briefly highlight the work of phase two phase three the goal of this talk is is I think more focused there's probably 17 talks you can give about all the facets this is more of a 20 to 30,000 foot view I do want to comment if we're just going to the balcony if you will on The Talk itself there's several education Frameworks and um Concepts that I'll allude to I'm not going to do Deep dive into but underlying all of the steps and almost all the slides are strategic planning and change management Frameworks the idea of Education scans which have been in the literature for a number of years you'll you'll see the education and guiding principles which comes from a a science-based key driver diagrams and some of the key presentation model so I just ask you to look for these um these Frameworks as they come up because a lot of the slides I'll present are based upon these education science principles and Frameworks before I get started though I I want to just highlight the fact I don't have a several slides to identify all the individuals who have been involved in this process so I'm just going to say it out loud up front there has been so many people who are leading this change for the past um year and a half two years it's just an amazing Community to be in to be leading these changes so I don't want to leave anybody out but just know many of them are on the call I can see the names on here and many of them are not so I just want to acknowledge the great work that's been going on from so many of our leaders at the school of medicine so I want to start with the social accountability framework again this is kind of how I um look at any change going on in medical education I've listed several of the the challenges if you will there are many more than these but just this is just several of the few Workforce shortages um not only for physicians in Virginia the country of the world but also for Health Professions uh pas nurse practitioners therapists that that potentially impact Virginia and the Commonwealth more so than other states Virginia is one of the kind of in the middle to the upper um percentiles for net next net exporter for uh Physicians they come to Virginia to train and then most of the time that they leave comparatively to other um States and that creates unique challenges for us medical student Recruitment and debt in addition to other medical student factors impact specialty Choice impacts the number of underrepresented Medicine Physicians we have across Specialties most underrepresented medicine physicians are entering primary care or non-surgical or medical subsp specialty based uh Fields it impacts the location of practice practice uh those who are in research careers typically come physician research careers come from more urban areas and end up practicing in more urban uh areas which when you think about our land grant Mission um premise that we have for Virginia Tech we got to think about the the Virginia and those in Southwest Virginia graduate skills for current and future practice Beyond medical knowledge has been increasing calls the past several decades to be thinking about the skills of of what's happening in practice some of which maps to health system science many of which map to clinical reasoning and systems thinking and other higher order skills and a lot of what we do in medical education we have to be thinking about the time La our students who come in in a month will be in independent practice in 2031 and that imprinting that to gme transition matters tremendously for what they'll take into their careers which hopefully will last 30 40 plus years and of course patient Health outcomes these are the the variables that we need to be considering as we think about the curriculum in our education programs which really channels into the quintuple aim I we've seen the evolution of the triple aim to the quadruple aim about eight or 10 years ago now into the quintuple aim of meeting the needs of of patients populations Equity costs and provider team well-being the social accountability framework was founded by Charles Bolan in The Who and I I just condensed it down into one table um because I think it's remarkably helpful to think about this before we get into the curricular change there's different layers typically moves from left to right responsibility to responsiveness to accountability and our goals we need to be trying to push as far as we can into the accountability column this can apply to research clinical operations and education for the purposes of this it's education so if you think about our objectives for the curriculum the quality of our graduates the focus of evaluation assessors we want to be pushing all the way as far as we can get to the right because that's what our our accountability is to the public so for example the focus of evaluation our Focus shouldn't be on process number of hours in a classroom it should be on outcomes or the impact on patient health so how do we move our educational program objectives and our assessments all the way as far as we can get it to the right quality of our graduates we can have great match great matches I mean we all want great matches our students want really great matches we also want them to be change agents be really good practitioners but also change agents in that Health System to help it evolve to meet the needs of patients that is what an accountable medical school and integrated academic Health System would do so I just put this here as an initial frame to be thinking about the changes that um I'll be describing here in the next few slides so as everybody I think everybody knows we began as a med school in 2008 first students came in in 2010 we've had tremendous success by and large our curricular approach has remained consistent Med schools typically undergo curricular revisions every 6 to8 years to adapt to the evolving needs as social accountability lands educational science principles so we have been due for this evolutionary pivot and shift and I think thinking through the change process that we've been through nearly every person or educator that I've interacted with over the past two years has seen a need for this Evolution which has been a really positive thing for the school in addition the lcme requirements 50% of the policies and requirements for our 2026 review are new compared to our 2018 review so when I talk about some of the changes you'll see the alignment and the need to be doing it for lcme so our primary needs you can read them at the bottom here LC requirements alignment I'm trying to help our Learners get into the clinical space earlier and moving towards the shift of Competency Based medical education that process to outcome impact on the social accountability spectrum is what we're really trying to do with Competency Based medical education so our strategic planning approach I just want to highlight that we did use an approach prior to starting this work um I want to acknowledge Dr Emy Holt Forest who is the co- facilitator in this strategic planning process well over a year and a half ago so we use the dobs and dobs model there's many other models that you can use for strategic planning and most of them culminate in what you see here a common fact base quantitative and qualitative data that is being channeled into strategic initiatives so what kind of data did we use to build that common fact base we did 60 plus oneon-one interviews with key stakeholders there was a series of clerkship creativity meetings and swad analyses Dr Paulie and Dr lman was leading this charge even before I came two years ago then I came and we were able to continue that work and Caitlyn Basset and Brock mches helped create some unified swats for the clinical phases which were tremendously helpful in our processes we did two education scans this is the process whereby you do a set of interviews we did it with 11 and 12 schools on phase one and six or seven medical schools and you get real time snapshots of the core areas that you want to look at to see how they are evolving what are the strategies that they use these were tremendously helpful we did a strategic planning survey with the with the broader Community several hundred people we had hundreds of hours of strategic planning committee dis discussions and then we built a number of data reports to inform this common fact base here's just several examples we we really analyzed hard the dou AMC year two questionnaire as well as the graduation questionnaire all the curriculum EV valves we built a graduate profile for Specialties we came up with a process for work hours reporting and then our competency reports and what our outcomes were and we also assess what is not present many times you assess for what is in place but then you also have to look for what's not available or not in existence that's really needed for the Strategic initiatives and that process was also helpful as we created our our next steps we had over 300 people involved in that uh process which is a remarkable thing I believe for Killian Clinic Virginia Tech Killian so here's our overview our 30 to 40,000 foot overview we built this back in November of 2022 we mapped it out and maybe surprisingly I'm not sure it we really remained the same um all the way to current day and we broke it up into teams and um I'm sorry committees and task forces the Committees are in green committees typically last they're not focused they don't disband after after a focused area of time but our task forces were in purple and we had those um task forces focused on specific areas that came out of our common data model holistic assessments phase one restructure phase two phase three faculty identity and fund support and professional identity um which is really about conscientious behaviors and raising the bar for professionalism and excellence in the medical school and then we put these into motion to operationalize all of these revisions and you pull this bar on where we are we have come a very far away credit to everybody who is leading the teams and the Committees and the task forces and knows doing the hard work but we're almost there we're just over a month uh for this launch you can see the phases at the very bottom of the slide that articulate the the the change and strategic planning processes and now we're very much in the implementation phase even though we're still building a number of things after phase one anything in the chat Sherry that I wanted to just highlight the collaborative processes we had in the strategic planning process that was evidence-based but anything I can answer to this point nothing is in the chat right now but folks feel free to unmute yourselves and make any comments uh questions concerns think you can probably go ahead J all right everybody keep them coming though all right so how did this culminate our in our action plans let me just check that chat yeah okay so our primary goals I just want to start here and I when I have thought about our goals of the curriculum my mind frequently has gone to the Cruis Cruis model and I'm just showing a figure from this um citation traditionally in medical education the competency base the nose knows how shows and does ended up being the peak of that pyramid like we want our Learners to be perform performing and acting in a in the in the profession of Medicine with certain competencies but creu and crew has modified The Miller's pyramid to culminate at the Apex with identity what is the professional identity that really pulls together the knowledge attitude skills and behaviors into how one views their role as a position in our context so really there are primary goals and this came out of the strategic planning process so we're focused on what are the BTC and professional identity so I'll walk through um these three synergistic identities of course we have the patient- centered physician in in the middle which will will should never go away the idea of a physician with an individual patient with the clinical reasoning to help them Reach their best outcomes but how do we supplement that in a synergistic way these other professional identities the first is a scientist physician The Physician who has the ability to integrate the clinical medicine and scientific inquir and research bridging the gap between bench sciences and direct patient care this has been part of our DNA as a medical school since the beginning it was that you see the documents back in 2010 commenting on the scientist physician which really comes from the work of of gme the gme space all the way back to the 1890s I mean this has been one of the the foundational ideal goals of medicine and medical education is to be developing the scientist physician to take this inquiry driven approach and applying it in the practice practice the second is the system citizen The Physician leader who uses a systems thinking mindset in their role to develop the Knowledge and Skills necessary to contribute to the holistic needs of patients populations and Health Systems the system citizen is one who understands the the numerous social determinants of Health in the patients context factors them into their reasoning to come up with the best most most stop plan for those patients the system citizen knows that they need to be knowledgeable about p patient safety gaps and quality needs within the micro system or the misos system and they are a citizen of this larger context that is interprofessional that is a an interprofessional um clinical environment and we have been set up for this with our health system science and interprofessional practice domain um since the beginning it has evolved over those years but it culminates in this system citizen IDE identity and the last is the lifelong Master adaptive learner The Physician who possesses skills and qualities related to learning adaptability ability to thrive in changing environments and ongoing personal and professional development it's idea that no one individual can know it all that there are resources available to us that we need the critical reasoning and and systems thinking skills to be brought to that interaction to be brought to the profession but we need to be committed to lifelong learning because things are going to evolve and information changes on a daily basis so these are our primary goals of the curriculum and the the education program channeled towards these identities so how do we get there I wanted to comment on The Guiding or operating principles um that exist for all of our design phases next I'm going to get to what the changes are but the guiding principles is kind of like I have these pictures on the right of a roadway that gets you straight up into a compass to your Nord star so we know where we want to go we want to go to these professional identities as our outcomes and all the core competencies which I'll talk about in the the educational program objectives in a few minutes but you get there through this roadway and the roadway the best most efficient way to get there is to stay on the road you don't want to be driving off into this field to the left or right so your guiding principles are what keeps you in that roadway to get directly where you want to go ideally to that North Star so they give you your bumpers by which you are designing and implementing any of the curricular changes so I'm going to comment on just several of the guiding principles all of which are aligned with educational science principles I.E those principles that have been identified in the literature that are um evidence-based and some would consider best practice so this is specifically for phase one so we wanted the curriculum to promote skills required for those professional identities we wanted to move Beyond medical knowledge and be thinking about these higher order behaviors and skills the foundation of the curric ular weeks would be focused on patient presentations so if one of our goals is the clinically based professional identities we wanted to make sure the curriculum was designed in a way to be focused on patients and how they are presenting to clinics and operating rooms emergency rooms curricular integration will occur horizontally and vertically horizontal integration is the the integration across your different curricular areas at any one point in time and vertical integration is occurring over that time frame from year one to year two to year three and year four we wanted a holistic integration of the curriculum this is going to take years to fully accomplish but it is one of our guiding principles the curriculum integration would be interdisciplinary and it would spiral Concepts across the phases ensuring appropriate space repetition so that means you might have the oneone bit on on a core concept occurring within the first two months of medical school then it's being Revisited in in the second semester and it's being Revisited in the third and then it's revisit visited again within the clinical clerkship phase learning needs Drive course design and pedagogy versus fixed curricular time instead of saying just generally hey we have four hours what can we do in four hours it's really how do we design our learning needs and what they are and then you design what happens in that space and time and that's what drives the time that it takes to do it rather than in reverse and then the complexity of learning will increase progressively between curricular units to transfer knowledge and prepare for those transitions transitions are so critical and if you were in our many of you are but if you haven't been in our planning meetings we talk frequently about the transition from year one to year two into the clerkship into the AIS and into internship so the complexity of learning needs to be spaced and incremental so as an example if you have an assessment in a clinical clerkship on histories interview skills and clinical reasoning then it should be incremental as you enter your acting inter internship or your elective that the complexity is increasing the expectations of those assessments should be higher at that later time Point curricular delivery would be grounded in learning methods that promote higher order reasoning when we did an assessment Dr Meson did an assessment on the knowledge based 60 to 65% of our assessments were knowledge based we probably want to balance a bit more with these other behaviors and skills so the learning methods need to align with where those high order reasoning pieces are and then learner advancement will be progressively assessed with formative low stakes and high Stak summatives meaning that we don't want all grades summi of Assessments at the end we want to blend with formative feedback low stake summative and high stake summative and I think we've got a good plan in place for that and then we will seek student perspective about learning approaches and Improvement areas and this is an area that we have focused hard on when I acknowledge Emily H Forest again for her work and the team for working with Learners we have a student consult group students have been involved in a strategic strategic planning process which has been very helpful so these are a subset of our guiding principles that guide the changes you're going to see in the next few slides anything I can clarify here before I dive into those changes feel free to unmute yourselves nothing in the chat right now or type it in there okay let me know if anything comes up so I'm going to walk through several of the the key changes I think I have four on the list there's many more but I'm just highlighting the Salient ones for the broader Community here um I'm starting with a a onepage handout back in late August we wanted to make sure that we were communicating with our applicant about what the core changes were it was pretty challenging actually to present at the MMI days or interview days about the curriculum because we were in build mode for nine months so we made it we made the the overarching document that at least showed where the main changes were coming so you can see the goals on the left alignment integration I mean essentially you just saw them in the guiding principles our changes live in the middle column reduction of phase one class hours I'll talk about in a minute shortening of phase one promoting a new phase three and holistic assessments but on the right is what's unchanged when we were going through strategic planning it was pretty clear that um particularly from the students that what they care most about is this small group learning this community small group Community Based feel and the close student faculty interactions so we wanted that to stay problem based learning has been 60% give or take of medical schools in the country have pbl people value pbl it's been a a great means for learning so that if anything we have doubled down on pbl um in a very good way dedication to research inquiry and longitudinal Mentor research projects all of the all of our students get a certificate and translational research that is going nowhere um in we're trying to accentuate and enhance what we're doing in that research area and all of our value domains remain intact so here here's number one of four I'll highlight is the three-phase model of the curriculum so here's what we currently have in place is a two-phase model I have ms1 MS2 years mapped out from left to right phase one has been in blue and phase two has been in Orange it's been essentially this way since 2010 um what nearly every medical school has done has transition to a phase three three phase model or a four phase model I believe some are five phase we have created the template for implementation for a three-phase model so that phase one in blue essentially takes us up to um currently it's going to be February of of next uh Academic Year but it's a shortening of that phase one from May up until February phase two the clinical clerkships remain essentially unchanged for time and then we name it this green s set um halfway through ms3 year through the ms4 is a new phase three so we're it's kind of like a story or a narrative and the learner's Journey are now better reflected in the phases phase one is that pre-clerkship phase two clerkship and then phase three the career exploration into the residency into advancing skills through AIS and electives um through graduation and the rationale is here on the right um this gets our Learners into clinical learning environments with the which the Physicians and students were asking for significantly in the strategic planning it allows for C exploration earlier as you enter in April of that uh ms3 year um they're able to think about the acting internships and board study it allows us to integrate more vertically across the phases and then it opens up a lot of space for Pathways of learning this is one of the more aspirational pieces for the school of medicine but this type of model that we have now allows us to think about accelerated programs because the accelerator program if you do it in three years you're able to to in interdigitate or integrate those curricular areas across all the phases so we're excited about the canvas that this also allows us to do to be doing other educational opportunities so two to three-phase model and we have leadership now to reflect that um Dr Leslie lante is the phase one director director of found foundational science is Phase One Dr Aubrey Knight is the phase two director and Dr Christy Stewart is our phase three director all right change number two our phase one work hours probably one of the one that has been driven most by lcme um there's been Trends in in medical education for hours per per week the main Push by lcme has been to promote independent and self self-directed learning we have a lot of expectations at a medical school from the accreditation lens this demonstrate that we have created space for our Learners to have self-directed learning and we have also are able to assess their self-directed learning within the curriculum a lot of schools get cited for their work hours in in class hours per week so we had to kind of Norm ourselves so the graphs at the bottom our work hours in phase one across our blocks the blue are the in-class number of hours so you can see from block one through five we've averaged 26 to 28 and a half hours per week in class and several years ago Dr Andrew Binks and team Dr Jen Cleveland Dr Chris needen Dr Renee lir the whole team um modified what was happening in 5 six 7 and 8 you can see the work hours went down to 21 hours in class but those 26 to 28 and a half hours is over what would be expected in by lcme accreditation Center but also educational science principles so the estimate here was that when you look at our phase one length and our weekly hours we are probably in the 95th percentile for uh the size and scope of the phase one curriculum so our goal here in change number two is to get us closer to 22 hours per week we're probably averaging 20 hours I'll show you a weekly grid with some flexibility to flex up to 22 and maybe Flex down to 18 but it puts us right in the national mean or or maybe even higher than the national mean but closer to where um all the other schools are and where accreditation is requiring us to be any questions here on this one I can't see the chat no questions are in the chat currently anybody have any comments Reflections here okay I'm I might make one comment J just on the curricular hours it's um I think the approach you've taken to this is very wise because based on prior experience with the lcme they definitely have a strong expectation that we would be in that General range of 22 to 24 hours per week I I can recall a dozen years ago at my prior stop where I was the curriculum person that we had 23 to 24 hours per week and we were right on the edge in terms of the LC meets acceptance of that so we have to we definitely have to get down in that territory yeah thank you David I appreciate that comment um when I mentioned the Y 2 questionnaire before that's that's the survey that students get after their year two in the curriculum it's done by the double AMC one of the key findings from that was students we were double double the the national mean in what students were telling us about their work hours in phase one that they were essentially asking we too compressed it's too busy of a schedule for us in phase one so a lot of this also was driven by what the students were were saying not that we respond all the time to what students are saying but they also need time to process their learning um work in groups work independently have some time for those clinical immersions so it's lcme and also education based we have heard from schools though that were closer to 22 and 24 hours per week and they they can continue to get cited every year because it's still too high there's no gold standard you can't pull up an lcme stand David as you know you can't pull up a standard it's going to say you need to be below this number but you can talk to schools to see where they're getting sighted and there's a general um consensus to be closer to 20 all right this is change number three this is my heaviest slide in the in the slide set but I do want to provide some background into this clinical presentation curriculum model which we're doing a little bit of a blend but we're shifting into this model for the phase one curriculum so I'm just going to walk through the different models that have existed um all the way back to the 1870s 1880s starting with the discipline based curriculum model this is this was the model that was where you have a discipliner field say biochemistry and anatomy bacteriology and you have a a course that is specifically dedicated to that and it's primarily focused on knowledge and facts so it's based upon that discipline there were limitations to that so medical education evolved steadily into an organ based system curriculum um there was concern that the discipline base was disjointed it was fact based so how do we kind of integrate into these organ systems so pulmonary system C Cardiology renal and you integrate those disciplines around the the organ based system in many ways this was my curriculum I was in med school from 02 to 06 and I was was primarily a blend between between this one and the next but it was you had your renal block you had your Cardiology block there were struggles though in in the education literature finding for for Learners to integrate in their minds on on what practice is in the clinical setting for a for a physician you walk in you're you don't have Cardiology case Cardiology case Cardiology case all stemmed in a row so there was questions on whether or not the forward reasoning skills were being developed with strictly an organ based system so the problem based learning curriculum model originated in the 70s but it took off probably more in the 90s um in in a lot of medical schools I say upwards upwards of two-thirds of schools have a problem based learning curriculum with the goal of providing contextual focal points for Learning and enhancing that problem solving so a lot of good has come out from the literature on pbl I think that's why a lot of schools are are continuing on that path the challenges that have been identified are those with this forward approach to reasoning um this idea that when when when we're in clinic or in an operating room or whatever the clinical setting is for a physician we're thinking about the data that we're collecting creating our our hypotheses and our differentials and we're approaching it in a very forward manner into um through the illness script through the management script and into treatment plans the concern that some have about parts of pbl is that sometimes it promotes a backward reasoning you have a diagnosis of myocardial infarction and sometimes when students go into a clinical setting they're thinking about myocardial infarction and they're backwards in a backwards manner saying hey do we have radiation down the arm is it is it typical chest pain and we're trying to back fit from the diagnosis not to say that that shouldn't happen in normal reasoning but it needs also be balanced with the forward reasoning approach and that's where the clinical presentation curriculum model which originated out of Calgary about being able to balance a lot of the good from pbl while also promoting forward reasoning into the clinical scenario so I'm going to comment a little bit more in the clinical presentation model next but our goals have been blend pbl with the clinical presentation model so we've had pbl since we started we're pulling it more into this patient frame using pbl to think about our weeks through patient presentation which I'm going to show you on the next slide so that means you create your list of clinical presentations your signs and symptoms and then you backwards design the curriculum to meet those clinical presentations so here's here's what I shared with a slide I shared with our applicants as they came in you can have patients that present to the clinical setting with any one of these signs or symptoms so let's take one of dizziness so how would you design a week around this this clinical presentation of dizziness you present the case of dizziness and then your Core Concepts to learn that that the Education team has identified or Society has identified or the literature has identified as Core Concepts that are critical to understand and forward reason through dizziness so the examples might be adverse effects and toxicity of medications cranial nerve exams Etc and then there's also a differential diagnosis that is underlying that dizziness um Pres presentation so it's a backwards design based upon how patients are presenting to the clinic or whatever clinical setting they're presenting to that means you have to have your your road map of your presentations what are those signs and symptoms that are coming that end up into the curricular design so we made our list of btcs so we ended up with 55 many meals have their own model some have 220 some have 40 um some have other numbers we landed on 55 and this will probably change over the years but we try to make sure our case presentations were informed by health conditions encountered in Southwest Virginia we looked at our community health needs assessment we looked at a lot of the Community Health Data of Southwest Virginia to ensure that the diagnoses that underly these signs and symptoms were being experienced by the patients that our our students are will encounter in clinics in their lace um encounters or their clinical workshops so here's our 55 these are signs or symptoms what you don't see are the differentials the differentials live in a in the next tier behind this um a lot of these and the differentials we again pulled from the top 15 cause of death in Southwest Virginia the Appalachian diseases of the spear um which we are on the border of a Appalachia um and those diseases are are prominent within our catchment area of of Southwest Virginia and a lot of them were on our vtcsom year 3 passport so our weeks are designed around these clinical case presentations mainly through a pbl means and the rest of the week is designed around on these so I'm going to close with um a fourth of four are strategies or or changes that are happening holistic and Blended assessment I just want to acknowledge Dr Brock mesen who's been awesome at leading the changes here that we have as we transition towards Competency Based medical education so our our current model um I had mentioned before about medical knowledge it's been medical knowledge heavy in our assessments and mainly summi of around grades and in clinical settings we have predominantly used Global assessments as our main assessment method but our evolved approach is more towards competency base and this is also going to take several years to be fully realized we're going to try to blend formative and summative assessments ments we're building a coaching program which I'll comment on in a minute very briefly um and intentionally developed assessments workplace based assessments that are designed around those outcomes that I started with in the social accountability framework how do you develop those assessments Implement them in the clinical space using Milestones using portfolios so big picture on this is we're trying to move from maintain the medical knowledge based board exam board prep for sure but also blend with the higher end of Miller's pyramid to those identities that we care most deeply about through those um behaviors and other core competencies the main Foundation of this has been our educational program objectives so JT if you don't mind um sharing it in the Box I wanted to just share with everybody um our curriculum committee approved educational program objectives um this slide is a is the overview the abstract if you will of what's in that document in case anybody wants to see what they are with more verbiage and narrative around it but these are educational program objectives you start with an educational program objective which is your overarching competency for the entire education program and then nested below them are subcompetencies so for example um domain one patient care or EPO is gathering essential accurate information and below that is two subcompetencies interview skills and physical and mental status exam and we have 21 educational program objectives and then 42 different sub competencies you can see them in the document what may be familiar to most are the domain names the these are the acgme core competency domains Patient Care Medical knowledge system based practice and a lot of the subcompetencies are taken from the harmonized milestones in the gme space probably 70 to 80% of what we have here actually comes from the GM space only frame shift that up for the um part of the Continuum in addition to others that we care deeply about that align with our identities so this is our outcomes this is really what we're aimed towards in the curriculum these are educational program objectives that gets us up Miller's pyramid to our identities so let me just provide one example I'm going to look at EPO 14 um subcompetency 27 so this is uh the reflective practice subcompetency the text is on the left in the learner or individual incorporates reflective practice and individualized pro Improvement plans and is committed to personal growth and and improving patient care so you have your subcompetency and then you have your driest levels of Milestones that map out level one level two level three level four and they go continually across time through med school and into res internship and residency and then we have to have assessments for these these different levels of reflective practice subcompetency 27 so we have these 21 epos lcme is going to be here they're going to say how you assessing these epos so that's what we're in the process of doing now ensuring that we don't have a process outcome of here's where we cover it in lecture here's where we cover it in the clerkship our job in Competency Based meta is to say look we care deeply about these and this is where we're assessing them in Phase One in phase two and in phase three so ideally the leers going on their professional growth Journey from left to right across these Milestones I'll stop there anything I can clarify I think I only have two more slides three more slides after this but anything I can clarify or if you have questions hey Dr Gonzalo um thank you for that synopsis so far it's a lot to uh to unpack um I was wondering a little bit about how you foresee the clinical faculty's role either changing or shifting um with all these new curriculum changes and and roll outs yeah Tyler I I appreciate that question I close with the slide for phase two phase three it's only one slide because if we were to play out the presentations ideally we this is really phase one so I think to answer that question directly for fa clinical faculty any clinical faculty who is in pbl is in the classroom in um our integrated foundational science course either leading a a lecture which we don't have a lot of or concept mapping exercises or is in lace our our longitude and ambulatory care experience which is now part of a larger course that's really the interface where I think it's going to impact the clinical faculty which probably is more limited than the phase 2 phase three which is going to come sequentially after after the phase one is implemented if that makes sense so I think for the clinical faculty to this point in the talk at least is awareness of we're really focus we're trying to enhance focus on skills and behaviors in that clinical space and providing Learners their opportunities as they work with our faculty Physicians to learn and practice these in everyday um practice but Tyler please respond to that did that answer it enough I I might I might be answering more of it in three slides yeah that that does answer I and I was curious yeah specifically about phase one because I know folks come in for guest lectures or workshops and things like that um and for those who aren't as familiar with skills like concept mapping or some of the other teaching techniques that that um the vtcm um s so faculty are trying to integrate um I guess I was curious about how those some of those skills will be t taught to you know physician faculty who don't have all the educational necessarily background yeah Tyler I appreciate that so I just fast forward I'll go back to the side I just hopped over this is a a weekly schematic um so everybody can see it I hope some of that Tyler can be um addressed here too so this is just one example week you can see the case presentation is listed up here this one happens to be around fatigue problem based learning re clearly remains as a as a a base of the whole week um Monday Tuesday Wednesday mapping it out you see the integrated foundational science course which is a new named course it's the basic in clinical Sciences being integrated we talked about horizontal integration and The Guiding principles this is that horizontal integration coming to life and a course that is now renamed integrated foundational Sciences so in there would be basic science L uh core learning Concepts um say potentially Monday morning where there's three or five Core Concepts basic in clinical science and Tuesday afternoon might be a dissection in the anatomy lab with a clinical science application um and then Thursday might be a clinical reasoning session which would include a concept map um potentially or another educational method that our Educators in basic and clinical Sciences are Dynamite they're so good um and it is truly a strength of our school so when I think tyot answer your question on that I think it's the brid bridging happens between the core educator um educational designer with the physician educator to be blending and meeting in the middle so the content expertise is being brought in by The Physician educator and then our lead educator is they're they're teaming to to deliver the best um educational method in that in that classroom you see the three gray um half boxes community and clinical immersion this is a a newly named course it combines boots on the ground which previously has lived in health system science and interprofessional practice and the lace experience all of the class outof classroom activities now is part of a unified course so a learner may be in their former lace experience on Tuesday morning that means that they don't fulfill the gray on Wednesday afternoon and Thursday afternoon it's essentially one of those three gray boxes if any that week research and inquiry stays um where it is some of the research and inquiry hours have gone down I mean those 27 hours on average down to 20 every different core value domain has had to become more lean and efficient and think critically about about which parts are absolutely core for phase one what can we do more in phase two so some of the Core Concepts now will be introduced in phase two in the next year or two and health system science and interprofessional practice remains our are patients coming into the classroom Dr Jen Cleveland I saw her on the call here she's a pbl co-director John Greenwald has done an amazing job too and they're teaming together in a great way and our our our patient wrap-ups remain we're going to modify a couple of them um our students gave us some feedback that said when when there's patients in the room every week sometimes there's a downtrend in engagement so it that that could be an opportunity now to modify just several of those weekly wrap wrap-ups to be more team based or to me professional medicine based but by and large the patient weekly wrap-ups will remain the same what can I clarify here on the schedule I think that clarification about the the gray blocks is really helpful there's that teeny tiny little writing down at the bottom of that third gray box it says no more than one gray block per week um that really helped with clarification thank sht okay let me go to this curricular schematic this is the I started with this on the treetop um just to see the overall snapshot on where we are and I'll highlight a few of the Salient features I'll just Orient everybody first here's that phase one starts the ms1 year runs across and then runs to about essentially halfway through that second year and then the phase two is this um maroon colored bar that takes us up into ms3 year and then step two study and then phase three is the orange so we're on designing and implementing kind of in sequence so phase one first and then we're going to go into phase two next and phase three next so I'm just going to highlight some of the salent pieces here so the first I'm pulling these black arrows is the professional medicine identities course this is a brand new course um Dr em H force is the the lead Dr Brock mches Leslie lante are are leading this this is really around those identities we talked about system citizen uh lifelong Master adaptive learner scientist physician there's a two- week immersion and then you see that orange bar run all the way across that orange bar in many ways is asynchronous it's happening through a new coaching program that we've been designing we have 17 or 18 um coaches now who have signed up to help us which is wonderful they'll have two to three um students and they'll be coaching them through their academic achievement and progress over time the second point I'll make is now we have five courses traditionally up until now we've had one Uber course everything was packaged into this one course now we have five discrete courses that are articulated through the through the registar um so that if you struggle if a student struggles in one of the courses but did well in the other ones and then their remediation and their work can happen if they have to retake a course for example they can retake that one course it allows us to create a little bit more definition around each of the courses that exist the next is that research and inquiry block we've had um blocks of research and inquiry in phase one and they remain you can see it in the early summer of ms1 year and this um MS2 research and inquiry block is moved up um a a bit into the fall so it's occurring at a earlier time zone and then it drives into that step one study which is right here which will be um in the winter break into January and into February and then they'll start the clerk ships and intercession I'm just highlighting this box because I saw Arthur on here earlier um who's been tremendously helpful in helping us think about um the clinical capacity this would be in February to May of 2026 we'll have our Learners who are one year head of this cohort stealing clerk ships and this group of Learners will be entering clerk ships at an earlier step in phase two because now we've shortened phase one by two to three months so there's a lot of complexity in here about the overlap of students in this in this Zone we might write will likely right size a little bit in the next year as it is becomes part of routine but that will be a challenging Zone uh for Virginia Tech Cilan kilan clinic at that time time point and then I'm highlighting the phase three rotations this frame shift of phase one up frame shifts it all up so now we have the acting internships iives career exploration that is happening now starting in April May and June which is a great time for our Learners to to figure out their specialty choices letters of recommendation Etc anything I can clarify here because I'm down the home stretch here I only have one more overarching slide but what can I answer what can I clarify for everybody Jed will there still be blocks of time protected in the third and fourth year for the students to work on their research projects yep that that will remain the same um the timing of that will be could modify as we get into the phase two phase 3 planning we have to get into an operational plan for phase two phase three um but the research the focus on Research remains well I'm just going to close out with this last slide this is the phase two phase three there's much more to be done I just want to show everybody the bird's eye view and what we're working on we made this last week this is a key driver diagram your outcomes are on your left and then you have your priority areas and you you traditionally have strategies I didn't include it on this slide but you can see where we're going in phase two phase three we have a lot of scheduling and capacity issues to figure out we have new curriculum programs including inter session weeks we're really looking hard at our cqi and integration processes got a whole bunch bunch of operations to figure out those holistic assessments and and all the educational program objectives that are in that document is much of which is really happening in the workplace so to Tyler's point I think that's that's where it's going to happen and hit the interface of the clerkships with our faculty customized Learning and Development I'm so excited about accelerated programs the the certificates and Masters that were set up to kind of build into which is an exciting piece for the school of medicine and our clerkship directors that last piece is as a community of practice identity we've got an amazing Cadre of clerkship directors who are fully engaged in the mission how can we help them grow as a community of practice to lead the next wave of change so I'm hoping I hit these learning objectives and you saw some of the education framework so please what questions do you have what can I clarify everybody and thank you to Sher and team for having me thank you Dr Gonzalo it's been very helpful to me at least folks what types of questions comments concerns any comments on the process I'll put out a comment real quick hey it's Arthur um having gone through two curriculum changes before leading one and being the member of another there's a certain amount of natural discomfort and that's okay okay and I really I thank Dr Gonzalo for not explaining what they're doing but why you get behind the why like there's a reason we're doing this we have a great curriculum we put out great students but we have to adapt and change for the reasons that Jed pointed out so yeah it's both you know we can be wow are really excited about this but yeah you know I kind of like how we did it before and that's real normal that's what I've seen in other places and if you've never gone through curriculum change before lucky you um but in the end it's always worth it on the backside you learn a lot and the students are the ones that benefit the most thank you Arthur thank you Dr Gonzalo this has been again very helpful I think uh it's important for you all to know um Dr Gonzalo is here for you uh Dr Emily H Forest Dr Brock Merson Dr uh Leslie lante all here just some of these core folks but there are so many people who have worked so hard to get these changes in place but they anytime I've asked them a question they they are very clear on it and um if they don't know the exact answer they will AB absolutely get clarification for you and really help they want us all to understand uh this isn't intended to be some some mysterious process everyone one wants us to be informed and understanding of what's going on and so that we can all be on the same page and help our Learners progress as intended thank you sh thank you Shar Elena do you have a question okay no right feel pre to reach out everybody enjoy the rest of your day and your week thank you for joining us.