Undergraduate Medical Education for the 21st Century: A Demonstration of Curriculum Innovation to Keep Pace with the Changing Health Care Environment (UME-21)

William Howard Markle M. D. - Project Co-Director

The Community/Ambulatory Medicine Initiative at the University of Pittsburgh School of Medicine (UPSOM) is a longitudinal program which integrates learning in community and ambulatory settings across all four years of the medical student curriculum. The keystone of this initiative is the Community/Ambulatory Medicine Clerkship (CAMC), an innovative, multidisciplinary, integrated 12 week rotation required for all third year medical students. The CAMC will help students achieve a comprehensive understanding of how to deliver high quality, primary health care to individuals and populations, including underserved and special populations, in a changing environment. UPSOM requests funding to support the implementation of the CAMC.

UPSOM, along with its community and health care delivery partners, will implement a curriculum consisting of three integrated components: an experiential component, a didactic component, and an evaluation component. Participation in patient care in the three core primary care disciplines - Family Medicine, General Internal Medicine, and General Pediatrics - will anchor learning for the experiential component (72 half-days). In addition, to complement the core experience, each student will select a longitudinal experience for one or two half-days per week, with the same physician, in adult medicine, pediatric medicine, or other area (e.g., geriatrics, adolescent medicine, women's health). Didactic sessions (e.g., epidemiology, public health, decision making, informatics, evidence-based medicine, health care delivery organization and finance, quality improvement, preventive medicine, behavioral medicine, immunization, nutrition, and others) will augment experiential learning, while time spent in the clinical environment will make didactic sessions relevant. The evaluation component will include formative and summative assessments of students, faculty and sites.

The CAMC will be an integrated component of a newly reorganized third year curriculum, and thus will not be hampered by the difficulties of integrating a new segment into an old program. It will be the longest third year clerkship.

UPSOM is an LCME accredited school with a Department of Family Medicine; a Division of General Internal Medicine (within the Department of Medicine); and a Division of General Pediatrics (within the Department of Pediatrics). The CAMC director will be chosen from one of these units and a co-director will be chosen from each of the other two units. A broad based Multidisciplinary Clerkship Committee will superintend the clerkship.

The CAMC is an innovative educational program which integrates core and longitudinal primary care experiences, didactic sessions, and an evaluation component. Students will benefit as they learn patient-centered, multidisciplinary, cost-effective primary care to prepare them for future practice in community and ambulatory settings. Health professions educators at UPSOM and other schools will benefit from the challenges, successes, and lessons learned as a result of implementing this curricular model.