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16 - Developing and implementing an undergraduate curriculum

from Part IV - Case studies in promoting professionalism and professional identity formation across the continuum

Published online by Cambridge University Press:  05 April 2016

By
Mark D. Holden ,
Era Buck  and
John Luk
Edited by
Richard L. Cruess ,
Sylvia R. Cruess  and
Yvonne Steinert
Mark D. Holden
Affiliation:
University of Texas Medical Branch, Galveston, Texas, USA
Era Buck
Affiliation:
University of Texas Medical Branch, Galveston, Texas, USA
John Luk
Affiliation:
University of Texas at Austin, Austin, Texas, USA
Richard L. Cruess
Affiliation:
McGill University, Montréal
Sylvia R. Cruess
Affiliation:
McGill University, Montréal
Yvonne Steinert
Affiliation:
McGill University, Montréal
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Summary

Texas has a reputation comparable to its size, for doing things in a big way and for being individualistic. This chapter presents a Texas-sized pilot study that includes six undergraduate institutions and four medical schools engaged in an initiative to transform medical education. A fundamental part of the transformation is the authentic integration of professional identity formation into premedical and undergraduate medical education.

Time initiative

In 2007, the University of Texas (UT) System launched Transformation in Medical Education (TIME), a broad initiative to redesign the continuum of premedical to undergraduate medical education. This ambitious project, funded by the UT Regents and championed by the Executive Vice Chancellor for Health Affairs, aimed to reform the content, methods, and timeline of the attainment of the medical degree, based on the belief that current methods are inefficient, outdated, and unnecessarily long and expensive. The TIME steering committee identified four foundational elements for the initiative: (1) instituting a pre-health-professions program; (2) implementing competency-based education; (3) incorporating nontraditional topics; and (4) intentionally focusing on professional identity formation.

Within the TIME initiative, six undergraduate campuses and four medical schools across the UT System created four pilot program partnerships. Each partnership included one to three undergraduate campuses and one or two medical schools, with the goal of developing and implementing a pilot that incorporates all four foundational elements. The heterogeneity of the partnerships and their pilots provided the opportunity to identify successful designs and strategies as well as lessons learned. This heterogeneity also extended to methods of student selection, number of institutions, curriculum design, and geographic spread, which ranges from eight to 800 miles between partner institutions.

As the first TIME initiative element, each undergraduate campus established a pre-health-professions program. By including students interested in a variety of health professions, these programs allow students to share experiences and learn collaboratively, with the goal of fostering teamwork and interprofessional professionalism. These programs also provide a structure for developing and managing educational activities and tracking student progress.

The second TIME initiative element, competency-based education, grew from the work of the Accreditation Council on Graduate Medical Education (ACGME) and the Royal College of Physicians and Surgeons of Canada to incorporate competency-based principles into postgraduate medical education.1,2 Undergraduate medical education has since adopted competency-based medical education, including the development of graduation competencies.

Type
Chapter
Information
Teaching Medical Professionalism
Supporting the Development of a Professional Identity
 , pp. 231 - 247
Publisher: Cambridge University Press
Print publication year: 2016

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References

1. Englander, R, Cameron, T, Ballard, AJ, Dodge, J, Bull, J, Aschenbrener, CA. Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Acad Med. 2013; 88(8):1088–94.Google Scholar
2. Frank, JR, Danoff, D. The CanMEDS initiative: implementing and outcomes-based framework of physician competencies. Med Teach. 2007; 29(7):642–47.Google Scholar
3. The University of Texas Professional Identity Formation Task Force. Galveston, TX: University of Texas Medical Branch; 2013. [Accessed Jan. 30, 2015.] Available from http://ar.utmb.edu/timepif/home.
4. Dyrbye, LN, Harper, W, Moutier, C, Durning, SJ, Power, DV, Massie, FS, Eacker, A, Thomas, MR, Satele, D, Sloan, JA, Shanafelt, TD. A multi-institutional study exploring the impact of positive mental health on medical students’ professionalism in an era of high burnout. Acad Med. 2012; 87(8):1024–31.Google Scholar
5. Holden, M, Buck, E, Clark, M, Szauter, K, Trumble, J. Professional identity formation in medical education: the convergence of multiple domains. HEC Forum. 2012; 24(4):245–55.Google Scholar
6. Inui, TS. A Flag in the Wind: Educating for Professionalism in Medicine. Washington, DC: Association of American Medical Colleges; 2003.
7. Cooke, M, Irby, DM, O'Brien, BC. Educating Physicians: A Call for Reform of Medical School and Residency. San Francisco, CA: Jossey-Bass; 2010.
8. Holden, MD, Buck, E, Luk, J, Ambriz, F, Boisaubin, EV, Clark, MA, Mihalic, AP, Sadler, JZ, Sapire, KJ, Spike, JP, Vince, A, Dalrymple, JL. Professional identity formation: creating a longitudinal framework through TIME (Transformation in Medical Education). Acad Med. 2015; 90(6):761–67.Google Scholar
9. The Pediatrics Milestone Working Group. The Pediatrics Milestone Project. Chicago, IL: Accreditation Council for Graduate Medical Education and the American Board of Pediatrics; 2012. [Accessed Jan. 27, 2015.] Available from www.acgme.org/acgmeweb/Portals/0/PDFs/Milestones/320_PedsMilestonesProject.pdf.
10. Hicks, PJ, Schumacher, DJ, Benson, BJ, Burke, AE, Englander, R, Guralnick, S, Ludwig, S, Carraccio, C. The Pediatrics Milestones: conceptual framework, guiding principles, and approach to development. J Grad Med Educ. 2010; 2(23):410–18.Google Scholar
11. Jarvis-Selinger, S, Pratt, DD, Regehr, G. Competency is not enough: integrating identity development into the medical education discourse. Acad Med. 2012; 87(9):1185–90.Google Scholar
12. Cruess, RL, Cruess, SR, Boudreau, JD, Snell, L, Steinert, Y. Reframing medical education to support professional identity formation. Acad Med. 2014; 89(11):1446–51.Google Scholar
13. Astin, AW. Student involvement: a development theory for higher education. J Coll Stud Dev. 1999; 40(5):518–29.Google Scholar
14. Speirs Neumeister, KL, Rinker, J. An emerging professional identity: influences on the achievement of high ability first-generation college females. Journal for the Education of the Gifted. 2006; 29(3):305–38.Google Scholar
15. Gyer, J. Development of Adolescent Identity Formation through Extracurricular Activities. Master's thesis. Dallas, TX: Southern Methodist University; 2014.
16. Albarracín, D, Wyer, RS Jr. The cognitive impact of past behavior: influences on beliefs, attitudes, and future behavioral decisions. J Pers Soc Psychol. 2000; 79(1):5–22.Google Scholar
17. Chávez, AF, Guido-DiBrito, F, Mallory, SL. Learning to value the “other”: a framework of individual diversity development. J Coll Stud Dev. 2003; 44(4):453–69.Google Scholar
18. Kegan, R. In Over Our Heads: The Mental Demands of Modern Life. Cambridge, MA: Harvard University Press; 1994.
19. Baxter Magolda, MB. Three elements of self-authorship. J Coll Stud Dev. 2008; 49(4):269–84.Google Scholar
20. Johnson, JL. Self-authorship in pharmacy education. Am J Pharm Educ. 2013; 77(4):69.Google Scholar
21. Nadelson, LS, McGuire, S, McAdams, K, Farid, A, Davis, K, Nagarajan, R, Wang, S, Kaiser, U, Hsu, Y-C. Am I a STEM Professional? Self-Authorship and Student Professional Identity Development. Poster presentation. NSF Improving the Undergraduate STEM Experience Conference. Washington, DC: National Academy of Sciences; 2014. [Accessed Jan. 30, 2015.] Available from http://stem.boisestate.edu/wp-content/uploads/2014/02/SA-and-LP-Poster.pdf.
22. Naudé, L. On (un)common ground: transforming from dissonance to commitment in a service learning class. J Coll Stud Dev. 2015; 56(1):84–102.Google Scholar
23. Moss, JM, Gibson, DM, Dollarhide, CT. Professional identity development: a grounded theory of transformational tasks of counselors. J Couns Dev. 2014; 92(1):3–12.Google Scholar
24. Ryynänen, K. Constructing Physician's Professional Identity – Explorations of Students’ Critical Experiences in Medical Education. Helsinki, FI: Oulu University Press; 2001.
25. Goldie, J. The formation of professional identity in medical students: considerations for educators. Med Teach. 2012; 34(9):e641–e648.Google Scholar
26. Graungaard, AH, Andersen, JS. Meeting real patients: a qualitative study of medical students’ experiences of early patient contact. Educ Prim Care. 2014; 25(3):132–39.Google Scholar
27. Phillips, D, Fawns, R, Hayes, B. From personal reflection to social positioning: the development of a transformational model of professional education in midwifery. Nurs Inq. 2002; 9(4):239–49.Google Scholar
28. Wald, HS, Borkan, JM, Taylor, JS, Anthony, D, Reis, SP. Fostering and evaluating reflective capacity in medical education: developing the REFLECT rubric for assessing reflective writing. Acad Med. 2012; 87(1):41–50.Google Scholar
29. Niemi, PM. Medical students’ professional identity: self-reflection during the preclinical years. Med Educ. 1997; 31(6):408–15.Google Scholar
30. Mann, K, Gordon, J, MacLeod, A. Reflection and reflective practice in health professions education: a systemic review. Adv Health Sci Educ Theory Pract. 2009; 14(4):595–621.Google Scholar
31. Thompson, BM, Teal, CR, Rogers, JC, Paterniti, DA, Haidet, P. Ideals, activities, dissonance, and processing: a conceptual model to guide educators’ efforts to stimulate student reflection. Acad Med. 2010; 85(5):902–08.Google Scholar
32. Shapiro, J, Kasman, D, Shafer, A. Words and wards: a model of reflective writing and its uses in medical education. J Med Humanit. 2006; 27(4):231–44.Google Scholar
33. Nothnagle, M, Reis, S, Goldman, RE, Anandarajah, G. Fostering professional formation in residency: development and evaluation of the “forum” seminar series. Teach Learn Med. 2014; 26(3);230–38.Google Scholar
34. Song, P, Stewart, R. Reflective writing in medical education. Med Teach. 2012; 34(11):955–56.Google Scholar
35. Travers, CJ, Morisano, D, Locke, EA. Self-reflection, growth goals, and academic outcomes: a qualitative study. Br J Educ Psychol. 2015; 85(2):224–41.Google Scholar
36. Noble, C, O'Brien, M, Coombes, I, Shaw, PN, Nissen, L, Clavarino, A. Becoming a pharmacist: students’ perception of their curricular experience and professional identity formation. Curr Pharm Teach Learn. 2014; 6(3):327–39.Google Scholar
37. Verghese, A. Bedside Manners. Austin, TX: Texas Monthly; Feb. 2007. [Accessed Jan. 30, 2015]. Available from www.texasmonthly.com/content/bedside-manners.
38. Shivji, FS, Ramoutar, DN, Bailey, C, Hunter, JB. Improving communication with primary care to ensure patient safety post-hospital discharge. Br J Hosp Med (Lond). 2015; 76(1):46–49.Google Scholar
39. Scalise, D. Clinical communication and patient safety. Hosp Health News. 2006; 80(8):49–54.Google Scholar
40. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 587: effective patient-physician communication. Obstet Gynecol. 2014; 123(2 Pt 1):389–93.
41. Travaline, JM, Ruchinskas, R, D'Alonzo, GE Jr. Patient-physician communication: why and how. J Am Osteopath Assoc. 2005; 105(1):13–18.Google Scholar
42. Eisenberg, A, Rosenthal, S, Schlussel, YR. Medicine as a performing art: what we can learn about empathic communication from theater arts. Acad Med. 2015; 90(3):272–76.Google Scholar
43. Mills, JKA, Dalleywater, WJ, Tischler, V. An assessment of student satisfaction with peer teaching of clinical communication skills. BMC Med Educ. 2014; 14:217.Google Scholar
44. Konkin, J, Suddards, C. Creating stories to live by: caring and professional identity formation in a longitudinal integrated clerkship. Adv Health Sci Educ Theory Pract. 2012; 17(4):585–96.Google Scholar
45. Roh, H, Park, SJ, Kim, T. Patient safety education to change medical students’ attitudes and sense of responsibility. Med Teach. 2015; 37(10):908–14.Google Scholar
46. Kenyon, CF, Brown, JB. Mission Statement Day: the impact on medical students of an early exercise in professionalism. Med Teach. 2007; 29(6):606–10.Google Scholar
47. Cork, N, Llewellyn, O, Glasbey, J, Khatri, C; Royal Society of Medicine Student Members Group; STARSurg Collaborative. Bridging medical education and clinical practice. Lancet. 2014; 384(9954):1575.Google Scholar
48. Kaczmarczyk, JM, Chuang, A, Dugoff, L, Abbott, JF, Cullimore, AJ, Dalrymple, J, Davis, KR, Hueppchen, NA, Katz, NT, Nuthalapaty, FS, Pradhan, A, Wolf, A, Casey, PM. e-Professionalism: a new frontier in medical education. Teach Learn Med. 2013; 25(2):165–70.Google Scholar
49. Brody, H, Doukas, D. Professionalism: a framework to guide medical education. Med Educ. 2014; 48(10):980–87.Google Scholar
50. Boudreau, JD, Cruess, SR, Cruess, RL. Physicianship: educating for professionalism in the post-Flexnarian era. Perspect Biol Med. 2011; 54(1):89–105.Google Scholar
51. Lipsitt, DR. Developmental life of the medical student: curriculum considerations. Acad Psychiatry. 2015; 39(1):63–69.Google Scholar
52. Rawson, JV, Thompson, N, Sostre, G, Deitte, L. The cost of disruptive and unprofessional behaviors in health care. Acad Radiol. 2013; 20(9):1074–76.Google Scholar
53. Graves, L. Teaching the wounded healer. Med Teach. 2008; 30(2):217–19.Google Scholar
54. Boudreau, JD, Fuks, A. The humanities in medical education: ways of knowing, doing and being. J Med Humanit. Apr. 8, 2014. [‘Online first’: DOI 10.1007/s10912–014–9285–5]
55. Eichbaum, QG. Thinking about thinking and emotion: the metacognitive approach to the medical humanities that integrates the humanities with the basic and clinical sciences. Perm J. 2014; 18(4):64–75.Google Scholar
56. Rodenhauser, P, Strickland, MA, Gambala, CT. Arts-related activities across U.S. medical schools: a follow-up study. Teach Learn Med. 2004; 16(3):233–39.Google Scholar
57. Remen, RN, Rabow, MW. The Healer's Art: professionalism, service and mission. Med Educ. 2005; 39(11):1167–68.Google Scholar
58. Rabow, MW, Evans, CN, Remen, RN. Professional formation and deformation: repression of personal values and qualities in medical education. Fam Med. 2013; 45(1):13–18.Google Scholar
59. Rabow, MW, Wrubel, J, Remen, RN. Authentic community as an educational strategy for advancing professionalism: a national evaluation of the Healer's Art course. J Gen Intern Med. 2007; 22(10):1422–28.Google Scholar
60. Rabow, MW, Newman, M, Remen, RN. Teaching in relationship: the impact on faculty of teaching “the Healer's Art.” Teach Learn Med. 2014; 26(2):121–28.Google Scholar
61. Felstead, I. Role modelling and students’ professional development. Br J Nurs. 2013; 22(4):223–27.Google Scholar
62. Cohen, MJ, Kay, A, Youakim, JM, Balaicuis, JM. Identity transformation in medical students. Am J Psychoanal. 2009; 69(1):43–52.Google Scholar
63. Learning Communities Institute. Boston, MA: LCI. [Accessed May 4, 2015.] Available from http://sites.tufts.edu/lci.
64. Smith, S, Shochet, R, Keeley, M, Fleming, A, Moynahan, K. The growth of learning communities in undergraduate medical education. Acad Med. 2014; 89(6):928–33.Google Scholar
65. Malloy, MH. The Osler Student Societies of the University of Texas Medical Branch: a medical professionalism translational tool. HEC Forum. 2012; 24(4):273–78.Google Scholar
66. Fleming, A, Cutrer, W, Moutsios, S, Heavrin, B, Pilla, M, Eichbaum, Q, Rodgers, S. Building learning communities: evolution of the colleges at Vanderbilt University School of Medicine. Acad Med. 2013; 88(9):1246–51.Google Scholar
67. Mitchell, R, Parker, V, Giles, M, Boyle, B. The ABC of health care team dynamics: understanding complex affective, behavioral, and cognitive dynamics in interprofessional teams. Health Care Manage Rev. 2012; 39(1):1–9.Google Scholar
68. Arenson, C, Umland, E, Collins, L, Kern, SB, Hewston, LA, Jerpbak, C, Antony, R, Rose, M, Lyons, K. The health mentors program: three years experience with longitudinal, patient-centered interprofessional education. J Interprof Care. 2015; 29(2):138–43.Google Scholar
69. Towle, A, Brown, H, Hofley, C, Kerston, RP, Lyons, H, Walsh, C. The expert patient as teacher: an interprofessional Health Mentors programme. Clin Teach. 2014; 11(4):301–06.Google Scholar
70. Bridges, DR, Davidson, RA, Odegard, PS, Maki, IV, Tomkowiak, J. Interprofessional collaboration: three best practice models of interprofessional education. Med Educ Online. 2011; 16:10.Google Scholar
71. Eckenfels, EJ. Contemporary medical students’ quest for self-fulfillment through community service. Acad Med. 1997; 72(12):1043–50.Google Scholar
72. Ramakrishna, J, Valani, R, Sriharan, A, Scolnik, D. Design and pilot implementation of an evaluation tool assessing professionalism, communication and collaboration during a unique global health elective. Med Confl Surviv. 2014; 30(1):56–65.Google Scholar
73. Tannan, SC, Gampper, TJ. Resident participation in international surgical missions is predictive of future volunteerism in practice. Arch Plast Surg. 2015; 42(2):159–63.Google Scholar
74. Veronesi, MC, Gunderman, RB. Perspective: the potential of student organizations for developing leadership: one school's experience. Acad Med. 2012; 87(2):226–29.Google Scholar
75. Haq, C, Grosch, M, Carufe-Wert, D. Leadership opportunities with communities, the medically underserved, and special populations (LOCUS). Acad Med. 2002; 77(7):740.Google Scholar
76. Chadi, N. Medical leadership: doctors at the helm of change. Mcgill J Med. 2009; 12(1):52–57.Google Scholar
77. Sweigart, JR, Tad-Y, D, Pierce, R, Wagner, E, Glasheen, JJ. The Health Innovations Scholars Program: a model for accelerating preclinical medical students’ mastery of skills for leading improvement of clinical systems. Am J Med Qual. Apr. 8, 2015. [‘Online first’: DOI 10.1177/1062860615580592]
78. Crites, GE, Ebert, JR, Schuster, RJ. Beyond the dual degree: development of a five-year program in leadership for medical undergraduates. Acad Med. 2008; 83(1):52–58.Google Scholar
79. Sherrill, WW. Dual-degree MD-MBA students: a look at the future of medical leadership. Acad Med. 2000:75(10 Suppl):S37–S79.Google Scholar
80. Hojat, M, Michalec, B, Veloski, JJ, Tykocinski, ML. Can empathy, other personality attributes, and level of positive social influence in medical school identify potential leaders in medicine? Acad Med. 2015; 90(4):505–10.Google Scholar
81. The Health Foundation. Evidence Scan: Improvement Science. London, UK: Health Foundation; 2011. [Accessed May 5, 2015.] Available from www.health.org.uk/sites/default/files/ImprovementScience.pdf.
82. Houlden, RL, Raja, JB, Collier, CP, Clark, AF, Waugh, JM. Medical students’ perceptions of an undergraduate research elective. Med Teach. 2004; 26(7):659–61.Google Scholar
83. Fishleder, AJ, Henson, LC, Hull, AL. Cleveland Clinic Lerner College of Medicine: an innovative approach to medical education and the training of physician investigators. Acad Med. 2007; 82(4):390–96.Google Scholar
84. Schuwirth, L, Ash, J. Assessing tomorrow's learners: in competency-based education only a radically different holistic method of assessment will work. Six things we could forget. Med Teach. 2013; 35(7):555–59.Google Scholar
85. Schuwirth, LW, van der Vleuten, CP. Programmatic assessment and Kane's validity perspective. Med Educ. 2012; 46(1):38–48.Google Scholar
86. van der Vleuten, CP, Schuwirth, LW, Driessen, EW, Dijkstra, J, Tigelaar, D, Baartman, LK, van Tartwijk, J. A model for programmatic assessment fit for purpose. Med Teach. 2012; 34(3):205–14.Google Scholar
87. Krathwohl, DR, Bloom, BS, Masia, BB. Taxonomy of Educational Objectives: the Classification of Educational Goals. Handbook II: Affective Domain. New York, NY: David McKay; 1964.
88. Spike, JP, Cole, TR, Buday, R. The Brewsters: An Interactive Adventure in Ethics for the Health Professions. edition. Houston, TX: University of Texas Health Science Center at Houston; 2011.
89. Wald, HS, Davis, SW, Reis, SP, Monroe, AD, Borkan, JM. Reflecting on reflections: enhancement of medical education curriculum with structured field notes and guided feedback. Acad Med. 2009; 84(7):830–37.Google Scholar
90. Wald, HS, Anthony, D, Hutchinson, TA, Liben, S, Smilovitch, M, Donato, AA. Professional identity formation in medical education for humanistic, resilient physicians: pedagogic strategies for bridging theory to practice. Acad Med. 2015; 90(6):753–60.Google Scholar
91. Hendelman, W, Byszewski, A. Formation of medical student professional identity: categorizing lapses of professionalism, and the learning environment. BMC Med Educ. 2014; 14:139.Google Scholar
92. Davis, MH. Measuring individual differences in empathy: evidence for a multidimensional approach. J Pers Soc Psychol. 1983; 44(1):113–26.Google Scholar
93. Hojat, M, Gonnella, JS, Nasca, TJ, Mangione, S, Veloksi, JJ, Magee, M. The Jefferson Scale of Physician Empathy: further psychometric data and differences by gender and specialty at item level. Acad Med. 2002; 77(10 Suppl):S58–S60.Google Scholar
94. Lave, J, Wenger, E. Situated Learning: Legitimate Peripheral Participation. Cambridge, UK: Cambridge University Press; 1991.
95. Forsythe, GB. Identity development in professional education. Acad Med. 2005; 80(10 Suppl):S112–S117.Google Scholar
96. Monson, VE, Roehrich, SA, Bebeau, MJ. Developing Civic Capacity of Professionals: A Methodology for Assessing Identity. Paper presented at the annual meeting of the American Educational Research Association. New York, NY; 2008.
97. Monson, VE, Hamilton, NW. Entering law students’ conceptions of an ethical professional identity and the role of the lawyer in society. Journal of the Legal Profession. 2010; 35(1):1–28.Google Scholar

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