Building Consensus: Shared-Decision Making in the Preclerkship Curriculum

1. Building Consensus: Shared-Decision Making in the Preclerkship Curriculum Cynthia Standley, Ph.D. Professor, Basic Medical Sciences Chair, Curriculum Committee University of Arizona College of Medicine-Phoenix Paul Standley, Ph.D. Assistant Dean of Curricular Affairs Professor, Basic Medical Sciences University of Arizona College of Medicine-Phoenix

2. Rationale • Shared decision making in curricular governance can benefit a culture of: • Curricular planning • Implementation • Review and continuous quality improvement • Resulting in high quality: • Curricular content • Organization • Student assessment • Achievement of educational program objectives

3. Objectives • By the end of this session, participants will be able to: • Define shared decision making in regards to medical curriculum • Describe best-practices for shared decision making in the preclerkship curriculum • Identify common curricular struggles in medical institutions and possible solutions based on shared decision making.

4. Outline • Overview of integrated and centralized curricular work flow (30 min) • Group activity 1: identify current curricular struggles related to work flow (30 min) • Group activity 2: arrive at possible approaches and/or solutions (30 min) • Post meeting collaboration and continued discussion of common curricular struggles

5. A college, by definition, is a collection of very smart people. Important stakeholder: faculty

6. Define: Shared-Decision Making • A structure and process by which faculty direct, control, and regulate the many goal oriented efforts of other members to support an interdisciplinary design for quality medical education. • Embodies four principles: • Partnership/Collaboration • Accountability • Equity • Ownership Involvement Empowerment Team-Building

7. Case Based Instruction Curricular Workflow Block Course Theme Electives Clinical Curriculum Curricular Evaluation Workgroups Exam Review Teams Assessment and Evaluation Curriculum Committee Theme and Topic Management Team Simulation Dual Degree Educational Policy Committee Color legend: Blue – Committees Green – Advisory/workgroups Red - Subcommittees Pathways

8. Membership

9. Ideas about curriculum can come from anywhere! Case Based Instruction Block Course Theme Electives Clinical Curriculum Curricular Evaluation Workgroups Exam Review Teams Assessment and Evaluation Curriculum Committee Theme and Topic Management Team Simulation Color legend: Blue – Committees Green – Advisory/workgroups Red - Subcommittees Dual Degree Educational Policy Committee Pathways

10. Can get very granular. Case Based Instruction Block Course Theme Electives Clinical Curriculum Curricular Evaluation Workgroups Exam Review Teams Assessment and Evaluation Curriculum Committee Theme and Topic Management Team Simulation Color legend: Blue – Committees Green – Advisory/workgroups Red - Subcommittees Dual Degree Educational Policy Committee Pathways

11. A chain of events must occur. Never a situation with 1 person making a decision in a vacuum.

12. How This Works: An Example Curricular Struggle • Struggle: Structure, quality of exams across preclerkship curriculum • Issues: • Inconsistent use of USMLE-type questions • Mapping to objectives • Inconsistent student means on exams • Difficulty of questions • Number of questions per session/lab/cases

13. Development of ERT • An Exam Review Team was developed • Initially composed of 3 faculty members • Block director of the previous block • Current Block director • Assistant Dean of Curricular Affairs • Guidelines for process were developed between faculty Block Directors and the members of the BCT subcommittee. • Submitted to the Curriculum Committee and endorsed. Partnership Accountability

14. Results of Implementing ERTs • Improved consistency among preclerkship exams • All questions include a clinical or research stem, in alignment with USMLE standards • Consistent number of questions per session (i.e. 2 for each 50 minute session) • Range of difficulty on exams (recall  analyze) • Students know what to expect each exam Partnership, Ownership

15. Continued Refinement of Process • ERT membership now at 6 members • Added additional basic science and clinical faculty (i.e. “content experts”) • Exam coordinator hired and added as member • Explanations added to all questions • Assessment and evaluation data from previous years sent to ERT (point biserials, discriminatory index) • Improved tagging of competencies for curricular mapping Equity

16. group activity 1:Identify current curricular struggles at your institutionsWorksheet 1

17. List of Struggles • Google doc link with worksheet 1

18. group activity 2:Suggest possible approaches and/or solutions Worksheet 2

19. Possible Solutions • Google doc with worksheet 2

20. Wrap up Never a situation with 1 person making a decision in a vacuum. • Goal: Empowerment of faculty and building a culture of community in identifying and solving problems.

21. Follow up • Summaries of struggles and potential solutions will be documented and made available • Via email • Via Google docs • Let’s continue the discussion post-meeting!