text:
University of Illinois College of Medicine Institutional Self-Study Report for the Liaison Committee On Medical Education November 25-29, 2001 CONTENTS _____________________________________________________ Introduction/ Progress Report 1 Components of the Self-Study I. Objectives 4 II./III. Governance and Administration 6 IV. Educational Program Leading to the MD Degree 8 V. Medical Students 14 VI. Resources for the Educational Program 18 VII. Graduate Education in Basic Sciences 24 VIII. Graduate Medical Education 26 IX. Continuing Medical Education 26 X. Research 27 XI. Medical School Departments 27 Summary 31 Appendix 36 UIC College of Medicine Institutional Self-Study Introduction The University of Illinois at Chicago (UIC) College of Medicine offers a four-year program leading to the MD degree at four geographic sites in the State of Illinois. Each of the sites offers a comparable medical education experience complemented by the site's own unique features. Approximately 300 students graduate with the MD degree from the UIC College of Medicine each year; the program is the largest in the United States. The Chicago campus of the College of Medicine is the administrative home for the dean and all other College-wide officers, as well as the Chicago program site. It is located on the near west side in one of the world's largest medical center districts and is part of the UIC health science campus (including the Colleges of Applied Health Sciences, Dentistry, Nursing, Pharmacy, and the School of Public Health). The other three regional medical education programs are located in Peoria, Rockford and Urbana-Champaign. This Institutional Self-Study is the work of over 220 faculty, administrators, and students who served on the LCME Self-Study Task Force and Subcommittees representing the four geographic sites of the College. The Self-Study Subcommittees met frequently throughout the entire process. They were charged with reviewing the database, drafting answers to the Self-Study questions relevant to their area, and developing a list of strengths, areas of concern, and recommendations to be presented to the Steering Committee and the entire Task Force. The Steering Committee met several times a month to monitor, summarize and provide overall coordination. It also produced the draft of the final report for review, modification, and approval by the Task Force. Meetings of the entire Task Force occurred at the beginning of the process and periodically through the process to review the work of its subcommittees and to review the recommendations. All the work products were maintained on the Internet in Web Crossing enabling members of the Task Force to comment and discuss through the months of the self- study. The formal meetings were held periodically in person at various geographic locations. To the extent possible meetings were held by video and teleconference to provide more opportunity for active participation. The multi-site College organization is effective in carrying out its multiple missions. This is accomplished through the establishment of the MD/PhD programs in Urbana (Medical Scholars) and Chicago; the James Scholars Programs (Independent Study Program) in Chicago, Peoria, and Rockford; the Rural Medicine Program in Rockford. Of particular importance is the education of a multicultural student body. These efforts directly complement campus goals of diversity and address state and societal health care issues. The UIC COM Urban Health Program and the Illinois Agricultural Association Program have facilitated the admission of targeted groups, leading to a student population comprised of approximately 22% from underrepresented minorities and 32% from rural counties. Over 70% of the graduating students, eventually practice in Illinois, and approximately 58 % of the class choose primary care as their initial specialty. According to the latest Institutional Program Survey of the AAMC, UIC produces more primary care physicians than all but one medical school in the country, while graduating more underrepresented minority students than all but two schools. In addition, we produce more academic physicians than all but five schools, and our research endeavors have moved us from 62nd to 48th place among US medical schools. PROGRESS SINCE 1994 The LCME, following a site visit on November 7-10, 1994, granted accreditation to the University of Illinois College of Medicine (UIC COM) for a seven-year period. In addition, they asked that the dean submit a progress report by March 1, 1997 to both LCME secretaries. a. Evolution of the "Executive Head" system to integrate and uphold achievements of the college's objectives consistently across the four campuses The College of Medicine has instituted a number of parallel and interlocking mechanisms to achieve consistency in objectives and to ensure comparable effectiveness in the delivery of instruction across all 1 sites. Initially, the primary method of coordination was the appointment of an executive head for each major discipline, who had many responsibilities in addition to educational coordination. As the College governance system evolved and matured, the role of the executive head diminished and has now been eliminated. The executive head chaired a "Joint Conference Council (JCC)" consisting of the corresponding disciplinary heads at each site, which met to review the educational components of its discipline. The committee structure in place at the time of the 1994 LCME visit did not address either the basic science or bridging curricula, but groups for those areas were subsequently created. It became clear that the focus of their activities should be comparability of educational objectives, quality of instruction and consistency of evaluation, and that membership on such groups should be the individuals in the discipline at each site most involved and qualified in education. Consequently, in March 2000, upon recommendation of the Committee on Instruction and Appraisal, the old Joint Conference Council system was discontinued and the present system of Education Coordinating Committees (ECCs) was established. This is now an important mechanism for academic coordination. ECCs are now active in Family Medicine, Medicine, Obstetrics/Gynecology, Pediatrics, Psychiatry, Surgery, as well as Pathology, Pharmacology, basic sciences, and the bridging courses. The disciplines' department heads from each program site have appointed at least one faculty member who functions with the responsibility and authority of their head. The responsibilities of the ECCs are as follows: (1) Coordinate the discipline's educational activities; (2) Determine appropriate competencies within their discipline and insure the comparability of experiences, and student evaluation for all students at all program sites; (3) Determine how their discipline helps students master the Graduation Competencies; (4) Develop innovations in clinical education; and (5) Capitalize on the unique capabilities of the various program sites. In addition, the ECCs were asked to participate as LCME Self Study subcommittees (of the "Educational Program for the MD Degree") and review the discipline's database from the four program sites. b. The assessment of anticipated changes in health care and financing across the four campuses, and planned strategies to safeguard the college's missions The progress report in 1997 addressed this issue in some detail and it is also described in this report under the Objectives section. The overall strategic plan is a constantly evolving one that is coordinated by the Educational Planning Group. This group includes the dean of the College of Medicine, the regional deans and their vice deans, the vice dean, the senior associate deans for education and for research, the associate dean for finance, and the assistant dean for educational planning. The initial meeting was held in July 1994, and from its inception, the Educational Planning Group has met regularly with discussion often carried over into the Academic Council of Deans' meeting that occurs routinely preceding the College Executive Committee meetings. As a key strategic planning mechanism, we also conduct regular, periodic, and scheduled in-depth reviews of the programs at each educational site. Comprehensive reviews of Urbana and Peoria have been completed and form a substantial element of our strategic planning. c. Progress in educational reform, including decompressing the pre-clerkship curriculum, incorporating greater measures of participative and active learning, consistent early clinical experience across the campuses, and the status of generalist initiatives As of 1999, we have significantly reduced scheduled lecture hours (decreases of 28% in the M1 year in Urbana, and 33% in the M2 year in Chicago, for example). At all educational sites there have been shifts from lecture to small group experiences, with an emphasis on student-centered, active learning. There is protected, unscheduled time for all students during the basic science years. The number of hours per week available for class preparation and review, independent study, personal affairs, and social activities are now viewed by the faculty and students as sufficient and appropriate. 2 d. The system of outcomes assessment validating the effectiveness of the educational programs across the campuses A program to assess student outcomes following graduation has been in place beginning with the graduating Class of 1997. There is an active "Outcomes Study Group" with representation from all program sites. This group has been developing the instruments and providing feedback as to the appropriate data for assessment of the curriculum. This group reviews all the data and provides advice concerning presentations to be made to the various College and program sites. Key components of the data are regularly presented to the College Committee on Admissions, the College Committee on Instruction and Appraisal, the College Committee on Student Promotions, and the College Executive Committee. The data presented currently include USMLE Step 3 scores, feedback from the graduates during their PGY1 year, feedback from the GME program directors. While long-term outcome studies can provide valuable information, formative evaluation must occur in a shorter time frame and corrective actions should be taken promptly. Student performance on progress and shelf exams is continually monitored, and when problems in the curriculum are identified that information is directed to the appropriate College committee for consideration and action. The College Committee on Instruction and Appraisal is the body generally responsible for reviewing such issues and making recommendations to the College Executive Committee; the Education Coordinating Committees review curricular innovations and standards in their disciplines. For example, each spring the ECCs review student performance on the NBME Subject Examination for the core clerkships, and from time to time, the actual examinations themselves. Based on review of student performance, subject examination content and clerkship objectives, passing standards are set for the next academic year. USMLE data from all sites are also reviewed annually. e. The adequacy of research and scholarly activity across campuses Substantial progress has been made in enhancing faculty research and in encouraging student participation in biomedical research, although the pressure of clinical service loads has been a constraining influence, especially in Peoria and Rockford. Since the progress report was submitted, growth in research activity (in terms of dollar expenditures) has exceeded 20% per year. Based on the level of NIH funding, the College is currently ranked 48th among the US medical schools. There has been a major effort to involve our medical students in scholarly activity as emphasized in our MD/PhD programs, James Scholar Programs, and the efforts being made in the basic curriculum to emphasize student participation in research as a significant part of the medical education. The goal is to aid in understanding and internalizing the research and sciences foundation needed for the challenges of contemporary medical practice and life-long learning. To this end, the Office of Student Affairs sponsors a Student Research Initiative. There is a Faculty/ Student Medical Research Committee that offers guidance and oversight, research assistantships, summer research fellowships, a medical student research forum, a research fair, a research opportunities database, a web site publicizing of research information and opportunities. In addition, there are many presentations from invited speakers representing organizations that offer research support and experiences . f. The status of facilities' maintenance and renovation, especially research space at the Chicago campus As noted in the Interim Report, the Illinois General Assembly provided two million dollars in planning funds for the development of a new College of Medicine building that would be dedicated to research. Construction is now well underway for the new 300,000 square foot research facility, which will house the basic science departments not currently located in the Molecular Biology Research Building. The state-of-the-art facility is slated for completion in July 2004. To help address the problem of deferred maintenance at all sites, the University has requested $8,000,000 in new recurring state funding for a 3 Major Remodeling Fund. The state is already appropriating $5,000,000 per year for space remodeling and the campuses are providing an additional $11,000,000 from their operating budgets. It is anticipated that an annual fund on the order of $24,000,000 will make a significant impact on what has been a persistent problem. g. Progress recruiting permanent department chairs NEW PERMANENT HEADS SINCE MARCH, 1997 Chicago Urbana Dermatology, Virginia Fiedler Obstetrics & Gynecology, Sherman Elias Ophthalmology & Visual Sciences, Jose Pulido Orthopaedics, Edward Abraham Otolaryngology, J. Regan Thomas Pathology, Robert Folberg Psychiatry, Joseph Flaherty Radiology, Mahmood Mafee Peoria Rockford Obstetrics & Gynecology, C. William Gibson Psychiatry, Robert Slack Neurology, Jorge Kattah Psychiatry, S. Atezaz Saeed Surgery, Norman Estes CURRENT ACTING/INTERIM HEADS Chicago Urbana Anatomy & Cell Biology, Rochelle Cohen Family Medicine, Christian Wagner Family Medicine, Patrick Tranmer Medical Information Sciences, Allan Levy Molecular Genetics, Elliot Kaufman Obstetrics/Gynecology, Ralph Kehl Pathology, Gregory Freund Peoria Rockford Biomedical and Therapeutic Sciences, J. Thomas Hjelle Family and Community Medicine, Eric Henley Dermatology, Rajagopala Swaminathan Medicine, Gary Rifkin Pathology, Alan Campbell Pathology, Gary Anderson Surgery, Jeffrey Schauer I. Objectives Our program goal is to graduate students who possess the scientific knowledge, relevant skills, and behavioral attitudes that will give them a foundation for practicing evidence-based medicine throughout their careers. We recognize that medicine is rapidly evolving, both in terms of its scientific content and in the societal context in which it is practiced. Our graduates should have the training and the motivation to continue to keep pace with these changes, whether their careers lead them to patient care, research or other responsibilities within the health care system. 4 We have recently (1999) codified these principles into a set of nine "Graduation Competencies," that were established after extensive review and debate involving the faculty, administration and students. Led by the College-wide Committee on Instruction and Appraisal (CCIA), the process of developing and refining the list of competencies spanned nearly three years. The College, through the CCIA, the discipline-specific Education Coordinating Committees (ECCs) (See Governance) and the local curriculum committees at each campus, is in the process of implementing and evaluating this set of educational outcomes. The final elaborated list of Graduation Competencies is included in the Objectives section of the database. The competencies themselves follow: 1. Basic and Clinical Science Knowledge 6. Management/Clinical Decision-Making Base 7. Health Maintenance/Disease Prevention 2. Communications/Biopsychosocial 8. Social and Community Contexts of 3. Ethical Reasoning and Judgment Health Care 4. Life-Long Learning 9. Professional Behavior (Personal, Family 5. Data Gathering/Problem Definition Community) Determination of Institutional Priorities The faculty set institutional priorities through advisement to the dean. This is accomplished through the Executive Committee and local groups advising the regional deans. The particular mechanisms that enable this are detailed in the Governance Section. For example, in 1996, the CCIA created a Technology Subcommittee to expand the use of information technology in the educational programs of the College. Its charge was to explore the use of computers in medical education and make recommendations concerning the most effective manner for the COM to expand in this area. In May of 1998, a set of recommendations was sent to the College Executive Committee; the dean appointed a high-level study group to assess the implications and respond to the CCIA. As a result, four of the five recommendations were endorsed by the College Executive Committee and forwarded to the dean. The Mission Statement, which is appended to the Objectives database Section and in the College catalogue, also drives overall goals such as training minority physicians and physicians who are likely to establish practices in medically underserved areas of Illinois, as well as medical scientists and academicians. Resources are allocated to achieve those goals; examples are the RMED Program, the Urban Health Program and the Medical Scholars and MD/PhD Programs. Educational Accountability Maintaining the essential balance between the faculty who are responsible for curriculum content and the educational leadership to shape a contemporaneous, well-integrated and innovative program requires a partnership between the faculty and the senior associate dean for educational affairs. This manifests itself in frequent interactions with the Educational Planning Group, the Academic Council of Deans, the Academic Associate Deans and standing faculty committees, such as College Executive, CCIA, ECCs, Admissions, and Promotions, and conjoint retreats in which the effectiveness of the educational program is continuously re-examined. The College is committed to the success of the educational program: to support learning, to enforce educational accountability, and to assess the extent to which students are mastering objectives. This area is the current focus of the CCIA and the impetus for the College Outcomes Study. We are attempting to develop the means to measure student attainment of the Graduation Competencies, melding objective testing of cognitive knowledge with observed competence in clinical skill. As an example, the COM at Rockford has begun a Pilot Study (AY 01-02) in which students are assuming significant responsibility for mastery of the educational objectives. The Student Professional Development Program utilizes the graduation competencies as the basis from which to assess their progress. The Student Portfolio is appended to the Objectives Self-Study Report. The results of the Pilot Study will be reported to the CCIA. There are also internal written examinations in all basic science courses, and in the clerkships, common grading forms include specific notations regarding competence in performance-related aspects specific to that discipline. Remediation is required for students who show less than satisfactory performance in behaviors related to the discipline. Students must pass the subject 5 examination of the NBME as a requirement for completion of clerkships. Furthermore, students must pass USMLE Steps 1 and 2 prior to graduation. Performance on external examinations is generally at or slightly above national means, and our retention rates are high. A substantial majority of our students receive one of their first three choices in residency selection, and our Outcomes Study survey of residency directors shows generally high satisfaction with our graduates. Balance Between Resources and Activities/ Strategic Planning Planning is done at many organizational levels. The overall strategic plan is a constantly evolving one that is coordinated by the Educational Planning Group, which includes the regional deans for all campuses, their vice deans, the dean of the College of Medicine, the vice dean, the senior associate deans for education and for research, the associate dean for finance, and the assistant dean for educational planning. The group is charged with oversight of all aspects of the College's mission: education, clinical services, and research. Detail is provided in the database. The Educational Planning Group meets regularly, usually every other month. We are also in the process of reviewing each educational site or campus in-depth through an intensive process of data acquisition and review, interviews of faculty, students, and community members over many months. These efforts are led by a special assistant to the dean (a former dean of the College), and are reported to the dean, the Executive Committee, the University and the faculty. The reviews of Urbana and Peoria have been completed and the recommendations clearly include the efforts of strategic planning. The self-study both utilizes the results of ongoing strategic planning and adds new information for future planning. In the process of accumulating the database, both strengths and weaknesses became apparent, and will be incorporated into future planning. Planning has facilitated accomplishment of the school's purpose. In addition, each educational site is engaged in local strategic planning activities for its individual needs, special programs, culture, and location. II. / III. GOVERNANCE/ ADMINISTRATION The UIC College of Medicine is one College with multiple instructional sites across the state. Essential to its success is a governance structure that affords all sites sufficient flexibility to enhance unique and individual strengths as well as respond to local issues. This structure is designed to ensure that all sites act under a common mission and direction such that student instruction and evaluation are equivalent and that academic decisions adhere to a common set of policies and standards across all sites. The College functions with a single dean and other College-wide administrators and regional deans in Urbana, Peoria and Rockford. The dean consults with the faculty through a College-wide Executive Committee, composed of elected faculty from all four sites, other College-wide committees and, directly, through general meetings convened at least annually. The administrative structure at the regional site level is similar to that at the College level. The regional deans report to the dean and are responsible for the administration of their respective sites. They consult with the faculty through a site Executive Committee, other standing committees, and directly through general faculty meetings. The curriculum committee and the student promotions committee at each site also function as subcommittees of the corresponding College-wide committees. Decision-making in the College follows the traditional model of student, faculty, and administrative input and action. The College is structured around a departmental model, modified by the mechanisms of educational coordination (such as the ECCs) needed to insure comparability at the four instructional sites. Many decisions are made at the departmental level, but for matters extending beyond departmental boundaries, decisions are made at the site or College level through the committee structure. Experience over past years with multi-site governance has resulted in an organization with as much delegation to the site level as possible, without compromising basic College standards of graduation competencies, 6 curricular comparability and student grading and promotion. The Executive Committee of the College of Medicine and the key standing committees of the College (Instruction and Appraisal; Student Promotions; Faculty Appointments, Promotion and Tenure; and Continuing Medical Education) all have balanced representation from the four sites of the College. Meetings are either rotated among the sites, or video or teleconferenced. The governance structure is supplemented by additional mechanisms designed to facilitate communication among faculty members and administrators at the sites and assure continuity and consistency of the undergraduate curricula across the sites. For each core clinical discipline, the basic sciences, and the bridging courses, there are Education Coordinating Committees (ECCs), composed of the department heads or key faculty members at each site. These bodies recommend and coordinate curriculum for their disciplines. Other integrating mechanisms include regular meetings of the Academic Associate Deans, the Academic Council of Deans (the dean, regional deans and senior associate deans), and a College-wide Educational Planning Group. The College of Medicine (COM) is an integral part of the University of Illinois at Chicago (UIC) campus and is fully integrated into the governance structure. University faculty governance is exercised through the Senate, in which COM faculty currently chair four standing committees. The COM administration also plays a prominent role in administrative decision-making . The dean communicates regularly with the provost/vice chancellor for academic affairs about academic matters and with the vice chancellor for health affairs about health service matters. The dean is a member of both the UIC Council of Deans and the Health Sciences Council. The COM has the largest research budget at UIC in terms of external research funds generated, and it conducts collaborative research not only with the traditional health sciences colleges, but also with the Colleges of Engineering, Urban Planning and Public Affairs, and Liberal Arts and Sciences. The COM has strong collegial and administrative links with the other health science colleges, the University Hospital, the Library of the Health Sciences, and the Office of the Vice Chancellor for Health Affairs. The dean sits on the advisory council for the vice chancellor for health affairs, along with the deans of the Colleges of Pharmacy, Dentistry, Nursing, Applied Health Sciences, the School of Public Health, the executive director of the University Hospital, and the provost/vice chancellor for academic affairs. The relationship between the UIC Medical Center and the COM is cordial and productive. The leadership of the medical center and the dean meet regularly to discuss issues of joint interest, including the educational environment for students and residents; the recruitment and support of clinician faculty members; investments for programmatic or capital needs; and strategic planning toward common ends. In Chicago, the University of Illinois Hospital serves as the College's major teaching hospital and also functions as a focus for the integration of faculty and curricula across the University's diverse health science programs. There is a close working relationship between the dean, hospital executive director, and vice chancellor for health affairs. The COM clinical department heads in Chicago are responsible to the hospital executive director, the Medical Service Plan Executive Committee and Board of Directors for the quality of patient care. The COM and the University Hospital share many of the same challenges and frustrations that characterize tertiary academic health centers in this era. As such, there is often a tension between the academic nature of the COM and the service- and profit-oriented University Hospital. Our strength lies in the cooperation and willingness to actively manage this dynamic for the overall good of the enterprise. In addition to the University Hospital, the West Side Division of the Veterans Administration Chicago Health System is a primary teaching site for COM students, and there is close collaboration between the VA Hospital and College in both teaching and research programs. The COM also has strong affiliation agreements with other hospitals (in Chicago and in each of its other sites) as identified in the database. Although all regional sites are administratively part of the University of Illinois at Chicago, the College of Medicine program on the Urbana campus has additional relationships with the faculty and governance mechanisms of the University of Illinois at Urbana-Champaign (UIUC). The regional dean sits on the UIUC Council of Deans and consults with the provost/vice chancellor for academic affairs. COM and 7 UIUC faculty collaborate frequently to offer several joint educational and research programs, which are organized as special administrative units. There are interdisciplinary programs at all four sites of the College. The interdisciplinary programs of the COM at Urbana-Champaign and UIUC offer good examples of the collegiality and cooperative working relationships between medical school faculty members and other university faculty members. Several interdisciplinary programs exist and new programs are being developed between the COM, other Urbana colleges, the National Center for Supercomputing Applications and the Beckman Institute. In Chicago, there are programs in interdisciplinary neurosciences, bioengineering, oncology, and AIDS research; these bring about interactions with faculty from the Colleges of Engineering, Liberal Arts and Sciences, Dentistry, Pharmacy, Nursing, Applied Health Sciences, and the School of Public Health. COM faculty in Peoria teach in the graduate programs of the College of Nursing and the UIUC College of Applied Life Sciences. In Rockford, faculty of the College of Pharmacy share responsibilities in the COM Office of Family and Community Medicine, and faculty members of the Departments of Biomedical Sciences, Medicine and Psychiatry teach in the graduate programs of the College of Nursing. The dean is responsible for the academic programs at all four sites, and is directly responsible for the program at Chicago, without an intermediary regional dean. The administrative structure is designed to minimize conflict of interest between Chicago and the other regional sites. The principal mechanisms to accomplish this include (1) the delegation of substantial and defined responsibilities to the regional deans, and (2) the delegation of many aspects of the day-to-day operation of the Chicago site to the senior staff of associate and assistant deans for the academic program and student affairs at Chicago. There is a vice dean, who meets with the dean daily, and acts on a day-to-day basis as the dean's liaison with regional deans. The access and communications roles of the vice dean allow all four sites, regional deans, chairs, department heads, other deans and staff, and campus administration to maintain continual contact with the Dean's Office. Despite the dean's necessary focus on the complex workings of the Chicago campus, the above-noted administrative mechanisms and communication pathways help to assure that he is always well-informed and actively involved in the academic, clinical, economic, and governance issues at each regional site. In February 2000, the previous vice dean became the vice chancellor for health affairs, and the regional dean from Peoria replaced him as current vice dean. A senior faculty member from Peoria became the new regional dean. This internal promotion allowed the institution to draw upon the long-standing expertise of these senior-level individuals, minimizing any negative effects on medical school planning or operations. During this same period, a new regional dean for the Urbana-Champaign site was recruited after a national search. This search benefited from a prior, in-depth site evaluation carried out by an ad hoc COM committee to determine current needs. IV. Educational Program Leading to the MD Degree Overview The goal of the UIC College of Medicine curriculum is to graduate physicians who are well grounded in basic and clinical sciences, oriented and competent as beginning general physicians, capable of entering graduate training in either generalist or focused specialties of medical science, and able to function in an ever changing health care environment. The curriculum is designed to provide the educational opportunities in which medical students will master the knowledge, acquire the skills, develop the attitudes, and adopt both the professional behavior and the commitment to lifelong learning necessary to prepare them for their graduate medical education. These are embodied in the Graduation Competencies (see the Objectives section of the database). Curricular integration is achieved through several mechanisms: 1) monthly meetings of the College Committee on Instruction and Appraisal (CCIA) and the local site curriculum committees, 2) meetings of the Academic Associate Deans, Academic Council of Deans and Educational Planning Group, and the 3) actions of the Education Coordinating Committees (ECCs). The ECCs are college-wide, discipline- 8 specific groups of educators that determine appropriate learning outcomes, assure comparability of experiences, and assure that the same standards are applied to all students regardless of program site. The curriculum committee at each site oversees all aspects of that site's medical student education program; e.g., the organization of clerkship experiences, the integration of basic sciences with clinical education and the ongoing evaluation of all courses delivered at the site. The site curriculum committees report to the CCIA. This College-wide committee serves as both an informational body, for sharing of curricular innovations across the sites and disciplines, and as an evaluative body that ensures the effectiveness and comparability of educational experiences, enabling purposeful adjustments across the curriculum. The COM Executive Committee, to which the major college committees report, is responsible for final approval and monitoring of all curricular activities. These various structures and processes facilitate continuous interaction among faculty with common interests and responsibilities as well as ongoing feedback from students regarding the effectiveness of their educational experiences. The College has a very extensive curricular review process, and program evaluation is an important component in the management of the curriculum. The responsibility for implementing this process belongs to the site curriculum committees and the CCIA, in conjunction with the senior associate dean of educational affairs. CCIA reviews the overall curricula from the program sites and the special programs such as MD/PhD, James Scholars, and RMED. These programs and curricula are reviewed using well- defined protocols, which guide the task forces toward the completion of sound program evaluation processes. The First Year During the M1 year, students build on the basic concepts mastered during their baccalaureate studies as these concepts apply to the basic structures and processes of human life. Courses integrate laboratory skills and small group discussions with didactic lectures, while providing an opportunity for understanding the elements that constitute "health," from the molecular level through more complex structures and pathways. In Chicago M1 students are encouraged to apply the concepts learned in the classroom to the realm of health and disease through the Essentials of Clinical Medicine (ECM) course. ECM includes longitudinal primary care experiences with a physician preceptor and plenary and small group sessions devoted to issues of professional behavior, doctor-patient interaction, and biopsychosocial aspects of medicine. Similarly in Urbana, the Introduction to Human Disease (IHD) course was extensively revised in AY 99- 00 to enhance early clinical application of basic science learning. Students are now introduced to "virtual patients" via multi-media, interactive experiences. Through this medium, students interview patients, simulate physical examinations, review radiographic findings, listen to heart sounds, and receive other diagnostic information in order to make a differential and treatment plan. These encounters occur five times a year, when students meet with physician preceptors in "expert consult sessions" prior to presentations. Students then break into small groups to discuss basic science correlations to the case. The Urbana-based course is taught by faculty from Rockford and Peoria as well as Urbana. Both of these major courses (ECM and IHD)are examples of educational change and curricular innovation to address a problem that had been identified in the curriculum: the need to incorporate greater student participation, active learning opportunities, and consistent early clinical experiences at all educational sites. The Second Year The M2 year provides the transition from fundamentals of molecular medicine to actual clinical experience. Laboratory and lecture classroom experiences focus on developing a fundamental knowledge base that will enable the student to understand and to integrate pathology, microbiology and pathophysiology of the patient with the basic biomedical and behavioral sciences. In addition, the pharmacological principles underlying patient responses to treatment are integrated into the second-year curriculum. Students develop and practice their skills in history taking and performing a physical examination, as well as encounter the basic principles involved in clinical decision-making and problem solving. Clinical experiences continue with the physician preceptors, and the ethical/legal aspects of the 9 profession are examined in the context of preventive care, evidence-based medicine, health promotion, and the role of both the patient and other health care providers within the larger community. Decompression of the pre-clerkship curriculum had been a concern of the last LCME accreditation team as well as increasing the emphasis on more active forms of learning. As reported in an LCME Progress Report in 1999, significant reductions in scheduled lecture hours have been achieved, particularly in the M1 year in Urbana (a decrease of 28%) and in the M2 year in Chicago (a decrease of 33%). Across all educational sites there have been shifts from lecture to small group experiences, with an emphasis on student-centered, active learning. There is protected, unscheduled time for all students during the basic science years. The number of hours per week available for class preparation and review, independent study, personal affairs and social activities are viewed by the faculty and students as sufficient and appropriate. The Third Year The M3 year consists of clinical clerkships in six core disciplines. At Rockford, however, the family medicine clerkship is experienced as a one-day-a-week student continuity clinic over two and one-half years. In some cases, because of a student's research commitments, a core clerkship may be deferred to the fourth year. In Peoria, up to six students per class may choose to participate in the Rural Student Physician Program (RSPP), an elective track for students who seek a community-based, extended family medicine clerkship experience with a rural family physician. It is designed to integrate medical education in the clinical specialties, increase the number of students who choose family medicine as a career, and redistribute physicians into rural communities. Students initially rotate through four-week clerkships in medicine, pediatrics, psychiatry, obstetrics/gynecology, and surgery, then complete their third year (28- weeks) in a rural site, under the supervision of a family physician. All students' clinical experiences guide them toward the development of those competencies that are specific to the discipline as well as those that are applicable to the practice of medicine in general. Supervised care of patients, increasingly in the ambulatory setting, gives students their first experience with both the time commitment and the emotional demands of the physician's life. The habits of information gathering and study developed in the basic science years are now brought into play in "real time" situations, further preparing students for the life-long learning required by their profession. Regular review of clerkship learning objectives, environments, and student performance occurs at each site and college-wide through the curriculum and promotion committees and the ECCs. Although some variation exists in the length of clerkships from site to site, each clerkship shares a single set of learning objectives and competencies as well as uniform methods of competency-based evaluation. As expected, workload requirements vary among and within disciplines due to the large number of clinical sites involved and the incidental nature of the clinical experiences. The Family Medicine clerkships are almost entirely ambulatory, so the on call experience differs from that of the other five. In the rotations that typically pose a high demand on students' time, such as surgery and obstetrics/gynecology, there have been concerted efforts toward relieving the students from long hours in the operating room, in which little teaching was reported to occur, to increased time in ambulatory experiences in the surgeon's office participating in pre and post surgical consultation and follow up. Most of the pediatric and surgical subspecialties experiences focus on continuity of care and consultative services. Moreover, teaching faculty have been reminded that clerkships are first and foremost learning experiences and students should be encouraged to spend their time wisely, allowing adequate time for reading. The College Committee on Instruction and Appraisal (CCIA) requires all core clinical clerkships to provide students with a formative evaluation at the midpoint of the clerkship. The students also receive a summative assessment at the end of the clerkship. Students are encouraged to discuss this evaluation with the preceptor and to sign the evaluation form. Despite efforts to enforce this requirement, students continue to report that they do not consistently receive midpoint evaluations. This is a particular problem in the four-week clerkships, but is also reported in twelve-week experiences. 10 The final student grade (as per CCIA requirements) is weighted such that 2/3 of the final grade is a composite of clinical preceptor evaluations and other assessments of clinical competence and 1/3 is the National Board of Medical Examiners (NBME) subject examination for the particular discipline. Several clerkships also use Objective Structured Clinical Exams (OSCEs) (or some variation) to help evaluate the student's clinical performance and non-cognitive attributes. This is counted within the clinical component of the student's grade (the NBME score still counts for 1/3 of the final grade). Summary statistics for the clinical teaching sites indicate that there is adequate equipment, clinician preceptors, and patient/ disease populations for the programmatic needs. Because of the size of the M3 and M4 student body and the variety, as well as complexity, of the clerkship sites within the various affiliated hospitals and clinics, quality assessment and consistency of evaluation is an important issue. Quality control is monitored through both clerkship directors and through site curriculum committee review. Criteria include adherence to curriculum, adequacy of patient mix, balance between ambulatory and inpatient experience, thoroughness of student evaluation, available resources, and critical evaluation by medical students of the overall clerkship experience. Clerkship directors at the various site clinical facilities meet to discuss and review their discipline's clerkship. The site clerkship directors for each discipline usually comprise the College-wide Education Coordinating Committee (ECC) for that discipline. The ECCs for each discipline report annually to the College Committee on Instruction and Appraisal, summarizing the state of their clerkships, deficiencies noted, and planned changes. The Fourth Year During the M4 year, students in Chicago, Peoria and Urbana complete a sub-internship in a major discipline, with supervised advanced clinical responsibilities. At Rockford, students choose among medicine "selectives" with advanced clinical responsibilities. Students also choose the specialty and elective clerkships that will help them narrow their choice of residency and acquire specialized clinical skills. Electives needed to complete requirements may be taken either within the UIC system, at another LCME or LMCC (Canadian)-accredited program or at a foreign medical school with which the College has a Memorandum of Agreement. General Educational Environment Facilities and faculty for the teaching of Primary Care are numerous and adequate. At Rockford, there is a particular emphasis on primary care and Family and Community with its two-and one-half-years longitudinal experience at one of three University Primary Care Centers (UPCCs). There is an increased emphasis on recruiting primary care physicians at the affiliated clinics throughout the system. Early introduction to clinical medicine is stressed both in Chicago and Urbana (the two sites where M1 instruction is offered): in Urbana through the Medical Doctor Advisor (MDA) program, and in Chicago through the longitudinal primary care component of ECM. Both experiences emphasize student assignment to primary care physicians. Student evaluations of these early introductions to clinical medicine are favorable. To encourage students to actively set and pursue clear learning goals to continuously integrate knowledge and apply it to improve medical care, all students are introduced to the concepts and practices of evidence-based medicine (EBM) during their first two years. The Library of the Health Sciences (LHS) plays a key role in this process. Library faculty have become valued professional EBM associates in the COM; their service is acknowledged through involvement in committee work, as well as research and teaching activities. Library Residents on two-year programs of training gain practical experience through focused EBM searches and in-person consultations with faculty and students. LHS is a leader in EBM course development. A web-based EBM tutorial was developed by LHS and Peoria COM faculty and is available to all sites. Library staff are available for consultation and assistance to both students and faculty. Library staff at all sites conduct orientation sessions with students, and offer classes on searching databases and other tutorials. Library faculty meet with COM faculty informally and at site-located COM Library subcommittees to determine how library resources can better meet curriculum needs and changes. 11 Student Evaluation Methodology Each spring, the clinical ECCs review the performance of all M3 students on the NBME subject examination completed at the end of their core clerkship experience. The purposes of the review are two- fold: to assess the extent to which students have mastered the body of knowledge required at this level of training and, to reassess the required passing standard for all students. Once consensus has been reached by each of the ECCs, the recommendations concerning the proposed pass levels for the next academic year are sent to the College Committee on Instruction and Appraisal for affirmation, and from there to the College Executive Committee. Likewise, all basic science end-of-course examination performance is reviewed by the site curriculum committees as well as the Basic Science and /or Pathology and Pharmacology ECC, depending on the course in question. These analyses are then forwarded to the parent CCIA as well. Assessments of skills, behaviors, and attitudes are more generally accomplished by clinical performance examinations and/or various rating forms. As previously noted, performance in the core clerkships is gauged against explicit, well-defined standards for all students. Each ECC has identified and described the essential components of competency (clinical performance objectives). Every student, regardless of site assignment, is evaluated by the faculty on each objective, using the following scale: Outstanding, Advanced, Proficient, or Needs Remediation. When students fail to demonstrate one or more clinical or professional behavior skills within the quality range required, they receive a grade of Needs Remediation In that case, faculty are obligated to describe the basis for the designation as well as activities to be completed by the student prior to re-evaluation, including length of time required, location in which the supervised remediation will occur and the name of the faculty member who will supervise the study plan. Because all students should receive a midpoint evaluation, especially when there is a serious concern, students should have been apprised about the deficit(s) prior to the end of the clerkship, so that they have had opportunity to resolve the issue within the time scheduled. The grade of Unsatisfactory is given only to students who are judged to be beyond remediation or have failed attempts to remediate their deficiency(ies). For courses taught during the M1/M2 years, students are generally allowed two opportunities to satisfy course requirements. If unsuccessful in meeting the absolute standard predetermined by the course director during the semester in which the course was offered, a summer make-up opportunity is available. Under certain conditions, students may be allowed to repeat an academic year. All students are subject to the same Promotions Guidelines that are written and applied at all sites by the College Committee on Student Promotions (CCSP). Students are allowed up to three attempts to pass licensure and NBME subject examinations. Students who have satisfied all requirements are promoted to the next level or recommended for graduation. The CCSP also determines the criteria for graduation with honors and identifies students who have achieved that distinction. In the basic sciences, the honors level has been set within disciplines across all educational sites. It is currently one standard deviation above the mean for all courses. Program Effectiveness Two major criteria by which overall program effectiveness is most easily evaluated are scores on the licensure examinations (USMLE Steps 1 and 2) and performance of senior medical students in the National Resident Matching Program (NRMP). With regard to the former, test scores provide an indicator not only of what our students have learned but also how effective the curriculum has been in supporting learning. In AY 98-99, the students' performance across sites of the College of Medicine for Step 1 was very similar and close to the national mean of 215 (Chicago 215, Peoria 219, Rockford 213, Urbana 214, all sites combined 215). Moreover, more students score above the 90th percentile than below the 10th. 12 Tukey Box Plots3 – USMLE Step 1- USMLE Step 2 (Data source: College of Medicine Oracle database; for first-time takers only) The national mean for the Step 2 examination was 213, with a standard deviation of 24. Again the performance of University of Illinois students was remarkably similar across the four sites, and very close to the national mean (Chicago 212, Peoria 207, Rockford 209, Urbana 210, combined sites 210). Results of the USMLE Steps 1 and 2 suggest that our College of Medicine is doing an adequate job of helping our students learn, and that the mechanisms in place to coordinate the curricula among the sites are functioning well. 3 The line bisecting the box corresponds to the 50th percentile; the top and bottom of the box represent the 75th and 25th percentiles respectively; the cat's whiskers the 90th and 10th percentiles. Circles indicate individual outliers above the 90th percentile or below the 10th percentile. 13 Ninety-seven percent of all UIC graduates from the Class of 2000 were successful in the NRMP. There are no significant differences in the match rate among sites. The average match rate for the Classes of '99,'00, and '01 is 95%. The national average is 94%. Over the last three years (1999-2001), 87% of UIC COM students matched in one of their top three choices. Fifty-eight percent of the Class of 2000 chose to enter primary care specialties. If one includes Obstetrics/ Gynecology, then 67% enter primary care residencies. The College graduates more primary care physicians than all but one other medical school in the country. If one excludes those who entered Obstetrics/ Gynecology, about 26% of the Class entered a surgical specialty, while about 16% entered non-surgical specialties, such as Neurology or Radiology. Taking into account those who will eventually enter the subspecialties of internal medicine, the balance shifts more toward 50% primary care, 26% surgical and 24% non-surgical subspecialties. Consistent with national trends (4.9% decrease), the Class of 2001 showed about a 4% decrease in selection of generalist disciplines. UIC COM graduates pursue a wide spectrum of medical career pathways, consistent with the broad mission statement of the College (See Objectives Section of the database, Appendix 1). The College provides more faculty to medical schools than all but five other medical schools, while it also graduates more underrepresented minority physicians than 123 of the 125 medical schools in the country. The College also has a state-mandated mission to enhance the health of all citizens of Illinois. Over 89% of rural counties in Illinois (75/84) are designated as medically underserved. Toward addressing this element of the mission, 71% of the Rockford site's Rural Medical Education (RMED) graduates have selected family medicine; 85% have selected primary care specialties (See Medical Students). Faculty at all sites provide career-counseling services. Faculty members serve as role models, mentors and advisors. Students at all sites are satisfied with faculty mentoring. A variety of programs are used across the sites to assist students in career selection. All sites use the Glaxo Pathway Evaluation Program to help students in their career decisions. A series of workshops is offered throughout the four years. Outcomes Study As described in the February '97 Interim Progress Report to the LCME Secretaries, the College conceived the Medical Education Outcomes Study in 1996. The purpose of the project is to collect data in a systematic manner that will thoroughly and accurately reflect the impact of the medical school curriculum on student learning. In 1997, the Study was expanded from Chicago to all educational sites. Performance on licensure examinations and during the first postgraduate year (assessments from Program Directors) are analyzed as well as former student assessments during PGY1, five and ten years post graduation. The first five-year survey will be sent to the Class of '97 in the spring of 2002. In summary, the curriculum of the College of Medicine is designed to assure that its graduates are well versed in the biological principles underlying the current practice of medicine and are capable of implementing these principles into effective care of the patient. We recognize that rapid changes are occurring in both biomedical knowledge and our national expectations for the health care system. These changes will greatly influence the nature of medical practice. We are confident that the mechanisms we have in place for curriculum development and our ongoing assessment of graduates will help us keep pace with these changes. V. Medical Students Three hundred students are admitted to each class. One hundred seventy-five (175) complete all four years at the Chicago campus; one hundred twenty-five students are assigned to the Urbana campus for the M1 year. Twenty-five students complete four years in Urbana, most of them enrolled in the Medical Scholars Program. Fifty students each are assigned to the Peoria and Rockford sites to complete their M2 through M4 years. As a state supported school, the College seeks to enroll 85-90 percent of each entering class with Illinois residents. The College actively recruits a broad range of students, reflecting the diverse population of the state, through programs that address the specific issues of the following 14 groups: those living in rural and underserved areas of Illinois, underrepresented minorities, and applicants committed to academic medicine and biomedical research. To help accomplish these goals, all qualified applicants are assigned a mathematical representation that reflects the weighting of intellectual and non- cognitive factors. These factors take into account diversity of socioeconomic levels as well as other attributes designed to help select classes that are both academically well qualified and representative of all the citizens of Illinois. There is a single standard that all students must meet or exceed to be considered for admission. The College has special programs or tracks that enable it to meet its mission and in some instances determine which educational site a student will be assigned. In all tracks, the basic academic requirements and graduation competencies must be achieved. The special programs are the Medical Scholars Program (MSP) at Urbana and the MD/PhD Program at Chicago, the James Scholar Programs for Independent Study (Chicago, Peoria, Rockford), the Rural Medical Education Program (RMED) at Rockford, and the Rural Student Physician Program (RSPP) at Peoria. To improve retention, the COM has developed Decompressed Programs at Chicago and Urbana. In Urbana, decompressing students are allowed two years to complete the M1 curriculum; in Chicago, such students are allowed three years to complete the M1/M2 curriculum requirements. Students must make separate applications to each of these Programs except the Peoria-based RSPP, which is an elective track for students who seek a community- based, extended family medicine clerkship experience with a rural family physician. The RMED Program was conceived and implemented at the Rockford site (1993) to address the persistent shortage of family practitioners in rural areas of Illinois. It prepares medical students who, upon completion of residency training, will locate and stay in rural Illinois as family practitioners. The curriculum provides the necessary socialization, clerkship, and community-based experiences to facilitate the development of effective rural doctors. Every year, 15 admission positions are available for students in the RMED Program. Special primary care experiences that enhance the curriculum are introduced during the M1 year, and greatly expanded during the M2 to M4 years to include the weekly longitudinal obligations at one of the University Primary Care Centers. RMED students then spend four months during their M4 year with a rural family physician while they also complete a community project that addresses a relevant health concern. In 1999, RMED received the Society of Teachers of Family Medicine's Innovative Program Award. In addition, the College has several programs that facilitate the admission of students from medically underserved areas who are likely to return there to practice. Since 1947, the College has maintained a cooperative relationship with the Illinois Agricultural Association (IAA) and the Illinois State Medical Society (ISMS). These organizations recommend candidates for matriculation based on the applicant's interest in primary care and intention to practice medicine in rural Illinois. Students selected for this program are supported in the admissions process, receive low-interest loans from IAA, and commit to provide primary care in rural Illinois for at least five years. They must meet all formal admission requirements. Of the class entering in 2000, 5.1 % were participants in this program. The Medical Scholars Program (MSP) and the MD/PhD Program were designed to educate physician scholars and leaders in medicine and medical research. Since 1978, the MSP at the Urbana-Champaign site has sought to recruit, enroll, and educate physician scholars and leaders in medicine and medical research. Up to 25 students per year may enroll in this combined MD/advanced graduate degree program; currently there are 172 participants. The MSP allows students to pursue graduate studies in all disciplines of the sciences, social sciences and humanities, as well as law (JD) and business (MBA). Students must satisfy all requirements of the graduate department or college in which their dual degree will be earned, as well as all requirements of the COM. This is typically an eight-year commitment. At Chicago there are currently 40 students enrolled in the MD/PhD Program, pursuing the MD degree along with graduate training in the five basic science departments of the College of Medicine as well as the University's Departments of Biology and Bioengineering. The Program accepts six outstanding students each year from undergraduate institutions nationwide. The students enter "at large;" that is, 15 without departmental affiliation until choosing an advisor for thesis research, typically by the end of the second year. The James Scholar Programs have been created to enhance the learning experience for a select group of gifted, highly motivated students by challenging them to create alternative pathways (under faculty guidance) to master the medical curriculum while completing a research project or an in-depth study. The Program recognizes the importance of promoting intellectual independence, self-motivation, and scholarship. Also supporting the recruitment of high-achieving students is the Guaranteed Professional Programs Admission (GPPA) program, instituted in 1996. Through this program, UIC recruits academically talented high school seniors to its Honors College, and guarantees them admission into the professional program of their choice, if they maintain a sufficiently high level of academic achievement during their undergraduate experience. Since 1969, the College has been a national leader in its commitment to address the paucity of underrepresented minorities (URM) in medicine. This commitment was further expanded in 1978 with the creation of the Urban Health Program (UHP). The College has been quite successful in achieving this goal with an average URM enrollment of approximately 22% for the classes from 1979 to 2000. All four sites of the College participate in this program that has the largest minority enrollment in the country, with the exception of the medical schools at Howard and Meharry Universities. To further support the UHP goals, the College instituted a Post-Baccalaureate Admission Program in 1997. This academic program targets and supports students whose undergraduate records suggest they may have had insufficient educational preparation to tackle the academic rigors of medical school. In this fourteen-month program of intensive study and preparation, students must maintain a "B" average to secure a seat in the next entering class. Of the 40 students thus far enrolled, 33 (82.5%) have been successful in matriculating into medical school. Tuition and Fees During the 1999-2000 academic year, the tuition for in-state students at the University of Illinois College of Medicine was $16,294. Even though significant tuition increases have occurred since our last accreditation (tuition for academic year 1994-1995 was $7,890), there does not seem to have been a negative impact on the applicant pool. In fact, the reduction of applications has been well below that experienced nationally during this time frame. Out-of-state tuition during the 1999-2000 academic year was $39,826. A wide variety of financial aid resources is available for students' needs; approximately ninety percent of students are receiving some form of financial aid. Over the past seven years, ninety-four scholarships have been awarded by the National Health Service Corps and the Armed Forces Health Professions Scholarship Programs, while the Illinois Department of Public Health provided an additional 431 scholarships to qualified students during that time. Students enrolled in combined graduate degree programs (MSP, MD/PhD) are awarded full tuition and fees as part of their program. The College also awarded five Dean's Scholarships in the 1999-2000 (full tuition, not fees), which were funded entirely from need-based scholarship funding. Seventy-six students in 1999-2000 received the full-tuition Illinois General Assembly Award, provided through the State Senators and Representatives. Furthermore, out-of- state URM students may be granted a waiver of the tuition differential between in-state and out-of-state residents. Student loans continue to comprise a significant element of financial aid. Based on the Class of 2000, eighty-seven percent of the class entered residency with educational loan debt, and the average debt held by those students was $89,332. The trend observed by the College is that the indebtedness of students is increasing faster than the growth of grant and scholarship assistance. 16 Adequacy of Resources/ Transfer Students Although the College of Medicine enrolls the largest student body in the country, the available resources and facilities appear to be adequate for the task. By utilizing a traditional urban academic health center campus along with three community-based medical centers, the College is able to leverage its resources most effectively. Faculty are best utilized in a variety of roles depending on their career track, academic talents, and teaching skills. The broad mix of full-time, part-time, and volunteer faculty is sufficient to execute the teaching, research, and patient care roles within the College. The clinical education of students is served through a wide variety of venues including the University-owned teaching hospital (in Chicago) and clinics (at all sites), private preceptor offices and practices, affiliated not-for-profit hospitals, and an extremely broad coalition of community-based organizations and health care entities. The quantity and mix of patients, the resources and diversity of clinical affiliations, and the depth of the faculty assure that students receive a quality medical education. A limited number of transfer students is accepted. However, resources for these programs are not diluted or adversely affected by acceptance of a small number of transfer students; approximately eight were accepted in the last three years. Moreover, all of the College's clinical teaching facilities accept visiting students for electives in the senior year. In a typical year, approximately 80 such students participate in M4 electives, the majority at the Chicago campus. A majority of the students are enrolled in LCME- accredited medical schools. Student Support Personal counseling, including academic, educational skills, and mental health are available at all sites. The services are offered both at specialized centers and by trained faculty and staff. Individual and group sessions are available to assess and improve time management, study and test-taking skills. Preclinical advising is available at all sites. Tutorial help is provided by teaching assistants and faculty. Overall, students are satisfied with the tutorial help. The UHP provides academic and educational skills services for all students, as needed. Urbana and Rockford offer assistance to all students. Peoria is in the process of recruiting an academic skills specialist. The Chicago campus targets students who are performing at the bottom quartile of the class. All sites support the recruitment of women and minority faculty members. Resources for psychological/psychiatric counseling are available to College of Medicine students at all sites. All sites provide psychiatric care separate from other health care services. Although many students have not used the services, those students who have are satisfied with the care they received. Information from counseling and psychiatric care is confidential and handled under conventional physician-patient relationship guidelines. Preventive / Therapeutic Health Services and Health Insurance This has proven to be the single most difficult area in which to achieve comparability among sites. In the winter of 1998, a college-wide subcommittee of student affairs deans was appointed by the Senior Associate Dean for Educational Affairs "to investigate student health benefits across sites and make recommendations about changes needed to ensure that all students receive good and equitable benefits, regardless of the site at which they are enrolled." About one year later the following additional charges were added: "Determine what the customs and standards for comparable student benefits are and submit an ideal benefits package." The deans were particularly concerned that the coverage for exposure to blood-borne pathogens and associated risk management were clearly delineated. In March of 2001, the Board of Trustees approved a new health care benefit package for all students at the University of Illinois that will become effective fall semester, 2001, which meets the needs identified. The student affairs deans at Peoria and Rockford are working to identify additional health care providers and finalize details to implement these additional health services benefits. Trends from data in Graduation Questionnaires over the last three years indicate that overall student health services satisfaction seems to be improving in Chicago, declining in Peoria and Rockford, and remaining stable in Urbana. The new benefits packages should have a marked effect in improving this important resource. 17 Currently enrolled students and Class of 2000 graduates at the Peoria and Rockford sites are the most satisfied with available space on campus for studying. Students at the Urbana site are less satisfied; however, renovations have been proposed at that site which will greatly improve student study space. Students at the Chicago campus are very dissatisfied, feeling that there is a lack of small-group study space and inadequate relaxation space as well. This dissatisfaction is reflected in the Chicago Class of 2000 graduates as well. Renovation of space that will become available when the new Research building is completed should alleviate this problem. All four sites have similar orientation and information statements that stress the ready availability of student access to administrators. Based on the student questionnaire for the LCME self-study, students at all four sites are generally satisfied with the accessibility of administrators though not to the same degree. Chicago students feel that many of the problems with accessibility could be resolved if there was better communication between faculty and staff in various COM and university departments. One suggestion to improve communication and service to students is a more efficient use of the web by departments and student affairs deans to disseminate important information and material. Likewise, accessibility to faculty for academic help and career counseling is emphasized by Academic and Student Affairs staff and faculty participating in the Student Advisory Program. Some students develop meaningful professional relationships with faculty members, especially in the clinical years. According to the student questionnaire, students are most satisfied with faculty availability in Peoria and Rockford. Dormitories are available at Chicago, one of which is located directly across the street from the medical school. Residential living apartments are also available. Housing is available within one-quarter mile of the medical school in Peoria, and at Rockford, information on housing within the community is provided by the medical school. Urbana offers University housing as well as extensive community options. Students at all sites must pay for parking. The rates differ according to the site; Chicago is the most expensive while Peoria is the most reasonable; extensive free bus service is provided on the Urbana campus. Security is adequate at all sites. There is a large security force in Chicago, and emergency phones and panic devices are available in many locations throughout the campus. Buildings are locked after regular office hours and student study areas are card access controlled. Picture identification badges are required. Escort service is available for students after hours, upon request. At Peoria, full-time security is available with a local housing escort service, and picture identification badges are required. All visitors must register with the receptionist or security guard upon entering the medical school. Rockford contracts with an outside source for security services. Visitors must register with receptionist or security guard when entering the medical school. Surveillance cameras are located throughout the building that is part of the overall electronic security system. Picture identification badges are required, and the building is closed to visitors after midnight. At Urbana, University buildings are locked after office hours; students gain access with keys they have been issued. There is an extensive campus police force. Emergency phones are available throughout the campus. Each of the affiliated hospitals offers escorts and security 24 hours each day. Student areas have keypad access, and picture identification badges are required. VI. Resources for the Educational Program The College of Medicine's state appropriated budget of $74,000,000 ($59,000,000 from general tax revenues and $15,000,000 from tuition) is a major source of financial strength and a solid underpinning for medical education. Although support from the State of Illinois for medical education has remained fairly constant, in the last five years, it has increased less than the CPI and less than that of peer state institutions. State government has recognized this issue, and the University of Illinois received an 18 increase in state-appropriated funds of 5.9% in FY 01 and a similar increase is expected in FY 02. In addition, the governor is supporting additional appropriations to the University and medical school for initiatives in biotechnology under a special development program. State-appropriated funds, including tuition income, provide about 70% of the total compensation of basic science faculty and nearly 50% of the total compensation of clinical faculty. We believe that this source of revenue will remain stable over the next five years and keep pace with inflation. Although tuition income has increased at a greater rate than inflation in the last five years, the total tuition and fees in 2001 are still only fourth highest among the Big Ten's public medical schools. The University administration is cognizant of the additional tuition burden and its impact on student indebtedness and career choices. It is not anticipated that tuition will rise further in the next five years beyond small inflationary increases. Overall Medical Service Plan revenues have been flat in Chicago and the regional sites for the last four fiscal years. Slight increases in patient volumes have been offset by decreases in reimbursement due mainly to the impact of managed care. Adequate MSP revenue is critical to providing competitive salaries for clinical faculty. Efforts to increase patient volume are underway throughout the College. According to the latest AAMC "Institutional Profile," MSP revenue as a percentage of total medical school revenue was at the 30th percentile. Sustaining the teaching-based clinical enterprise will be a major challenge for the College over the next five years. The Rockford and Peoria campuses feel acute pressure to increase revenues from patient care sources, because these educational programs have less support from research and are more dependent on state, MSP and affiliated hospital funding. Endowment income is low for a school the size and stature of the University of Illinois. In a major University development campaign that concluded in December of 2000, the COM received about $125 million. The target goal for the next University-wide campaign will not be determined for at least two to three years. A major thrust of this campaign will be to increase significantly the number of endowed chairs and professorships in the College as well as increasing the amounts available for student scholarships and unrestricted financial aid. Research income has been a major source of revenue growth in Chicago over the past four years. Overall, in FY 97 through FY 00, research revenue grew by annual rates of 21.5%, 14.0%, 17.4% and 13.7% respectively. New facilities have been created in Chicago to support this growth, and the new COM Research Building is scheduled to open in FY 04. Given the investments made in facilities, equipment and new faculty, research in Chicago should continue to grow at double digit levels for the next five years. The basic science faculty in Urbana-Champaign have a solid history of extramural research funding, and this should continue. Peoria and Rockford have been less successful in mounting research programs, and efforts are underway at both locations to increase the levels of research support. Recruitment of a nationally prominent research professor for the program in Peoria has recently been completed. Assuming that state support for the College will not continue to decline in real terms and that the tuition burden on students remains consistent with other public medical schools, while other funding sources remain stable, financial resources should be sufficient for the school to address its current missions and future objectives that enable it to enhance the health of all the citizens of Illinois. The diversity of educational opportunity in the College's programs facilitates the goal of educating physicians in adequate numbers and toward appropriate specialty choice to serve the needs of all citizens. For example, in Rockford, the school was rated number one in the nation last year in the percentage of students going into primary care residencies. These results are due in large measure to the unique clinical teaching model that includes extensive clinical experience in the University Primary Care Clinics (UPCCs). The financial viability of these centers is therefore critical to the teaching program. Overall, the biggest financial threat to the school's mission is the performance of the clinical enterprise both in Chicago and the regional programs. A financially viable clinical enterprise is essential to the success of the academic mission. This general topic is a major element of the College's strategic planning. 19 Clearly there is pressure on faculty to generate revenue from clinical practice and research. The MSP as a total percentage of College revenue has dropped from 33% to 26% in the last five years. In order to manage the pressure so that faculty activities do not become significantly distorted in reference to the COM's mission, new incentive strategies are being reviewed by the MSP governing committees that would reward faculty who bring more business to the clinical enterprise. Similarly, funded basic science faculty with academic year appointments (9 months) are able to devote themselves full-time to research over the summer months and receive summer salaries from their grants. As stated above, state funds continue to support the majority of basic science faculty salaries and a large percentage of clinical faculty salaries. Resources for the support of medical education are adequate. Department Heads and Deans can appropriately direct faculty effort. In Chicago, discussions related to the clinical enterprise are underway and several options are being reviewed regarding both the University Hospital and the MSP. The vice chancellor for health affairs has made this review a priority for his administration. A general consensus emerging from these discussions is that the hospital and the MSP need to be more closely aligned in strategic planning and business development. Managed care penetration varies by location and its relation to the school. The Chicago market seems to have stabilized and there is a growing movement to provide patients with more access to specialists and more choice in the selection of doctors. The Rockford market is unique nationally in that each of the local hospitals owns managed care insurance products. Although few of the local patients are in capitated plans, nearly half are in some form of HMO/PPO. This environment provides special challenges for the University-based clinical faculty. Capital needs are addressed through state and University bonding authority. As noted, construction of a new research building is underway in Chicago. The Illinois VentureTech program (the governor's development initiative mentioned above) has provided capital funding for biotech initiatives, including a Post-Genomic Institute in Urbana, which will share faculty and space with the College of Medicine. Adequate state funding for remodeling and maintenance remains a problem at all sites of the College. In many instances, the College is forced to divert dollars from its operating budget to cover deferred maintenance expenses. The University has requested an additional recurring appropriation of state dollars dedicated to space rehabilitation. On the clinical side, it is unlikely that additional debt instruments for new clinical facilities can be issued until the system returns to greater profitability. General Facilities With respect to general facilities, the Chicago campus of the College has appropriately-sized lecture halls and large classrooms. As a result of incorporating more participative, small group and active learning experiences into the M1/M2 curriculum, there is currently a deficiency of small rooms. As previously noted, more space is also needed for students to study and socialize. Former research space in the COM building will be converted for these purposes as soon as it becomes available. In Urbana, the new Carle Forum serves as a primary center for M2 education and other educational activities/conferences. Peoria completed renovations of its teaching facilities several years ago. A master plan and vision statement for medical education and the community is being developed that will address research and clinical space. Rockford is completing a master plan of its site and buildings, and a new addition primarily addressing educational program needs, is being proposed for the University capital budget. Research and clinical space of the College are adequate or improving. In Chicago, the outpatient care center (OCC) now provides state-of-the art facilities to University patients. The Molecular Biology Building, opened in 1996, has provided additional modern research facilities. Obsolete and poorly maintained research space had previously been a chronic problem in Chicago; however, the new 300,000 square foot facility scheduled to open in 2004 will transform the research environment in Chicago. 20 Faculty Governance as defined in College Bylaws involves an elected Executive Committee with proportional representation among the sites and other committees primarily related to education. Two other standing committees (the Committee on Faculty Appointments, Promotions, and Tenure, and the Committee on Clinical and Adjunct Appointments and Promotions) are appointed by the Dean after consultation with the Committee on Committees, and each plays an important role in the promotion and tenure process. Each of the four sites of the College also has bylaws that define local governance. There is communication between site and College committees dealing with related issues through the membership of local chairs or their designees on the analogous College committee. Currently, there appear to be sufficient faculty in the basic sciences at each site for the traditional teaching, research, and University service missions. Most are full-time faculty in tenure track positions. This is accomplished in Chicago with a classic academic departmental structure; in Urbana, faculty have joint appointments in the College of Medicine and their respective University colleges or graduate departments; and in Peoria and Rockford, through the more inclusive Departments of Biomedical and Therapeutic Sciences and Biomedical Sciences, respectively. The departmental classification and academic track of faculty involved in clinical roles for the College also varies by site. Part-time and volunteer faculty play a significant role in the education of medical students at all sites; however, there is a much higher proportion of part-time and volunteer clinical faculty executing the teaching in clerkships and elective rotations at Peoria, Rockford and Urbana. While the educational leadership at these sites may face greater challenges of schedule coordination and faculty development due to the number of volunteer faculty, but there are potential rewards from such arrangements as well. Community-based clinicians seem quick to accept a mentoring relationship with our students, and the "real world" health care environment in which they practice may afford considerable practical application of the learning acquired in classroom discussions. The negative effects that current financial pressures produce upon clinical teaching paradigms seem to fall indiscriminately upon both full- time and volunteer clinical educators. Educational leaders must also be on guard to adjust the clinical curricula to account for these potentially deleterious, economic influences. At some sites of the College, the teaching, research and service missions have flourished by the hiring of new department heads that received additional faculty lines. Such recruitment has been extensive in Chicago and Urbana, less so in Peoria and Rockford. For the clinical faculty throughout the College, a tremendous effort in patient care is necessary to maintain appropriate levels of funding. This situation is exacerbated at the sites away from Chicago, with fewer clinical faculty to cover the workload. The College's system for promotion and tenure of faculty is impartial, with faculty serving an advisory role to administrators throughout the process. Peer reviews are conducted at the department, College, and site levels. The Criteria and Guidelines for Appointment and Promotion of Faculty in the College of Medicine are consistent with standards and procedures for academic rank as described in the University of Illinois Statutes and campus operating guidelines for both Chicago and Urbana-Champaign. Criteria for promotion and tenure are explicit, and faculty are informed about the criteria and tenure forms. Department heads are informed about the process in a timely manner at department head meetings and in writing. Significant variation in the amount of protected time for research is a problem for many clinical faculty members in the promotion and tenure process. Increasing demands to see patients leave less time available for research. Some tenure track clinical faculty do not have sufficient time for research and, consequently, do not meet the criteria for promotion and tenure. Department heads/chairs are advised to protect tenure track clinicians' time at the outset. Faculty recruitment in the College is enhanced by its reputation as an active research center in basic and clinical sciences. Recent capital improvements are important factors in attracting faculty. In Chicago and Urbana, generous start-up packages are available for new faculty. Although clinical faculty salaries remain below the national norm, basic science faculty salaries now average above the nationwide mean. 21 Hindrances to the recruitment and retention of faculty include inadequate physical facilities and low salaries in some areas. This is especially true in Rockford and Peoria, where research space has not been upgraded. Another hindrance is the relatively low level of benefits provided by the University. A study published in 1996 showed that the University of Illinois ranked last of all Big Ten schools in a comparison of benefit valuation and benefits as a percentage of salary. When comparing the College's faculty with the medical student population, there are some differences in regard to both gender and ethnic diversity. Approximately 26% of the faculty are women, whereas women constitute about 38% of the student body. In the area of ethnicity, there is a substantially greater difference between the faculty and the student population. While the College's percentages of minority faculty do not vary widely from national averages, it is our large number of minority medical students that creates the disproportion. The College has endeavored to increase its minority faculty and has benefited from site and University programs that provide financial support in terms of salaries and research start-up funds to newly appointed underrepresented minority faculty who are in the tenure track. There is a high level of interaction and communication among the faculty at all sites. We anticipate the level will increase over the next few years with new and developing program projects and centers. Participation on committees also facilitates interaction. Teleconferencing and video conferencing for various committees improves interaction otherwise complicated by the geographic separation of the four College sites. Professional growth and scholarship are fostered through ongoing College/site programs related to medical student teaching and appraisal activities, research development, and faculty education/awareness. Teaching and appraisal activities have led to workshops on teaching in the clinical setting, faculty development programs on small group teaching, workshops for student advisors, the Residents-As- Teachers Program, and widespread development of faculty skills in examination development and results analysis through the student appraisal system. Programmatic research development occurs primarily through the Office of the Vice-Chancellor for Research and its Office of Research Services. Faculty education/awareness programs include promotion and tenure workshops, sponsorship of selected faculty at national professional development programs, mandated mid-probationary review of all tenure track assistant professors, and annual evaluation of all faculty whose appointments are at 50% or greater. Individual program effectiveness is variable and is best determined by continuing faculty interest. The specific programs identified above are those that have demonstrated longevity. Mentoring of junior faculty occurs at site, College, and department levels, with varying success. The site and College initiated a mentoring program for all tenure track assistant professors. The College offers an orientation program for new faculty. The College of Medicine places high priority on teaching excellence, which is an important criterion for faculty promotion. A faculty committee developed A Handbook on Evaluating Teaching in the College of Medicine in 1995. Including more extensive teaching documentation in the paperwork required for the promotion and tenure review process has raised the awareness of the importance of teaching among faculty and administrators. Teaching excellence is also rewarded through several site and College awards, some of which include monetary prizes and / or increases to base salaries. Although there is no formal mechanism to evaluate faculty satisfaction in institutional decision-making, anecdotal evidence indicates general faculty satisfaction in decision-making of the College. Some dissatisfaction has been expressed with regard to faculty input in the distribution of resources. Library The Library of the Health Sciences (LHS) is an integral part of the UIC library system, with the senior administrator located in Chicago and associate site librarians in Peoria, Rockford and Urbana. LHS participates in statewide, regional and national library networks and serves as the NLM-designated Regional Medical Library for the Greater Midwest Region. LHS is considered an excellent resource for 22 medical and graduate students, researchers, and faculty. In recent years, healthy budgets have enabled the library to maintain the strength of its print collections, expand the electronic collections and support equipment upgrades. LHS has been able to leverage journal expenditures by canceling duplicate print subscriptions held at different sites and using the funds to support the acquisition of titles in electronic format as well as add new, unique print titles. In the year 2000, the overall UIC library subscribed to more than 2000 electronic journals, 1,200 books in electronic form and 186 searchable databases. The LHS system operates in an integrated fashion, with planning and coordination of services and resources among all four sites. Daily delivery service among the sites and use of an electronic delivery system ensures that items from one site can be quickly delivered to any LHS site requesting them. The LHS collection is supplemented by other components of the total UIC library, the UIUC library and other research libraries in the state and region. Hours of service of all library sites vary between 80 and 96.6 hours per week, with late night hours Sunday through Thursday. Extended hours are maintained during periods preceding examination. There is excellent user access to computers with high bandwidth Internet connections. These connect the libraries with both student and faculty-office terminals throughout the campuses on a 24-hour/ 7-day basis. With the advent of web-mediated academic content, AV display/playback equipment has been in lesser demand, but a substantial collection of VCR tapes and players is still maintained and used frequently. Individual study space and small group areas are available at all sites, but this sort of space is at a premium. Although the library space in Chicago is adequate, facilities are in need of renovation, and planning is underway relating to physical improvements in the building. The library supports education in off-site clinical teaching locations primarily through the steady growth of the virtual library. As noted above, UIC students, faculty, and clinician preceptors have 24/7 access to online services and resources from any workstation, even in hospitals and clinics with firewalls. The virtual library includes not only electronic databases, full text journals and textbooks, but also online tutorials and instructional web pages, so that users not only have access to resources, but also can receive instruction on how to select and use these resources at the point of need. LHS librarians also provide remote reference service, both by email and by telephone. Currently several initiatives are being explored that would expand reference service available at off-site locations. For example, LHS-Peoria recently piloted a "Chat Room" for real-time online help that allowed users to engage in a "chat" with a librarian for help with a search strategy or to answer a reference question. Due to the success of the pilot, the program is being expanded to include all LHS libraries. As noted earlier, LHS librarians also conduct orientation sessions, offer classes, and provide in-person consultation and assistance. Accessing information effectively is the first step toward critical appraisal of its usefulness. Utilizing newer technologies and scientific advances to foster scholarship will be vital for the continued enhancement of the students' future medical practice. There is extensive high-speed connectivity between and within the entire Chicago and Urbana campuses; high-speed lines also connect the teaching sites of COM at Peoria and Rockford. M1 students matriculating in Chicago are required to have computers capable of Internet connection. Many courses at all sites use web pages to post lecture handouts, images and other material presented in the curriculum. Because much database software is licensed, network identifications are assigned to all students and faculty for authentication. Currently, work is progressing to extend authentication capabilities to affiliated hospital libraries. Computer-assisted instruction (CAI) is used to supplement and enrich traditional methods of teaching. It serves as an excellent medium for bringing scarce or fragile resources, such as histology or pathology specimens to the desktop, and it allows students 24-hour access to periodical literature and full texts. CAI has been used for asynchronous discussions and dialogues with fellow students and instructors. Planned developments include pre-laboratory practice using virtual anatomy dissections and a virtual microscope that simulates the full adjustment capabilities of a conventional light microscope. The Histology course at Urbana already makes extensive use of a computer laboratory with a library of high-resolution specimens. The 16 case studies of the required M4 neurology course in Rockford have been available as interactive on-line study since AY98-99, largely for the benefit of RMED students who have a 16-week rural family medicine preceptorship requirement. There is a need 23 for greater resources to expand information technology resources and staff; this is currently being considered by senior administration. Clinical Teaching Facilities The COM's clinical resources are adequate at all sites of instruction. The College is sensitive to the importance of the comparability of educational resources at its multiple sites, and this applies as well to opportunities for clinical learning. At all sites, both clinical faculty and patients available for teaching are adequate for the size of the student body. Each clerkship has a director and other key faculty who participate in the teaching; where the services have residents, they participate also. Instructors provide grade recommendations, but the clerkship director makes a final grade assignment, based on a system standardized for that discipline across the four sites. The Chicago site has the largest enrollment. It currently uses seven affiliated hospitals and more than twelve affiliated clinic sites, as well as practitioners' offices. Quality assurance procedures are in place to confirm adherence to curriculum and adequacy of teaching via student evaluation, clerkship reviews and on-site visits by COM administrators. Urbana uses three primary hospital affiliations, Carle Foundation Hospital, Provena Covenant Medical Center, and the Danville Department of Veterans Affairs Medical Center. There are clerkship directors and teaching faculty in each discipline at all teaching sites. Students at Urbana see ambulatory patients at the three affiliates. Since mid-2000, clinical conferences, lectures and other didactic sessions in Urbana are centered in a Carle Hospital building specifically built for educational purposes, the Carle Forum, which is equipped with state-of-the-art teaching equipment. In Peoria, clinical academic teaching and patient care environments are integrated; both inpatient and ambulatory care is delivered via faculty at the school's two primary, not-for-profit teaching hospital affiliates (Methodist Hospital and St. Francis Hospital). Rockford uses three community hospitals (Rockford Memorial, Swedish American and St.Anthony) for its clerkships. In addition, the Rockford program, which has an emphasis on Family and Community Medicine, owns and staffs three University Primary Care Clinics, in which all students see patients one day per week over their last two and one-half years. This combination makes for an effective clinical teaching milieu. Throughout the system, administrators of the hospital/clinics and university administrators, from clerkship directors to deans, interact to solve issues and to accommodate the joint needs for teaching and patient care. Of course, neither the College of Medicine nor the hospital/clinics are immune from financial pressures, but in general, relationships at most of the clinical teaching facilities are stable. Facilities and faculty for the teaching of Primary Care are adequate. There is an increasing emphasis on recruiting primary care physicians at the affiliated clinics throughout the system. Early introduction to clinical medicine is stressed at both Chicago and Urbana (the two sites where M-1 instruction is offered): in Urbana through the Medical Doctor Advisor (MDA) program, and in Chicago through the Longitudinal Primary Care program. Both programs emphasize student assignment to primary care physicians. Student evaluations of this early introduction to clinical medicine are favorable. In summary, the facilities for library, computer and information technology, clinical teaching facilities, and patient access appear to be adequate to meet our current and projected programmatic requirements. There is need for physical renovation in the Library of Health Sciences in Chicago, but the effectiveness of the program is not impaired. The use of computers is well established throughout the system, and there is increasing use of information technology as an educational supplement. Increased funding for information technology would be useful. Traditional hospital and clinical resources for training are satisfactory; relationships and affiliations are stable throughout the system and they support an effective clinical teaching program. VII. Graduate Education in the Basic Sciences The College of Medicine has made a major commitment to graduate education in the basic sciences. The programs are chiefly located at the Chicago and Urbana campuses. At Chicago all of the programs are in departments of the College of Medicine. At Urbana these programs are offered by departments that are primarily administered by the Colleges of Liberal Arts and Sciences; Agricultural, Consumer & 24 Environmental Sciences, and Communications, but each has faculty jointly appointed by the College of Medicine. The majority of the graduate programs admit students to the PhD program and do not have a specific masters program. At the Chicago campus, the number of PhD students per department varies from 14 to 54; the Department of Medical Education has 98 students enrolled in its masters program. A total of 180 students were enrolled in programs last year; there were 25 doctoral degrees awarded. There are currently 40 students pursuing the MD/PhD degree in Chicago. As previously noted, graduate training takes place in one of the five COM basic science departments as well as in the Departments of Biological Sciences and Bioengineering in the Colleges of Liberal Arts and Sciences and Engineering, respectively. Four students will complete the program in 2001. The program accepts six outstanding students each year from undergraduate institutions nationwide. One of the programs for which the COM at Urbana is most well known is the Medical Scholars Program (MSP), which is co-sponsored by the College of Medicine at Urbana-Champaign and the UIUC Graduate College. There are currently 172 students enrolled in the MSP pursuing the MD degree along with graduate training in over 35 graduate departments and programs. Both the MD/PhD (Chicago) and the MSP (Urbana-Champaign) programs promote interaction among these aspiring physician-scholars with annual research symposia allowing students to present their research findings and also to hear prominent physician-scholars from throughout the United States and the world present their research and career path presentations. Seminar series, evening dinner seminars, and a graduation banquet foster group cohesiveness and camaraderie. At the Urbana campus, several NIH training grants form an important basis for funding students in most departments. At the Chicago campus, NIH training grants in Cellular Signaling in the Cardiovascular System, and Signal Transduction and Cellular Endocrinology, and a Training Program in Lung Biology and Pathobiology, help support a number of students in the programs. Interaction between the graduate and medical students is generally considered beneficial and helps the MD/PhD students bridge the content between the two training programs. In some departments senior graduate students assist in the development and implementation of some of the laboratory courses offered to medical students. This provides teaching experience for the graduate students and the medical students benefit by having more direct access to the student instructors. In addition, medical students in good academic standing at all four sites are encouraged to undertake research projects early on. The quality of graduate students and their training is reflected in their being highly competitive in regional/national student forums, and more important, by their placement upon graduation. A good example of the former is the medical student research forum in which both graduate and medical students from the College of Medicine have won awards at the midwestern and national competitions. The potential and manifest weaknesses in the graduate programs are not unique to this institution. The two major problems stem from (1) funding levels and (2) the continuing decrease in numbers of domestic undergraduates choosing to go on to graduate careers in the biomedical and life sciences. All of the departments involved have identified a necessity to raise the stipend offered for graduate studies. One aspect of recruitment that continues to be a national and local concern has to do with minority students. There has been a substantial and continuing effort by both the Chicago and Urbana campuses to reach out in various forums, locally and nationally, to minority student populations, including summer research experiences. Construction of new research buildings is underway on both campuses, and is expected to foster continued growth in biomedical research and excellence in the graduate programs. Appointment of two new department heads in the basic sciences at the Chicago campus in the next year will also be a positive developmental step. 25 VIII. Graduate Medical Education Graduate Medical Education in the College of Medicine is an integral part of the College and substantially impacts the education of medical students. Mechanisms for governance, oversight and evaluation of GME programs are well established at each site and function appropriately. The two sites with the most graduate programs, Chicago and Peoria, have been awarded the full five-year approval from ACGME. Programs without a substantial residency presence cope well with the services of attending physicians. Any changes envisioned are not of great magnitude. At the Chicago site, the Graduate Medical Education Committee (GMEC) provides oversight of the residency programs. In Peoria, central oversight is accomplished by the Joint Committee for Graduate Medical Education (JCGME) that includes all residency program directors and associate directors, department chairs, and hospital and university administrators. In Rockford, central oversight for GME (which presently consists of a Family Practice Residency) is provided by the Assistant Dean of Graduate Medical Education, in conjunction with the Residency Advisory Committee. In Urbana, the Residency Oversight Committee provides central oversight for the Internal Medicine Residency Program. All sites for which there is extensive contact between residents and students have a mechanism for acquainting residents with the educational objectives of their departmental clerkship and their role in teaching and evaluating medical students. Mechanisms vary from site to site. Most sites have some type of institutional program to teach residents how to teach and evaluate medical students. Chicago's Obstetrics and Gynecology Residency Program received probationary accreditation on November 30, 1999. No other residency is on probation. Overall, most of the residencies are remaining constant in size. However, a few changes are in process in Chicago. Physical Medicine and Rehabilitation will be phased out as of August 2001. The Ophthalmology, Otolaryngology, and Emergency Medicine programs are each decreasing the number of positions by three. The Cardiology program at Christ Hospital is being integrated into the Cardiology program at the UIC Medical Center. All of these changes are being made in response to market influences and to "right size" the programs to fit the available educational material. These changes should not have a negative impact on medical student education. The Urbana campus does not anticipate any major changes in their graduate medical education programs in the near future; however, they are currently exploring new training sites and identifying preceptors in surrounding communities who can support specific areas of the existing curriculum. Although there are presently no firm plans in Peoria to create new residency programs, or to expand existing ones, several opportunities for growth will be explored in the coming year. There are no plans to drop or reduce any existing residency programs. No significant changes are anticipated in the Family Practice residency that would impact the education of medical students at the Rockford site. IX. Continuing Medical Education Continuing medical education is an integral component of the academic program at all four College of Medicine sites and the College is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to grant Category 1 approval for CME activities. The four sites function as an integrated CME unit. The College CME Program is directed by the senior associate dean for educational affairs. Each site has a local CME Advisory Committee with an oversight committee, the College Committee on Continuing Medical Education at the College level. This approval process is consistent with ACCME policy and allows for standardization of CME activities. 26 While resources and staffing differ somewhat at each site, funding and available personnel at the four sites appear to be appropriate and adequate. Support for the parent College Committee on CME in Chicago and the college-wide support for the CME program is provided from state funding by the dean. Last year, revenue from these activities exceeded expenses by $188,147. Primary characteristics of the activities at each site are related to local educational program goals and to the size of clinical departments at the sites. Each site also has activities that target teaching skills, which therefore promote faculty development. In addition, undergraduate students benefit from CME in several major ways: 1) They attend CME activities, conferences, grand rounds, etc., as part of their clinical rotations, learning directly from program faculty. This offers the students the opportunity to learn beyond the basic curriculum, study topics of interest in greater depth, and interrelate with faculty/experts outside their normal contacts. 2) They interact with University of Illinois faculty who prepare, teach and attend CME activities. 3) They have the opportunity to observe attending physicians learning, which provides a positive role model for the life-long learning that the College endorses. 4) They benefit from faculty development activities aimed at teaching, since curriculum development and teaching methodology improve as a result. X. Research All sites of the College of Medicine have active research programs as measured by extramural funding, faculty publications in peer reviewed journals, and the opportunity for medical students to engage in independent research projects under the direction of a faculty sponsor with externally funded research programs. Research programs differ from site to site, but the general principle underpinning research at all four sites relies on cellular and molecular approaches to basic and clinical aspects of disease. Extramural funding for research programs has grown across all sites over the past seven years as reflected by the shift in the College of Medicine's NIH rank among the nation's 125 medical schools from 62nd in 1994 to 48th in 2000. Research programs in Peoria and Rockford remain modest since both of these sites were established as community-based medical programs to enroll about 50 students per class in the M2, M3 and M4 years. No significant deficiencies were identified in the institution's support for faculty research programs or in laboratory facilities. The most pressing needs continue to include adequate institutional support for maintenance of the physical plant and the improvement and expansion of the facilities available for faculty research at all sites. Some shortcomings have been corrected with the construction of new research facilities in Chicago and Urbana, but building repairs and maintenance continue to be chronic deficits in institutional support that plague the physical plant available for research at all four sites. Institutional Review Boards operate at all sites, and all have been remodeled to comply with contemporary expectations for investigator education, the privacy and consent of research subjects, and conflicts of interest as promulgated by the Office for Human Research Protection, Department of Health and Human Services. Education programs are in place at all sites to make students, residents, staff and faculty aware of the need to adhere to a common set of ethical principles governing the conduct of research and the need for the objective management of real or perceived conflicts of interest in the conduct of basic or clinical research. XI. Medical School Departments Basic Science Departments There is a major commitment to medical and graduate education in the basic sciences at the College of Medicine. At the Chicago and Urbana sites, the basic sciences are organized along traditional departmental lines such as anatomy and cell biology, pharmacology, physiology and biophysics, and microbiology and immunology. A noteworthy change on the Chicago campus is the pending merger of the Departments of Biochemistry and Molecular Biology and Molecular Genetics into one department. The structure of the basic science programs varies from campus to campus. All four campuses have Departments of Pathology. The Chicago campus includes a Department of Medical Education that plays a unique service role in the College of Medicine. The Urbana campus has a Medical Humanities and 27 Social Sciences Program whose mission is to foster and develop a high quality interdisciplinary research and education program between medicine and health care on the one hand and the humanities and social sciences on the other. At the Peoria and Rockford campuses, the basic science disciplines come under the aegis of single Departments, Biomedical and Therapeutic Sciences and Biomedical Sciences respectively. The Department of Biomedical and Therapeutic Sciences in Peoria changed its name from Department of Basic Sciences in 1995 to better reflect the addition of its new section of Clinical Pharmacology. This department is now responsible for the teaching of microbiology and pharmacology, which includes clinical pharmacology and therapeutics to medical students and residents. The Department of Biomedical Sciences in Rockford is responsible for teaching primarily pharmacology and microbiology to second- year medical students and is currently exploring the development of a masters degree program in Biotechnology. Most departments throughout the College of Medicine have an elected Advisory Committee and those with graduate programs, a Graduate Education Committee. The consensus of the COM faculty is that they have adequate input at the departmental level. While there are some departments on the Chicago campus in need of space renovation, physical facilities have been improved by the opening of the Molecular Biology Research Building and renovation of research laboratory space in some COM basic science departments. As previously noted, the new College of Medicine Research Building scheduled for opening in spring 2004 will address many of the space problems that exist today. On the Urbana campus, some departmental space has been renovated and the Regional Dean is developing plans for the construction of new laboratory space, which should improve the physical facilities. The situations relevant to space and facilities for the basic science departments are somewhat different at the Peoria and Rockford campuses. At Peoria, the facilities are approximately seven-years-old and currently undergoing renovation. This has created less than optimal working conditions due to repeated space reassignment and moving laboratories and equipment. Once renovations are complete, it is expected that the short-term space needs will be adequately addressed. Moreover, the Regional Dean is developing plans for the construction of new laboratory space, which should improve conditions and enhance recruitment of new faculty to the campus. At Rockford, office and laboratory space are currently adequate. However, new laboratory space is being considered in the evolving capital building proposal to address regional needs. Financial resources for the basic science departments are constrained, as they are throughout the College of Medicine. Funding for faculty salary increases, recruitment of new faculty and replacement of aging equipment is a concern for the entire COM but appears to be more acute on the Peoria and Rockford campuses. The ability to conduct departmental research derives primarily from extramural funding. All departments appear to be meeting their current teaching obligations, but the ability to expand or develop new programs in some departments would require infusion of additional funds. Overall, the number of faculty positions in the basic science departments currently appears to be adequate to meet the departments' responsibilities. In Rockford, Peoria and Urbana, some departments are quite small, but they meet their teaching, research and service obligations because of the exceptional efforts of their faculty, often relying heavily on part-time and volunteer faculty. When departments have hired new full-time faculty, the quality has indeed been impressive. Within the last 3-4 years, several new Department Heads have been hired within the COM and have done an excellent job providing leadership and direction for their respective departments. The presence of graduate/research programs in the Basic Science departments is beneficial to the training atmosphere for the medical students. Very often, both graduate students and postdoctoral fellows play an important role in the day-to-day learning experience of the medical students. In several departments, 28 graduate students and postdoctoral fellows assist faculty members in supervising course laboratory sessions and tutoring students. The quality of teaching is evaluated by class observations by both faculty and students. Student evaluations include written commentary at the end of a course, meeting with student review groups during the course and informal feedback. Course evaluations are conducted by the Curriculum Committees, and they are discussed at the departmental level and with individual faculty members by the Department Head. Student satisfaction is regularly evaluated by questionnaire; students are generally satisfied with the quality of their instruction in the basic sciences. Active research programs are present in all departments, as evidenced by the following: extramural grants and contracts, publications of papers in top quality peer-reviewed journals, service on peer-review grant committees and editorial boards, and participation in national and international symposia and scientific panels. The level of extramural funding, particularly NIH funding, has increased year-by-year and several departments are listed in the top quartile of NIH funding nationally. These activities are judged to reinforce the quality of teaching provided to the medical students. Faculty serve on various departmental, College of Medicine and University committees. They engage in service nationally as journal editors, on editorial boards, on NIH study-sections and other scientific review committees, and as organizers and chairs of national and international meetings. Faculty regularly participate at major meetings in their fields of interest and routinely review manuscripts for major journals. In addition, they participate as invited speakers at other institutions' lecture series and in departmental lecture series within our College of Medicine and University. Clinical Science Departments The Clinical Departments in each of the four sites of the College are functioning effectively and meeting the goals of teaching, research, and clinical service. Many departments face unique challenges, and variations in community needs may modify the departmental focus of the separate sites of the College. For example, subspecialty departments (e.g., Urology and Emergency Medicine) exist only on the Chicago campus. When subspecialty units are not part of the program site structure, the teaching and research functions in these disciplines are fulfilled in the departments of Medicine and Surgery on the regional campuses. A detailed listing of faculty numbers by department for each campus is included in the Clinical Science Department Summary table in the database. The assessment of the Self-Study Group is that the number of faculty on each campus is adequate to maintain an effective and comprehensive program of teaching, research, and service at each site. There is a reasonable blend of junior and senior faculty on each campus. Many departments have exhibited significant growth in numbers over the past several years. For example, the Family Medicine Department on all four campuses has exhibited marked increases in faculty numbers of between 20 and 50% since 1994. Most department heads have held positions for a length of time, which provides stable leadership to the College. Some key positions are currently anticipating the retirements of long-time department chairs; interim personnel lead others. All educational sites have been blessed with a dedicated cadre of volunteer and part-time faculty who provide significant teaching and clinical service for the College. However, heavy reliance on these faculty may place the departments in a difficult situation should significantly increased demands for clinical productivity be placed upon faculty by outside forces, such as hospitals and health care systems that employ these physicians and teachers. At this time, departments have been able to adapt to changes in their local medical communities and thrive in spite of these concerns. Total expenditures and grant and contract revenue summaries are listed for each clinical department in the database. Each department, particularly those involved with primary care, has noted increased pressure for clinical productivity on the part of their faculty. Some departments, most notably Pediatrics and Emergency Medicine in Chicago, are markedly affected by this trend. The populations that these 29 departments serve are largely indigent, and reimbursement for care of these patients is relatively low and difficult to collect. As a result, clinical duties significantly impact the volume and quality of scholarly activity that faculty members can produce, adversely affecting eventual promotion and retention on the tenure track. In large measure, however, the clinical departments have been able to develop diverse funding strategies and adapt to changing conditions to adequately fund their educational, research, and clinical service programs. With few exceptions, space and facilities resources are currently adequate to allow the College's clinical science departments to fulfill their missions. In certain instances, facilities are described as out of date, but plans are underway to renovate much of this space. Often affiliated hospitals and health care entities have been extremely generous in donating and sharing space with the educational programs of the College, especially in the regional sites. In particular, the Carle Foundation Hospital and Clinic in Urbana has been very supportive. Some sites, particularly in Chicago and Peoria, note that recruitment of new faculty to their departments has been hampered to some degree by limitations of space for research and laboratory facilities. In other cases, space is adequate but scattered throughout a community, making departmental communication difficult. Many of these problems are already being addressed, particularly in Peoria where anticipation of a regional children's hospital may remedy the space difficulties of the pediatric department there. The multiple teaching programs provided by the clinical departments appear to be effectively achieving their goals. Many departments, in particular those on the regional campuses, have both teaching and clinical service to their communities as central missions. Faculty time commitment to teaching is high, especially among the volunteer faculty in these regional campuses. Residencies run by the College are well respected and popular. Departments responsible for core required clerkships assure uniformity of clerkship goals and assessment procedures through their respective Educational Coordinating Committees, which meet regularly. Overall responsibility for these teaching programs rests with the College Committee on Instruction and Appraisal. Research productivity is a priority of the College, not only in Chicago, but in the regional sites as well. In many departments, despite a stated focus on education and service, significant research funding, productivity, and scholarship have been achieved. Many departments have significant plans and expectations to increase their faculty's research productivity. In some cases, however, these plans are hampered by a lack of available space and resources to carry them out. Some departments are prevented from participating in research unless they receive a significant increase in resources. In some instances, clinical demands have been increasing to the point at which scholarly activity and research productivity become difficult to achieve, as stated above. In large measure however, the clinical departments of the College have had some success in crafting mechanisms to protect time for faculty to complete important scholarly work. The output of the faculty has been significant. The departmental reviews reveal that significant clinical service is provided in all sites by all clinical departments. The demands of service, and especially of generating patient care dollars as a means to fund the activities of the departments, has been noted. Despite faculty concerns about the uncertain nature of this trend, to date the College clinical departments have been able to meet the service requirements of their communities without sacrificing the quality of either the teaching programs or the research efforts for which they are responsible. These departments, while not resting easily about this situation, have so far been able to meet the challenges and maintain a high level of quality in all spheres of activity. 30 SUMMARY Strengths Educational Program The development and acceptance of the graduation competencies in both cognitive and non-cognitive domains, with full endorsement of the four regional sites as well as the College Executive Committee, provide a major mechanism for coordination of the curriculum across all program sites. It has enabled us to look at our multiple curricular tracks (RMED, RSPP, MSP, MD/PhD, MD/MPH, MD/MBA, James Scholar), and insure that they meet this set of basic competencies while still enabling them to provide additional emphasis for the multiple programs of the College. This and the unique characteristics of each program site provide the ability to accomplish our multiple missions. The College has a very extensive curricular review process that provides for comparability and quality of educational experiences at all sites. The responsibility for implementing this process belongs to the College Committee on Instruction and Appraisal (CCIA) in conjunction with the senior associate dean for educational affairs. CCIA reviews the overall curricula from the program sites and the special programs such as MD/PhD, James Scholars, and RMED. These programs and curricula are reviewed using a well- defined protocol that provides formative as well as summative evaluation. The individual courses and clerkships are reviewed by the program site curriculum committees and reported to the CCIA. Many of these reviews utilize modifications of the same review protocol; most are done on a three-year cycle. The effective role played by the Dean's Office, the Education Coordinating Committees, and the CCIA in the development of College-wide standards for curriculum and evaluation has insured comparability of experience and of student assessment across all program sites while permitting the regional curriculum committees to take advantage of their own unique community, needs, and facilities in implementing the curriculum. The decrease in basic science contact hours in the M1/M2 years has provided the time to more fully incorporate the needed early clinical experiences and the integrative approach to basic/clinical sciences. The early emphasis on the role of the literature and evidence based medicine has provided our students with the beginnings of their experiences in lifelong learning. Faculty The College faculty is strong and experienced, with continuing recruitment to assist in its growth and renewal. The faculty has demonstrated excellence in and commitment to teaching, and is productive in research as well as service. In FY 00, the faculty was awarded over 64 million dollars in external funding; during that time, approximately 1,700 scholarly publications were authored. We have had superb results in our department head searches and have been able to recruit several eminent heads. We have brought our basic science faculty salaries up and they now average above the national mean. We have been able to recruit and maintain a large number of dedicated volunteer and part-time faculty enabling us to provide for early clinical experiences for our students as well as providing for the needs of the clinical clerkships. This is one reflection of the strong teaching commitment at all the program sites and in the clinical settings at those sites. Admissions The large applicant pool is more than adequate to allow the College to maintain its enrollment and select candidates who reflect a diverse and capable student body. While the applicant pool for MD programs has decreased nationally by almost 14 % and by Illinois residents by 17.5%, applications to UIC COM have only decreased by 9.6%. Furthermore, despite the fact that the Admissions standards have risen each of last four years, the number of qualified (academically eligible) applicants has increased by over 26%, suggesting an increased awareness of the quality of the program, as well as a continued demand for its existence. 31 Graduate Placement Over 87% of each year's graduates receive one of their first three choices for residency programs. In 2000, 96% of the graduating class participated in the National Residency Matching Program, and 97% of these were successfully matched in a residency program. These figures are clear indicators of our students' success in progressing to the advanced stages of medical education. Role of Graduate Medical Education Having successful graduate medical education programs help the medical student curriculum and teaching in many ways. Dedicated, talented physician faculty are often attracted to the medical school because of the graduate medical education programs and become involved with medical student teaching as well. This has been a major source of volunteer faculty. The stability of the GME programs and the five-year ACGME accreditations in Chicago and Peoria, attest to the strength of the GME activities. All sites in which substantial resident-student interaction exists provide residents help in developing teaching and evaluation skills to enhance their effectiveness with students. Major effort is being placed on furthering this teacher training. The College's GME education sites have access to large and varied patient bases. These are the same sites used by our medical students. In many instances, the ability of the College to use some of these patient care sites is because of the presence of the residents. For many institutions and practicing physicians the presence of residents represents the "coin of the realm," the real incentive for their participation in the teaching program. Research Research income has been growing at double-digit rates in Chicago and continues to be strong in Urbana. All four sites have active research programs as measured by extramural funding, faculty publications in peer-reviewed journals, and the opportunity for medical students to engage in independent research projects under the supervision of a faculty sponsor with externally funded research programs. Extramural funding for research programs has grown across all sites. Organization and Governance The College functions well as "one College" and communication among the geographically separate sites is excellent. The governance structure affords all sites sufficient flexibility and autonomy to develop individual strengths and to respond efficiently to local concerns and issues, while ensuring that all sites act with a common sense of purpose and direction such that the curriculum across the sites is comparable and of uniformly high quality and that academic administrative decisions adhere to a common set of policies. The governance structure includes college wide committees that utilize a uniform policy for student progress and promotion, with initial review at the site and final action by the College Committee on Student Promotions (CCSP). This parallels the functioning of the College Committee on Instruction and Appraisal with the site curriculum committees. Facilities The College has recently significantly expanded the "Clinical Performance Center" in the former pediatrics clinic in Chicago. This has more than tripled the space available for standardized-patient-based performance assessment. In Urbana-Champaign, the College has access to outstanding facilities, e.g., the Beckman Institute for symposia and conferences, and the new Carle Hospital Foundation Forum teaching building, which has become a primary center for instruction in the second year. Clinical Teaching Facilities There is a strong commitment for space allocation and teaching space from clinical partners and hospitals, especially in the regional campuses. Our multiple primary teaching facilities provide a diverse clinical experience and educational environment. These facilities range from rural and urban ambulatory health care centers, to community hospitals, major metropolitan hospitals, a university hospital and Veterans 32 Administration hospitals. The ability of students to select clerkships in a variety of clinical settings exposes them to the diversity of environments in which medical care is provided. Areas of Concern Students Student health services and insurance historically have differed at each site. There is now a single health insurance plan and a single method for the operation of the health service. As the new plan has just been implemented it will need careful monitoring to insure its success and equality of service throughout the College. Tuition has increased rapidly and significantly. Although there are no additional increases in the planning, the impact of these increases has been significant on our student body. Additionally, the University has instituted a surcharge on all tuition which adds to the concern. Faculty There is a disproportionate reliance for clinical teaching on part-time and volunteer faculty. This reliance necessitates increased faculty development as well as more intense monitoring of the teaching. Dependence on volunteer faculty places some activities at risk if outside forces place more demands on faculty members, particularly in regional sites. Reliance on clinical dollars from patient care activity constrains significant teaching and research productivity of faculty in some departments. At the same time clinical faculty salaries remain below the national norm. Inadequate physical facilities and low salaries in some areas hinder recruitment and retention. This is of particular concern in Peoria and Rockford. Finances In a number of disciplines, the faculty salaries and medical service plan salaries are below national norms. Furthermore, the University of Illinois is ranked last among Big Ten schools in a comparison of benefit valuation and benefits as a percentage of salary. These issues do not seem to have caused any major retention or recruitment problems over the past several years. Revenues from clinical practice (Medical Service Plan) have been flat at all sites for the last four years. Facilities There are significant facility concerns throughout the college sites. None of them have prevented teaching/learning activities although they have made the activities less pleasurable and difficult to accomplish. There is a deficiency of small rooms for teaching in Chicago, but there is a plan to renovate space as it becomes available when the new COM Research Building is completed. The student facilities in Chicago are inadequate for the size of the student body and there is no way to provide space for learning communities or even the current special curricular programs. Facilities in Chicago are in need of renovation and all sites indicate a need for modern research space. Several capital projects have been initiated to address these problems. The problem of deferred maintenance and aging facilities will continue to be a problem for the foreseeable future. The College Financial Aid Office as well as the Admissions Office have inadequate space in which to operate. 33 There is a serious need for either upgraded or new educational space at the Rockford site. The current primary classroom and multi-use small group rooms are inadequate for the evolving educational programs. Additional room for augmented student support, offices for our new and expanding programs, and enhancements to the library and food service facilities could be included in the building project. At Urbana, the M1 lecture hall needs extensive remodeling to address problems with lighting, environmental control, acoustics, and seating. Recommendations for Improvement College Committee on Instruction and Appraisal The Committee has been effective in the monitoring of the curriculum at the program sites and for review of the special curricular programs. It should implement the evaluation methodology approved by the Committee in the past and adopt or modify it to be used for course and clerkship evaluation at the program sites. In order to best modify the M1/M2 curriculum to meet the changing needs of the community and the College there needs to be a continuous review with special attention to the M1/M2 density and integration of the courses and content. Continuation of the process of replacing lectures with small group activities and the additional use of web-based systems to supplement laboratories should be explored. The grading system in place has not been reviewed since its major overhaul several years ago. Now that the honors criteria are stable and consistent across all program sites, and there is a Basic Science Education Coordinating Committee to monitor the grading in the M1/M2 years, it is time to reevaluate the criterion-based system in the clinical years. This process should be implemented through the clinical Education Coordinating Committees, coordinated and approved by CCIA. Mid-clerkship feedback to students is a requirement, but remains problematic. Clerkship directors and the program site curriculum committees need to enforce the required mid-clerkship formative evaluation. At the same time there is a need to enhance the student evaluation and feedback process. Several Self-Study groups as well as the LCME Task Force suggested there should be an increased use of standardized patients in clinical teaching and student assessment Efforts must be continued to further integrate the graduation competencies into the curriculum and develop appropriate instruments for measuring attainment of these competencies. The Committee should investigate mechanisms for the integration of the Graduation Competencies with the ACGME and ACCME competencies. Collaboration among the Program Sites Better coordination among program sites is needed to encourage more frequent exchange among the student body for clinical clerkships and especially for senior electives. Efforts to identify opportunities for more collaborative research across all sites should be formalized. Use of Outcome Data The Outcomes Study data should be used to evaluate the special curricular programs as well as the standard curriculum to determine if the programs are meeting their goals. The data from the Outcomes Study should be presented to the appropriate committees to review the admissions process, the success of our students, and assess the need for curricular change. Finally, the data need to be analyzed by the COM Executive Committee to fulfill its role in enforcing educational accountability. 34 Continuous Operation of Education Coordinating Committee The Office of Educational Affairs must carefully monitor and assist the Education Coordinating Committees in meeting their charges. It must provide the resources and data needed to accomplish their charges. Use of Computer Technology in the Curriculum Efforts should be undertaken to evaluate the role of computer-assisted instruction in the overall curriculum and to explore which methods are most efficient in increasing current and continuous lifelong learning. This should be a charge for CCIA and the Office of Educational Affairs for the current academic year. The specific charges to these groups should be to optimize the benefit of computer technology in the curriculum as an adjunct to traditional faculty-student interaction; the role of web-based and other forms of computer-assisted learning; how to enhance the use of information technology in the curriculum; and the use of computer technology in case-based studies to assist in decision analysis, clinical decision- making, evidence-based medicine, and problem solving. Faculty Development With the pressures on faculty to generate more income from grants and patient care while more faculty time is needed to teach in small group settings, the role of faculty development becomes more important than ever. Formal teaching programs for faculty and residents need to be expanded. These programs should focus on the specific skills appropriate to the individual faculty member's teaching/learning needs. In order to maintain an atmosphere of scholarship, additional faculty development is needed to help faculty maintain their research and other scholarly activities and the residents begin their efforts in these areas. Library Resources With the goal of creating lifelong learners and providing the students with the foundation for dealing with uncertainty in order to properly utilize the principles of evidence and the evidence-based medicine process, the library must have the appropriate budget, personnel, and facilities. Faculty from the Library of the Health Sciences should have joint appointments in the College of Medicine and participate as members on the curriculum committees. Facilities Physical plant maintenance must be a serious consideration by the University for all its campuses including the program sites of the College of Medicine. An example is the need at Urbana to remodel the M1 lecture hall. Additional space needs to be found to provide the appropriate environment for efficient, user-friendly offices for Financial Aid, Admissions, and the Urban Health Program. In Chicago, a teaching/learning center is needed; architects should be retained to develop the plans. Additional student space is needed for study and relaxation. At Rockford there is also a need for more small group teaching rooms as well as a student recreational area. Students The College needs to identify additional financial resources to provide financial assistance to students through increases in scholarships and additional loans. 35
Pages to are hidden for
"UIC COM Curriculum Overview"Please download to view full document