Background
In 2008, the Wuhan University (WU) Health Sciences Center in Wuhan, China invited the University of Chicago (UC) to serve as Technical Advisors to their medical education reform effort. Among the issues to be addressed were a largely lecture-driven curriculum, poorly integrated basic and clinical sciences, limited opportunities for small group, case-based, and independent learning, lack of formative evaluation, lack of a Department of Community and Family Medicine linked to public health and infectious disease care and prevention, and outdated teaching methods and materials.
Leadership, Faculty and Progress (2009)
Established elements of the WUMER Project leadership include:
Commitment of Dean Zhou Yunfeng, WU Health Sciences Center
- Oversight by Vice Dean Yang Jiong and Vice Dean Yu Baoping
- Designation of Course Directors with protected time for reform Working WUHSC Committee for reform review and approval
- Institutional agreement to collaborate, and Intellectual Property Agreement
In year one, 11 UC faculty visits to Wuhan were made for assessment and early demonstration of key training methods at W. Eleven WU faculty visited UC in April, 2009 for 2 weeks, and another 4 WU faculty visited UC for one week in October and November, 2009. Progress has been made in further assessing clinical education needs at WU, linking faculty from the UC with areas and courses to develop for WU. Internet access has been granted that will enable WU faculty and students to share the UC year 2 ‘clinical pathophysiology and treatment’ (CPPT) course.
A new curriculum is in formation, and the first reform course in Anatomy is being taught in the fall semester of 2009. The Pritzker Initiative structure in the basic science years will be adopted. Best practices in clinical reasoning, training physical diagnosis and history-taking, formative evaluation, and ethics and professionalism are being adapted and scaled for use in Wuhan.
Results (2009)
WU began implementation of the revised curriculum and methodology for 50 MS1 students in September, 2009. Current plans will reduce lectures and increase lab, small group, and independent learning to 44% overall, with greater reductions in the senior years. An eager and aggressive Faculty Steering Committee has been created to develop and implement reform, and faculty ‘Course Directors’ have been assigned for the first time at WU with protected time for faculty to meet these new responsibilities.
Patient encounters will begin in the first year. Operational research will compare training outcomes in students participating in the reformed structure to students trained in parallel with the standard curriculum. A longitudinal track for scholarship, research, and service based on Science and Discovery is in formulation, and student participation in reform is active and integrated into all aspects of the reform process. A new Department of Community and Family Medicine is in formation that will serve an important role in China’s new health system reforms that include the expansion of primary health care and the provision of health insurance to all of its citizens. These plans are presented in greater detail in this poster.
Integration of Basic Sciences in Year 1 and 2
- Introduction of anatomy and cadaver work in year one
- Modeling the Pritzker Initiative in year two: 1) Cells and molecules: biochemistry, cell biology, and genetics; 2)Tissue stucture and function: Histology and physiology; 3) Response to injury: Pathology, pathophysiology,immunology, pharmacology, and microbiology
- Emphasis on case-based discussions
- Reduction in lecture time by 40%
- Increase in small group discussions and workshops
- Increase time for independent study and self-learning
- Inclusion of formative student evaluations and opportunities for
- student evaluations of faculty
Clinical Pathophysiology and Therapeutics (CPPT)
- 12 month course structure
- Combined teaching by clinician and pathologist or basic scientist
- Access to CPPWeb via secure network with password protection
- Full-scale launch in fall 2011
Modification of Clinical Clerkships- decision-making
- greater student independence as teachers and researchers in development
- an earlier introduction of exposure to clinical encounters and history taking a stronger emphasis on ongoing student evaluation with proven assessment tools
- broader use of new technologies
Operational Research
The WUMER Project Evaluation is a longitudinal study of student and faculty attitudes regarding medical education reform, and of the outcomes of reform on student learning. This study was approved by the Wuhan University Ethics Committee and University of Chicago Institutional Review Board (IRB #09-126-B) in 2009. We conducted an annual general survey of students and faculty that included closed ended questions with Likert scales organized within the domains in the Global Minimum Essential Requirements in Medical Education, which are modeled on the domains for medical education established by the United States American College of Graduate Medical Education (ACGME).
In August, 2009, two student focus groups and one faculty focus group were convened to test the survey questions and instruments, after which the survey was modified. In future years, follow up annual surveys will be conducted among student and faculty respondents to the initial questionnaires and analyzed for changes and trends over time for each respondent, and cross-sectional comparisons between the reform and standard curriculum students will be conducted.
Focused surveys were completed following the Human Body and Cells, Molecules, and Genetics (CMG) course in June, 2010 in randomly selected students in the intervention and the control groups. Similarly, focused surveys on Clinical Reasoning and Community Medicine were completed in 2010 to serve as a baseline against comparison for the medicine clerkship, and at the local Community Health Center (CHC) that will serve as a site for the Family and Community Medicine Clerkship. Similar focused surveys will be completed in future on the remaining reform basic science courses, on the CPPT course, and on the clinical clerkships in the later years of training, as well as on specific topics of interest, such as professionalism and communication.
WUMER Steering Committee members at the University of Chicago
Faculty:
Scott Stern Renslow Sherer Karl Matlin Aliya Husain
Eugene Chang Funmi Olapade S. A. Schumann David Pitrak
Jean Luc Benoit Mari Egan Joel Schwab Mark Potter (UIC)
John Schumann David Meltzer Vineet Arora John Schneider
Jennifer Christoff Karen Frank Adam Cifu Halina Brukner
John Schneider Callum Ross Rimas Lukas Wei Wei Lee
Anthony Montag Sujata Mehta Ni Liu Federico Innocenti
Students:
MS2: Kelly Ledbetter; Dan Thorngren
MS3: Yiuka Leung; Kate Lemler; Mu Xu
MS4: Aaron Cole; Minna Chen; Tiffany Chen; Laura Zhang; Nicole Bultrushes
PGY: Yang Shen; Elaine Lin; Nancy Luo
Anthropology: Jenny Hua
