CareForward Curriculum

 

 

Introduction

The mission of Eastern Virginia Medical School is deeply rooted in the education and training of genuinely caring and competent physicians, equipping them with the requisite scientific, academic and humanistic skills most relevant to today’s practice of medicine. Our institution also strives to prepare students to be lifelong learners capable of adapting to changes in medical practice. EVMS is committed to improving program performance and student learning outcomes using data-driven decision processes. As a result of our pledge to excellence, EVMS has the strategic opportunity to implement the next phase of improvement to the CareForward Curriculum (CFC).

The EVMS Faculty and Curriculum Team designed the CareFoward Curriculum to enhance learning through integration and innovation. The purpose was to develop and nurture the growth of individuals on their lifelong journey striving to be caring, compassionate, and skillful clinicians.

Rationale

In our next iteration of the CareFoward Curriculum, CFC-2.0, we seek to enhance the current medical program and build on its strong foundation. We remain unequivocally committed to developing and nurturing the growth of caring, compassionate, clinically proficient, culturally humble, community-oriented physicians!

EVMS School of Medicine is redesigning its curriculum to support our students’ growth and continued success while simultaneously adapting to changes in the medical education landscape and future clinical practice.

• Increase time for students to practice and develop clinical skills across the entire curriculum
  • Additional time for elective phase rotations
  • Earlier start to clinical clerkships
  • Accelerated pre-clerkship phase (achieved via refining the sequence and delivery of content)
• Refine vertical integration of curriculum and assessment
• Enhance coaching of student skillsets within and across phases of the MD program
• Preserve dedicated study time for USMLE Step 1 preparation while increasing dedicated time for Step 2 preparation
• Increase time for preparation for components of residency applications

Guiding Principles

Aligning closely with the EVMS MD program’s mission and objectives, faculty, staff, and students collaborated to develop guiding principles for planning and decision-making related to the CareForward Curriculum redesign. The principles noted in the diagram below create foundational touchpoints against which curriculum decisions are evaluated to ensure we remain consistent with the overarching goals of the new CFC-2.0. Additionally, this group identified a set of base assumptions, as seen in the dark blue circle, which indicate set criteria the new curriculum should meet overall.

 

Medical Education Program Objectives (Updated for CFC-2.0)

The EVMS MD program graduates are community-oriented physicians who serve their patients, colleagues, and the broader community with cultural humility and excellence. They seek to improve health outcomes through scholarship, patient education, and health prevention while supporting their personal well-being.

Medical Education Program Objectives (MEPOs)

CareFoward Curriculum 2.0 Diagram

 

Pre-Clerkship Phase Courses

CFC 100 - Human Structure (8 Weeks)

The Human Structure course provides a comprehensive overview of clinically relevant human anatomy through a case-based, collaborative approach. The module describes the human body’s form, structure, function, and development by recognizing typical variations and using these variations to describe and explain clinically relevant abnormalities.  Students utilize critical thinking skills and then learn to integrate the anatomical sciences and medical imaging while engaging with content that strongly emphasizes cultural humility, professionalism, and ethical behavior.  Students will also begin their journey in clinical skills, learning essential aspects of the “clinical conversation” such as taking a patient history using a culturally humble approach.

CFC 101 - Foundations of Disease (10 Weeks)

Foundations of Disease provides the fundamental building blocks necessary to progress to subsequent organ system modules within the curriculum. Foundational concepts are linked to corresponding pathological conditions, prioritizing the principles necessary for discriminating health and disease and predicting clinical manifestations from available data. Covered in the course are molecular cell biology and genetics, biochemistry and metabolic disorders, and the interaction of cells with their environment, including the fundamental concepts of neoplasia. Basic principles of pharmacodynamics and pharmacokinetics are introduced, and relevant pharmacology is integrated throughout the course.  Fundamentals of the immune system are also covered, with context provided by introducing microorganisms and corresponding infectious diseases.  General mechanisms of disease and the core principles of pathology are fully integrated throughout the course.

To address clinical skills, students will learn physical exam techniques and develop the exam skills required to obtain a core physical examination.  They will gain practice in interpreting clinical information and generating differential diagnoses.  Students will also learn and apply the basic principles of biostatistics, the scientific method and Evidence-Based Medicine (EBM) as they apply them to clinical problems.

CFC 102 - Introduction to Organ Systems (10 Weeks)

Introduction to Organ Systems represents the transition to organ system courses in the Care Forward Curriculum.    Students will explore the histology, immunology, microbiology, pathology, physiology/pathophysiology, and pharmacology of the following – heme, musculoskeletal (muscle/bone), skin, and gastrointestinal organ systems.  Integration is achieved across all major medical basic science disciplines, from normal anatomic and physiologic functions to abnormal disease states to relevant pharmacotherapy.  Students continue to develop their clinical skills such as hypothesis-driven data gathering, prioritizing a differential diagnosis, developing a problem representation, comparing/contrasting illness scripts, and proposing a leading diagnosis relevant to these organ systems.  

CFC 103 - Hormones and Reproductive Health (9 Weeks)

The Hormones and Reproductive Health course will enable students to acquire and apply knowledge of internal homeostasis/metabolism and reproduction from basic science to clinical situations.  Students will review the embryological and anatomical development of the endocrine system and reproductive tract; they will acquire and apply physiological, pharmacological, and pathological knowledge necessary to prevent, evaluate, and treat metabolic, endocrine, male and female reproductive disorders, sexually transmitted infections, and breast diseases.  Students will participate in discussions of the ethics of reproduction. They will also develop their clinical examination skills by working with standardized patients trained in teaching female pelvic and breast exams, male genital examinations, and using ultrasound.

CFC 200 - Heart, Lung, and Kidney (10 Weeks)

In Heart, Lung, and Kidney, students will learn about the disease processes which affect the cardiovascular, pulmonary, and renal systems in a fully integrated manner. The course builds upon students’ prior understanding of the structure of these systems. It provides students with the tools to recognize causes and potential diseases and develop diagnoses and management plans for diseases of the heart, lungs, and kidneys based on signs, symptoms, and diagnostic results. Intricate working relationships between these three organs will be reinforced by discussing disease states such as acid-base imbalances, hypertension, heart failure, chronic kidney disease, and atherosclerosis. Students will use clinical cases to integrate basic science and clinical concepts related to these systems.  In addition, appropriate medical imaging and diagnostic techniques are introduced, including ultrasound, pulmonary function testing, and EKG interpretation.

CFC 201 - Brain, Mind, and Behavior (9 Weeks)

The Brain Mind & Behavior course is devoted to developing an understanding of the nervous system.  This course intends to foster active, self-motivated learning with a strong professional drive to master the content of functional neuroanatomy, neurology & neuropathology and psychopathology.  Students will use clinical cases to integrate foundational science and clinical concepts to learn to localize the lesion, develop a differential, interpret physical and diagnostic exam findings, and determine appropriate treatment.  Clinical skills knowledge will expand, including how to conduct a neurological examination, ophthalmologic examination, and mental status examination.  In addition, students will expand their understanding of clinical ethics in practice and spend time considering the care of LGBTQ patients.

Clerkship Phase Courses

FAM301 Family Medicine (6 weeks)

The EVMS Family Medicine Clerkship provides students with clinical experience in the outpatient and inpatient setting with learning experiences at EVMS and with our community partners. Our faculty and residents contribute to medical student education through direct observation in the clinical setting, bedside teaching, interactive case-based didactics, standardized patient encounters, review of clinical documentation, and student mentoring and advising. Students will develop the ability to apply the principles of family medicine care to gather information, formulate differential diagnoses, and manage patients with one or more common acute or chronic disease. Additionally, students will discuss the critical role of physicians within any healthcare system and develop evidence-based health promotion and disease prevention plans for patients of any age or gender.

INT303 Internal Medicine (6 weeks)

The EVMS Internal Medicine Clerkship provides students with clinical experience in general medicine and subspecialty patient care teams in the inpatient setting. Our faculty and residents contribute to medical student education through direct observation in the clinical setting, bedside teaching, interactive case-based didactics, review of clinical documentation, and student mentoring and advising. Students will develop the ability to gather essential and accurate information about patients and their complex medical conditions through empathetic history-taking, physical examination, and use of laboratory data, imaging, and tests. Students will also demonstrate critical thinking skills and effective use of evidence-based medicine to enhance patient care.

OBG301 Obstetrics and Gynecology (6 weeks)

The EVMS Obstetrics and Gynecology Clerkship provides students with clinical experience in labor and delivery, gynecology, and the outpatient clinic at EVMS and our community partners. Our faculty and residents contribute to medical student education through direct observation in the clinical setting, bedside teaching, interactive case-based didactics, standardized patient encounters, and student mentoring and advising. Students will develop the ability to perform the medical interview and physical examination of women and incorporate ethical, social, and diverse perspectives to provide culturally competent care.

PED301 Pediatrics (6 weeks)

The EVMS Pediatrics Clerkship provides students with clinical experience in the inpatient and outpatient setting, including exposure to pediatric sub-specialties and the newborn nursery. Our faculty and residents contribute to medical student education through direct observation in the clinical setting, bedside teaching, interactive case-based didactics, standardized patient encounters, computer case simulation, and student mentoring and advising. Students will develop the ability to obtain an age-appropriate history, physical exam, and generate an initial diagnostic and therapeutic plan for children of any age. Students will demonstrate communication skills with patients and families that convey respect, integrity, flexibility, sensitivity, and compassion.

PSY301 Psychiatry (6 weeks)

The EVMS Psychiatry Clerkship provides students with clinical experience in the inpatient psychiatry setting at EVMS and partnering institutions. Our faculty and residents contribute to medical student education through direct observation in the clinical setting, bedside teaching, interactive case-based didactics, and student mentoring and advising. Students will develop the ability to diagnose psychiatric disorders commonly seen in the child, adolescent, adult, and elderly patient populations and demonstrate empathy for individuals experiencing mental illness.

SUR301 Surgery (6 weeks)

The EVMS Surgery Clerkship provides students with clinical experience in inpatient surgery at EVMS and partnering institutions as well as exposure to the outpatient surgical clinic. Our faculty and residents contribute to medical student education through direct observation in the clinical setting, bedside teaching, interactive case-based didactics, review of clinical documentation, and student mentoring and advising. Students will develop the ability to demonstrate basic surgical and procedural skills and provide pre-operative and post-operative care to a diverse patient population.

ITD301 Career Exploration (6 weeks)

The EVMS Career Exploration Elective provides students with the flexibility to participate in electives, ranging from clinical exposure to a wide variety of specialties and health professionals, protected time during the clerkship phase to participate in research or global health opportunities, away rotations, or self-directed learning through online certifications, courses, and training programs. All students participate in the FOCUS elective (Finding Opportunities for Collegiality, Understanding, and Sensitivity) and will reflect on the role of the physician and discuss the core professional attributes needed to provide effective care in a multi-dimensional and diverse society. Students will set short and long-term goals for professional development and career wellness.

Elective Phase Courses

Acting Internship (4 weeks)

Students must complete the Acting Internship (AI) at EVMS or an affiliated site. The Acting Internship is designed to encourage senior medical students, regardless of desired future specialty, to assume patient care responsibilities similar to those of an intern. Acting interns should care for patients independently of interns and have similar duties, schedules, and didactic sessions as interns. They should work all shifts with their teams. They should take ownership of their patients and be the primary point person regarding their care. They should be increasingly (but safely) independent in their clinical practice and able to recognize when help is needed. Acting Internships are available in Emergency Medicine, Family Medicine, Internal Medicine, Obstetrics & Gynecology, Orthopedics, Otolaryngology, Pediatrics, Physical Medicine & Rehabilitation, Psychiatry, Surgery, and Urology.

Ambulatory Medicine (4 weeks)

The Ambulatory Medicine elective is designed to allow senior medical students to participate in the evaluation and management of patients who present with a wide variety of disorders in the outpatient setting. By the end of the ambulatory medicine rotation, students should be proficient and efficient in the management of an outpatient in a clinic setting. Ambulatory Medicine electives are currently available in Dermatology, Emergency Medicine, Family Medicine, Internal Medicine, Neurology, Obstetrics & Gynecology, Ophthalmology, Orthopedics, Otolaryngology, Pediatrics, Physical Medicine & Rehabilitation, Psychiatry, and Surgery. Students may also complete the Ambulatory Medicine elective as an away rotation.

Critical Care (4 weeks)

The Critical Care elective is designed to expose senior medical students to the evaluation and management of seriously ill patients, often in intensive-care settings, with the goal of learning how to appropriately evaluate the emergent patient. By the end of the critical care elective students should be able to develop a thorough, systemic approach to the rapid recognition, evaluation, treatment, and disposition of the critically ill or injured patient. Critical Care electives are currently available in Anesthesiology, Emergency Medicine, Internal Medicine, Pediatrics, and Surgery. Students may also complete the Critical Care elective as an away rotation.

Community-Engaged Learning Capstone (4 weeks)

The Community-Engaged Learning thread at EVMS integrates meaningful community service with structured learning experiences, focused didactics, and reflection to enhance our student physicians’ overall learning. The Capstone course is the culminating learning experience for the 4-year community engaged learning initiatives. Students will reflect on the knowledge and skills they acquired through their engagement in affiliated academic and clinical programs, community collaborations, and health promotion efforts with the overarching goal to develop and nurture extraordinary community-oriented physicians.

Clinical Skills and Ultrasound Capstone (2 weeks)

The Clinical Skills and Ultrasound Capstone at EVMS is the culminating learning experience for the 4-year advanced communication in clinical skills and ultrasound curriculum. Students will participate in a final clinical skills assessment in which they will investigate a simulated patient’s concerns, obtain a thorough assessment of their past medical history, medications, allergies, social history, and family history, and complete a note and place orders. Additionally students will complete online modules and simulation practice in discussing informed consent, discussing serious news, and responding to microaggressions. Students will complete a final ultrasound assessment to demonstrate competency in ultrasound and performing a RUSH examination.

Residency TIPS (Transition in Practice Series) (2 weeks)

The Residency TIPS course reviews the core competencies and entrustable professional activities graduating medical students should possess prior to starting internship. The course reviews high-yield topics specific to a student’s chosen field and professional development content in financial planning, healthcare delivery and administration, opioid management and misuse, and understanding malpractice. This course is designed to reduce student anxiety regarding the transition from medical school to residency.

Electives (14 weeks)

The EVMS elective phase is designed to promote a well-rounded educational experience including 34 weeks of full-time, scheduled, supervised, and evaluated educational experiences. In contrast to the pre-clerkship and clerkship phases, students have considerable latitude to design their educational programs to fit their individual needs and interests. Electives are available in Anatomy and Physiology, Anesthesiology, Dermatology, Emergency Medicine, Family Medicine, Interdisciplinary Studies, Internal Medicine, Neurology, Obstetrics and Gynecology, Ophthalmology, Orthopedic Surgery, Otolaryngology, Pathology, Pediatrics, Physical Medicine & Rehabilitation, Plastic Surgery, Psychiatry, Radiation Oncology, Radiology, Surgery, and Urology. Students are allowed to work with faculty to create an individualized experience or away rotation. Students also have opportunities to participate in teaching, quality improvement, clinical informatics, and research electives. A maximum of 16 weeks of the elective phase can be completed as an away rotation.   

 

A complete list of electives is available here.