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Land Ho! Preparing for Bridges Launch

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Dean Talmadge E. King, Jr., MD, (r) in conversation at the Medical Education Retreat.
Photos: Mark Wooding

By Mitzi Baker

After years of sailing in uncharted territory, land is in sight for the launch of UCSF School of Medicine’s new Bridges Curriculum.

The 2015 Medical Education Retreat, aptly dubbed “Land Ho!,” gathered 120 educators, clinicians, scientists, staff and students to experience elements of the new curriculum and give them a better understanding of what Bridges will look and feel like come the 2016 launch.

“This retreat was called ‘Land Ho’ because we can really see on the horizon the shore of a journey that we have been taking for a number of years,” said Executive Director of Medical Student Experience Phaedra Bell, PhD. “It is an exciting moment to make sure the whole crew knows exactly what is going to happen when we disembark.”

In her opening remarks at the retreat, Vice Dean for Education at UCSF School of Medicine Catherine Lucey, MD, recognized the tremendous commitment and hard work of those building Bridges over the past few years. “Because we are incredibly purpose-driven at UCSF, people were willing to put their hearts and souls into something to help our communities and we have been able to align things so that we are close to land,” she said.

Bridges has undergone many refinements over the last few years. Its main curricular approaches include early longitudinal immersion in clinical teams with a focus on continuously improving systems of care delivery along with direct patient care skills and an emphasis on “Inquiry,” exploring questions at the frontiers of different scientific disciplines to advance understanding of human health and disease.

The four-year integrated Bridges Curriculum is divided into three phases, each with its own focus interwoven with threads of foundational sciences, clinical and systems applications, and inquiry activities. Foundations 1 focuses on knowledge in basic sciences, systems and clinical patient care skills, while Foundations 2 concentrates on the advancement of patient care and systems improvement skills with the integration of advanced foundational sciences. Career Launch is the time of individualized clinical experiences and pursuit of a scholarly project aligned with career goals.

Brainstorming new ways to approach Bridges.

Building Excitement

The backbone of the Bridges planning process has always been its explicit inclusion of a range of expertise, backgrounds and perspectives. The retreat provided the opportunity for all the various constituencies to gain a deeper understanding for the integrative and novel components of Bridges, galvanize energy and excitement for the launch and provided a sense of the student experience throughout the new curriculum.

A series of interactive group workshops was held to brainstorm ideas across the range of focus areas for the new curriculum, including early integration of students in healthcare systems, foundational science knowledge, advanced clinical skills, how to weave the idea of “inquiry” into patient encounters and how to assess all of the new skills that Bridges will expect students to master.

Associate Dean for Curriculum Susan Masters, PhD, led a workshop to engage new ways of presenting foundational science authentically across the entire curriculum with the addition of foundational science days in the clinic-focused Foundation 2 phase. The group focused on creating a family-based clinical case to appear longitudinally across different courses in Bridges to help spiral both foundational science and the 21st-century solution of advancing diversity to achieve health equity.

“The groups in the workshop came up with some beautiful families that displayed diversity in age, gender, sexual orientation, race, ethnicity, socioeconomic status, living environment, and workforce demographic,” said Masters. “I was inspired by their ideas, and I look forward to bringing their creativity back to the working groups to more fully develop.”

Personal Touch

Another of the exciting aspects of Bridges is the ability of students to individualize their curriculum in accordance with their interests and goals, said Associate Chair of Education in the Department of Medicine Patricia Cornett, MD, who led a workshop focused on the clinical component of Foundations 2. Participants, including School of Medicine Dean Talmadge E. King, Jr., MD, generated many ideas about how students with different interests might arrange their schedules to explore areas of career interest.

“I was impressed with the participants’ ideas on how we can optimize students’ exposure to specialties and subspecialties that students would not otherwise be exposed to until later in medical school or in residencies,” said Cornett.

“One can see today how robust this discussion has been and that a large number of voices have been included,” King said. “I appreciate that the other schools have been included in the conversation, with the understanding that teamwork is required to practice modern medicine and be able to provide care to our patients.”

Bringing fresh air to the retreat.

Closing the Gap

The School of Pharmacy’s Tina Brock, EdD, professor of clinical pharmacy and associate dean of global health & educational innovations, couldn’t agree more with the inclusion of interprofessionalism as a key concept of Bridges. She has been monitoring the Bridges planning as the School of Pharmacy ramps up their own curriculum update.

“At the end of the day, with land in sight, it struck me that all the collaborative campus work that has gone into Bridges will ultimately close the gap between what we know and what we do,” said Brock. “UCSF Health promises that patients can count on us to help them stay well, get healthy and live better. UCSF Bridges is education’s commitment to keeping that promise.”

Student coaching is another new component introduced in Bridges through which faculty members are paired with six students each for the students’ entire four years of medical school. Coaches will help these students with a range of skills, including interviewing patients, performing physical examinations, clinical reasoning and incorporating systems science into their approach to clinical care.

“What is new is that instead of divvying up this clinical skill development among many different faculty members, the coach is providing a lot of this teaching and individualized feedback for a small group of students throughout the continuum of learning,” said Meg McNamara, MD, professor of pediatrics, who led a workshop on “moving students from great to greater through coaches.” McNamara pointed out that another key difference is the major emphasis and immediate application of quality improvement and patient safety efforts that are integrated into students’ early clinical experiences.

Alleviating any concern that faculty might be unwilling to take on the additional time commitment of student coaching, at the retreat it was revealed that for the 27 required coaches, more than 100 faculty members had applied.

Protected Time

In the realm of assessment, Bridges is introducing a novel idea: ARCH (Assessment, Reflection, Coaching, Health) weeks, which are week-long periods between the courses of Foundations 1, which will provide students with protected space and time to review and understand their progress and performance. ARCH weeks are not taking the place of course-specific examinations.

Assistant Professor of Medicine Justin Sewell, MD, has been helping design ARCH weeks for the past two years. “This may be the least understood part of the new curriculum,” said Sewell. Pilots of assessment weeks have shown that the purpose and reasoning behind these assessment weeks was not entirely clear to the students.

“If students approach these weeks as if it is a week of tests—which it is not—they are going to have a very different attitude than if they approach it as a week to learn about their progress so far, how they are doing and where they can improve or continue to excel,” said Sewell, citing one myth he wanted to dispel with students and faculty alike.

Workshop participants generated a number of ideas about ways to communicate with students that these weeks are more about assessment for learning rather than assessment for grading, and ways to study the effectiveness of the new strategy.

By the end of the day, Bridges planners walked away with a number of topics for further study or evaluation and also opportunities for further staff and faculty development related to the new curriculum.

“The participants’ enthusiasm, creativity and continuous generation of new ideas throughout the day demonstrated the strength and the commitment of the UCSF community to deliver the best curriculum possible for the physicians of the 21st century,” said Bridges’ Curriculum Project Manager, Lindsey Cannon, MPH. Some of the ideas she noted include integration and development of house staff and fellows in supporting the implementation of Bridges and their interactions with students, and evaluation of the integration of foundational sciences into the clinical experiences and clerkships and the dialogue between clinicians and basic scientists.

“Bridges thinks about how to get students into the actual practice of medicine from day one,” said Colette DeJong, a fourth-year medical student attending the retreat. “Today has been a really exciting and fun filled day for students and teachers to learn about the many intricacies of the Bridges curriculum and what it is going to look like in 2016.”