Abstract:

CHALLENGES:
In 2010 the Carnegie Foundation issued the “Call for Reform of Medical School and Residency”. The results of this 3 year landmark study were released just as the University of Minnesota (UMN) Medical School prepared for a 2012 accreditation visit. The Liaison Committee on Medical Education (LCME) accreditation standards include:
• Content integration within and across periods of study,
• Opportunities for active learning and independent study, and
• Assessment of students’ clinical reasoning and communication skills.
The LCME standards posed both educational and fiscal challenges for the UMN adjusting to the reality of > $44.6 M reduction in State funding. Best practices that advanced student-centered education and that triggered new financial opportunities had to be identified and developed.

ACTION:
Course level: To promote the integration of basic sciences with medical/surgical disciplines, a new ten subject 2nd year course (Human Diseases 2 – HD2) was created. Strategically organized into ten “theme” weeks, each week was bracketed by integrated readiness/formative assessments.
Curriculum level: To promote student independent study, advanced preparation and knowledge acquisition, 3 half days of unscheduled Independent Learning Time (ILT) were inserted into each academic week. A collaborative relationship with the UMN Digital Media Center (DMC) was leveraged to incorporate educational technologies that matched faculty/staff skills: all course materials were delivered on a UMN supported MOODLE learning management system.
Rheumatology subject level: To enhance active learning, clinical reasoning and application within these new scheduling restrictions, the DMC helped identify pedagogically appropriate learning activities, enabled by educational technologies and newly constructed Active Learning Classrooms (ALC).

OUTCOMES:
New Rheumatology learning activities: Large class lectures and related materials were repurposed into image augmented self study electronic resources. Knowledge application exercises held in a large capacity ALC replaced small group sessions.
Faculty and patient care benefits: The 9 student x 10 table ALC arrangement allowed for 1 faculty member to facilitate discussions among 90 students and released other faculty to resume clinical teaching that also created 320 new ½ hour patient appointments.
Optimum room utilization: 20 hours of classes were scheduled in the technology rich ALC during non-peak hours (e.g. Friday afternoons).
Student outcomes: The ALC setting provided an energizing forum for 90 students to work on clinical reasoning and intra/intergroup communication. The high level of student interactivity continued after the class. Students reported similarly designed assignments to be valuable; from a faculty perspective student performance exceeded expectations.
Cost savings: The 1 faculty to 90 student ratio saved > $14,000 in faculty instructional costs for one subject area with the potential for more savings.

CONCLUSIONS:
Motivated by the Carnegie Foundation challenge, the Rheumatology example within the HD2 course shows how a resource constrained division can integrate content, introduce active/independent learning and clinical reasoning exercises and deliver an effective and cost saving learning experience. Leveraging UMN resources such as the Digital Media Center, Active Learning Classrooms and Moodle added value that can be reproduced as best practices.

Keywords:

Medicine, new model, best practice, active learning classroom, learning management system, integration, financial savings.