Education Columns

Kathleen D. Brooks, MD, MBA, MPA, Rural Physician Associate Program, University of Minnesota Medical School

Family medicine faculty are typically key teachers in undergraduate medical education courses, including clinical history taking, physician diagnosis, family medicine clerkships, primary care integrated curricula, and elective clerkships. Medical school academic deans and curriculum committees charge individual faculty to assume leadership roles in developing curricula, implementing and operating courses and clerkships, assessing students, and performing program evaluation. As family physicians step into these educational leadership roles, it is important to develop a clear view of the curricular system for your school.

The Liaison Committee on Medical Education (LCME) sets educational standards that each medical education program leading to the MD degree must address to achieve and maintain accreditation in the United States and Canada. One of the key areas of focus involves curriculum management, and the LCME standard ED 33 outlines this: "There must be integrated institutional responsibility in a medical education program for the overall design, management, and evaluation of a coherent and coordinated curriculum."¹

What does this mean for a family medicine clerkship director? This can vary from school to school in terms of amount of autonomy versus oversight in clerkship management. As new faculty assume such educational leadership roles, it is important to survey your institution's landscape to understand such expectations. As you develop your curriculum, how much autonomy do you have? If you wish to change your curriculum within your clerkship, do you need to present such changes to others to obtain approval? If you change your grading structure, do you need approval from others in the medical education office or a committee? What committees direct your work and review your course evaluations? How much input do you have into the program evaluation of your course? What is the role of departmental chairs in establishing the curriculum? Who decides the length of your clerkship and its placement in the curriculum? All of these questions are vital for a new clerkship director to address to successfully direct a clerkship and to strategically engage in the overall management of the curriculum.

If a family medicine faculty member wishes to develop an educational innovation, it is important at the outset to answer a series of questions, including who are the players in the system I need to work with, how do innovations get traction, what is the culture in my school regarding cutting-edge educational programming, how should I pace the work with my colleagues, and what systems beyond medical school do I need to consider as I envision my innovation? Too often, faculty members think of great innovation ideas and move forward with significant planning before understanding "how the system works" and then may find themselves unexpectedly thwarted in their efforts to implement their plans.

Finally, another area where it is vital to understand how to work within your system is when dealing with challenged learners. Here it becomes important to delineate what is your responsibility, what is the school's responsibility, and how to optimize use of school resources and collaboration to best assist such a learner. In this situation, understanding the roles and responsibilities of faculty advisors, student affairs deans, learning specialists, and promotions committees is essential to this work. Some schools have a robust system of "forward feeding" of important information on academic progress of students. Others have a much more limited system of sharing information, and it is vital that a new clerkship director understand these parameters in working with colleagues. Each course and clerkship director will be involved in complex issues with learners, and understanding your resources and creating solid systems approaches to such situations will smooth your work and optimize the opportunities for such students to excel.

In summary, family medicine faculty are important members of the medical school's community of faculty who confer the doctor of medicine degree on their graduates. Becoming informed on your roles and responsibilities with colleagues in all the other disciplines who work together on the curriculum is essential to your long-term success in this work. Seeking opportunities to improve the school's systems of curriculum development, management, and evaluation can provide rich and rewarding work with students and colleagues.

Reference
1. Liaison Committee on Medical Education. May 2012. Functions and structure of a medical school. LCME accreditation standards. www.lcme.org/standard.htm. Accessed November 2, 2012.