Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso

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Medical Education Program Highlights The Paul L. Foster School of Medicine (PLFSOM) educational program features a highly integrated preclerkship curriculum in which the foundational sciences are taught in the context of common clinical presentations. The program deliberately incorporates principles of adult education, including learning in the context of intended application, expert-guided deliberate practice, protected unscheduled time, and frequent formative assessment and feedback. Preclerkship phase instruction occurs in systems-based units, with each week following a clinically focused experiential learning cycle.1 Each week a motivating context for learning is established via a common clinical presentation and diagnostic scheme. Subsequent content is derived from the foundational concepts required to “work” the diagnostic scheme. The diagnostic scheme is also applied in a medical skills session, including a standardized patient encounter. Each week culminates in case-based small-group discussions that integrate newly acquired knowledge, skills, and early diagnostic reasoning. A required 2-year Spanish language curriculum is fully integrated with the clinical presentation framework. The traditional core clerkships occur in three 16-week blocks consisting of set clerkship pairs. The pairings facilitate integration of didactic and practice-based experiences designed to emphasize the interdependence of the specialties. Curriculum Curriculum description See Supplemental Digital Appendix 1—Curriculum Description —at https://links.lww.com/ACADMED/A821. Preclerkship phase course explanatory notes: Scientific Principles of Medicine (SPM): Integrated biomedical sciences course as described above. Medical Skills: Introductory clinical skills instruction fully aligned with the SPM course. Society, Community, and the Individual (SCI): Regional health systems, medical social sciences, community-based clinical experiences, and medical Spanish. Masters’ Colloquium: A discussion-based course taught in the school’s learning communities (“colleges”) covering medical ethics; “physicianship”; and the role of the physician in medicine, research, and society. Scholarly Activity and Research Program: All students design, implement, and present a scholarly project prior to graduation. Curriculum changes since 2010 Preclerkship phase: Increased utilization of team-based learning and interactive problem-solving sessions.2–4 Systematic integration of session-level self-assessment quizzes.5 Transition of gross anatomy instruction from regional dissections to a blended multimodal approach.6 Enhanced integration of interprofessional education, including activities related to teamwork and communication skills, the roles and responsibilities of health care professions, and the ethical use of opioids. Clerkship phase: Two 1-week third-year intersessions emphasizing common cross-clerkship content and integrating clinical experiences with basic sciences. A 2-week simulation-based “boot camp” to prepare the graduating students for residency. PLFSOM is currently planning its first major curricular update. Modifications will include: Shortening the preclerkship phase to 3 semesters. An earlier clerkship phase, concluding with a flexible USMLE testing, remediation, early elective, and scholarship block. Transition to a longitudinal integrated clerkship model designed to promote transdisciplinary integration. Class size changes since 2010 See Table 1—Class Size Changes.Table 1: Class Size Changes Expansion occurred according to a predetermined development plan and did not involve substantial modification of the school’s structure. Assessment See Table 2—Medical Education Program Objectives and Assessment.Table 2: Medical Education Program Objectives and AssessmentA complete copy of the PLFSOM educational program goals and their subsidiary objectives can be accessed via the school’s online academic catalog, at https://elpaso.ttuhsc.edu/som/catalog/default.aspx. The PLFSOM medical education program goals and objectives are based on the Reference List of General Physician Competencies as proposed in 2013 by Englander and colleagues.7 Changes in assessment during the preclerkship phase since 2010 Transition from norm- to criterion-referenced grading for unit summative exams. Implementation of periodic progress testing using formative administrations of the NBME Comprehensive Basic Science Examination. Addition of regular evidence-based medicine literature reviews and problem sets. Changes in assessment during the clerkship phase since 2010 The final assessments in the clerkship phase for all required courses were redesigned for academic year 2015–2016, increasing narrative feedback; adding a final competency grade in each of 8 domains; and including a final overall grade based on clinical work–based assessments, clerkship assignments, objective structured clinical examination performance, and NBME subject test scores. Clinical experiences Inpatient clinical sites: County general hospital County children’s hospital State psychiatric center Military medical center Private hospital systems: 2 local, 1 outlying Ambulatory clinical sites: Multiple Texas Tech University Health Sciences Center El Paso clinics Multiple community private practices Multiple federally qualified health clinics Veterans Health Administration clinics Active military medical center clinics Prison system clinic Multiple freestanding surgical centers Clinics of 1 local and 1 outlying private hospital system Required longitudinal experiences There is a longitudinal experience in each of the 16-week third-year clerkship blocks: Internal medicine/psychiatry block: psychiatry selective Obstetrics–gynecology/pediatric block: mother/baby experience Family medicine/surgery block: family medicine selective Clinical experience first encounter Learners begin clinical experiences within the first week of medical school: The medical skills course introduces students to history taking, physical exam, and diagnostic reasoning skills via standardized patient encounters, simulations, and expert-guided sessions. Students attend clinic with a community preceptor 12 times across the preclerkship phase. Required and elective community-based rotations Required: preclerkship phase SCI course Spanish instruction and community assessment and cultural competency activities Students work with a primary care preceptor 8 days in year 1 and 4 days in year 2 (including experiences with a dentist, an optometrist or ophthalmologist, and a pharmacist) Required: clerkship phase Family medicine clerkship Minimum of 1 day per week for 5 weeks with a community preceptor 1 week with community hospice Surgery clerkship 1 week with a community general surgeon Elective: clerkship phase Psychiatry clerkship Several longitudinal selectives are community based Internal medicine clerkship Students have an option to spend 3 weeks at a community inpatient site Surgery clerkship Third-year students can choose from a variety of community-based subspecialty 3-week selectives Fourth-year electives Family medicine: Big Bend rural health care elective, border health Spanish immersion course, public health and community-based approaches for disease prevention Internal medicine: multiple subspecialty community-based electives Surgery: clinical ophthalmology, orthopedic surgery, otolaryngology/head/neck surgery Physical medicine and rehabilitation Challenges in designing and implementing clinical experiences for medical students Development of clinical sites over an expanded geographical area Competition for clinical sites with private osteopathic medical schools and midlevel practitioner programs Variable credentialing requirements across clinical sites Recruitment and retention of community preceptors Curricular Governance See Figure 1—Curricular governance.Figure 1: Curricular governance.Curricular governance is centralized, as is provision of academic information techno

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