Cadaver Rounds: A Comprehensive Exercise That Integrates Clinical Context Into Medical Gross Anatomy.

PROBLEM: The purpose of medical schools is to train students to care for patients; however, the temporal and conceptual gap between course work and patient care may induce students to undervalue preclinical course work, thereby decreasing learning and retention. Bringing clinical context into preclinical courses reduces this problem, and many preclinical programs incorporate "cameo" appearances of clinical material. In contrast, the authors describe a comprehensive program at Virginia Commonwealth University School of Medicine that uses the cadaver as the students' first patient to embed clinical context within preclinical anatomy. APPROACH: As the students' first patient, cadavers undergo modified physical exams, whole-body computed tomography scans, and pathology sample analysis. Students log daily dissection observations onto a "patient chart." Group findings are integrated, on a self-directed basis, into a final grand rounds-style presentation ("Cadaver Rounds") requiring students to synthesize longitudinally collected observations into a plausible clinical condition likely experienced by the cadaver-patient when alive. The entire exercise uses few additional contact hours (about six) and runs concurrently with the existing medical curriculum. OUTCOMES: According to course surveys used to assess students' perceptions of the relevance and effectiveness of Cadaver Rounds (2015-2017), the students' experience was highly positive. Participation by faculty and clinicians has been enthusiastic. NEXT STEPS: The authors hope both to identify additional authentic clinical tasks to import into the dissection lab and to partner with other programs to adopt and evaluate this clinically centered approach to anatomy.

Developing Comprehensive Strategies to Evaluate Medical School Curricula.

Evaluation of medical school curriculum is important to document outcomes, effectiveness of learning, engagement in quality improvement, and to meet accreditation compliance. This monograph provides a roadmap and resource for medical schools to meaningfully evaluate their curriculum based on specific metrics. The method of evaluation includes an examination of Kirkpatrick's levels of outcomes including reactions, learning, behavior, and impact. It is important that student outcomes are mapped in relation to curricular objectives. There are specific outcomes that may be utilized to determine if the curriculum has met the institution's goals. The first is comparison to national metrics (United States Medical Licensing Examinations and American Association of Medical Colleges Graduation Questionnaire). Second, medical schools collect internal program metrics, which include specific student performance metrics, such as number of students graduating, attrition, and matching to specialty. Further, schools may examine student performance and surveys in the preclerkship and clinical phases (e.g., grades, failing courses, survey responses about the curriculum), including qualitative responses on surveys or focus groups. As the learning environment is critical to learning, a deep dive to understand the environment and mistreatment may be important for program evaluation. This may be performed by specifically examining the Graduation Questionnaire, internal surveys, and mistreatment reporting. Finally, there are numerous attitudinal instruments that may help medical schools understand their students' development at one point or over time. These include measurements of stress, wellness, burnout, lifelong learning, and attitudes toward patient safety. Together, examining the composite of outcomes helps to understand and improve the medical school curriculum.

Development, implementation, and results of the ASN in-training examination for fellows.

The American Society of Nephrology and the fellowship training program directors in conjunction with the National Board of Medical Examiners developed a comprehensive assessment of medical knowledge for nephrology fellows in-training. This in-training examination (ITE) consisted of 150 multiple-choice items covering 11 broad content areas in a blueprint similar to the American Board of Internal Medicine certifying examination for nephrology. Questions consisted of case vignettes to simulate real-life clinical experience. The first examination was given in April 2009 to 682 fellows and six training program directors. Examinees felt that the examination was well structured and relevant to their training experience Longitudinal performance on the examination will be helpful in allowing training programs to utilize results from content areas in identifying deficits in medical knowledge as well as assessing the results of any curriculum changes.