Informal Curriculum
Though no credit is awarded for this aspect of the medical curriculum, all of
the efforts listed below (and more) contribute to the development of emerging
physicians at IUSM. Attention to competencies such as professionalism,
effective communication, and self-awareness, self-care and personal growth are
particularly evident throughout the informal curriculum.
View Video Clip—
Thoughts on the Informal Curriculum
Thomas S. Inui, Sc.M., M.D.
President and CEO of Regenstrief Institute for Health Care Research
Click on topic to expand.
In January 2003, Indiana University School of Medicine began a three-year process
of self-study and organizational development known as the Relationship-Centered Care
Initiative. Initial development of the project has been supported through a grant
from the Fetzer Institute. Thomas Inui, President and CEO Regenstrief Institute
and Associate Dean for Health Care Research, Richard Frankel, Professor of Medicine
and Professionalism Competency Director, and Debra Litzelman, Associate Dean for
Medical Education and Curricular Affairs, are the principal investigators.
The focus of RCCI is the social environment, or informal curriculum, of the medical school.
IUSM is studying how to transform the informal curriculum of a medical school to
foster relationship—attentiveness to human interactions—in all aspects of medical
school and practice. The desired outcome is a social environment that consistently
reflects and reinforces the moral, ethical, professional, and humane values expressed
in the School’s formal curriculum.
In 1994, the Fetzer Institute published Health Professions Education and Relationship
Centered Care, based on the work of the Pew-Fetzer Task Force on Advancing Psychosocial
Health Education. An important conclusion of this report is that healing relationships
are at the core of humane and effective medical care—relationships between physicians
and patients, among members of care provider teams, between care providers and their
communities, and physicians’ relationship with themselves—their own self-awareness
and self-care. While IUSM has made great strides in articulating an innovative formal
curriculum based on nine core competencies, the administration recognizes that the
formation of a physician’s professional identity is not accomplished solely through
the formal curriculum. Learners tend to assimilate and propagate patterns of
relating that they experience during their day-to-day training. If we desire our
graduates to demonstrate empathy, thoughtful inquiry, and positive, respectful,
and collaborative interactions, then that is what our community must consciously model.
RCCI began with a small administrative workgroup and a Discovery Team consisting of
competency directors, students, two external consultants, Anthony Suchman, M.D. and
Penny Williamson, Ph.D., and a project coordinator. The Discovery Team now has over
100 members, representing the entire IUSM community, and continues to grow. Using
the process of appreciative inquiry, the team has collected interview stories of the
system at its best. Core strengths and values of the IUSM community have been identified.
Inspired by these findings, participants are engaged in fostering these core strengths
and values through various activities including campus publications and forums,
training opportunities, departmental partnerships, and faculty committees.
The number of participants in various RCCI activities has now exceeded 1000.
A remarkable array of RCCI impacts are recognizable,
including new group processes within existing standing committees of the
school, new value-based publications on the character of the IUSM
community, a student honor code attracting formal faculty commitments, new
faculty-student networks for collaborative action, national workshops, and
requests for consultative efforts at other medical schools. Explicit use
is being made of student narratives from clerkship and other experiences
in order to understand how professional values and attitudes emerge from
experiential learning in the experience of IUSM students outside the
classroom, what the “sentinel events” are that exert powerful influences
on their perceptions of physician professional roles and expected
behaviors. These narratives also provide feedback to residents, staff, and
faculty on student perceptions of their performance, as well as fueling
organizational measurement and feedback processes that inform, benefit,
and inspire everyone at the academic medical center, including our
organizational leaders
In the context of the RCCI and development of a campus-wide Center for
Research in Health Care Quality and Outcomes, IUSM has further developed
its capacity for team formation not only across
specialty disciplines within the medical school but also among schools in various basic disciplines,
including formation of new partnerships with graduate faculty in Liberal Arts, the School of Public
and Environmental Affairs, the School of Law, School Nursing, School of Pharmacy, various
Purdue University schools, and still others.
For more information about the project, or to join in RCCI activities,
email Dave Mossbarger, Project Manager, at
dmossbarger@regenstrief.org.
During the span of three semesters (Fall 2003-Fall 2004)
MSA, MECA, and IUSM Competency Directors and
Coordinators organized and implemented a series of competency focus
groups for the purpose of inviting feedback from students and faculty
regarding their understanding of this curriculum and to receive and
compile information that will lead to enhancement of the
competency-defined curriculum throughout the IUSM system. Dr. James
Greene, a medical anthropologist and external consultant, served as lead
facilitator of this statewide communication activity. Thirty-eight
sessions were held. Participants in these sessions included medical
students representing all four years of study, center competency
coordinators, clinical faculty, and a particularly large cohort of second
year students and basic science faculty across all of IUSM’s nine
educational centers. A follow-up forum was held in Fall 2005 to discuss
the analysis of results and to initiate CQI projects to further advance
the competency curriculum. For more information about this initiative,
contact Sandra Herrin or
Mary Alice Bell.
An
Honor Code was established in 2004 at IU School of Medicine ;in order
to create an atmosphere of honesty, a culture of respect, and an
environment of trust among students, residents, faculty and staff.
In order to develop the skills required to operate in a self-governing
profession, it is imperative that students and faculty learn to work
together to resolve problems and are held accountable for addressing any
unethical behavior of their peers.
Implementation of the IUSM Honor Code was student-driven. Impetus for the
initiative began in 2002 when students explored similar policies
at other medical schools and determined that the lengthier
document in use at IUSM did not fully encompass the message they
wished to convey. Honor Code pins, distributed for the first time at
the White Coat Ceremony in fall 2004, express the three major tenets
promoted within the IUSM community—honesty, integrity
and respect. All individuals affiliated with the nine campuses
of IU School of Medicine have been asked to sign the Honor
Code. For further information, contact
Toyia Martin.
Prior to interviewing students for the 2004-2005 school
year, IU School of Medicine engaged in a faculty development project
to facilitate training of the school's Admissions Committee in evaluating
the competency of medical school applicants in nonacademic attitudes and
behaviors representative of the nine undergraduate competencies that are
assessed throughout four years of study at IUSM. Additionally, the
project aimed at discovering how Admissions Committee members actually
perform in reviewing these qualities important to success in IUSM’s
competency-defined curriculum. A workshop was held to review with
committee members the competencies to be considered as well as the process
to be employed. “Unannounced standardized students” were trained to join
the regular pool af applicants and, thus, provide a means of evaluating
the performance of committee members. The project was successful and will
continue as it was concluded that this type of faculty development has
merit in selecting medical school applicants who will be likely to succeed
in a competency-defined curriculum. For more information about this
project, email Susan Ballinger, M.D.
During the 2001-2002 academic year a task force composed
of students, residents and faculty recommended the creation of small group
mentoring experiences for students in order to improve personal
interactions within the large school environment. As a result, students
are now assigned to a mentoring group during their first year of training
and remain with the same group of students throughout their four years of
medical school. Meetings with mentors occur at minimum on a
quarterly basis. Topics of discussion are based on need and, thus, vary
between groups. Sample offerings include: self-care during medical
school, the importance of lifestyle in making ‘specialty’
decisions, discussion of important medical-legal issues, shadowing
opportunities with upper classmen, etc. To obtain further
information, please contact
Stephanie Fortune
or
msaa.iusm.iu.edu/studentdevelopment/mentoringmain.asp.
IU School of Medicine is fortunate to have a very active
Office of Medical Service-Learning that offers medical students many
opportunities to share their time and talents within the larger community
setting. Currently, students may voluntarily select from fourteen
different options, including: the Adolescent Substance Abuse Program,
Safe Sitter (a national program developed at IU School of
Medicine), overseas medical experiences, and a four year
extended learning opportunity in a Community Leadership Mentor Program.
Visit the following website to explore the complete list of
opportunities—
http://www.medicine.iu.edu/~omsl.
IU School of Medicine has celebrated the beginning of
medical school for 280 freshmen with a special White Coat Ceremony each
year for nearly a decade. The ceremony is designed to impart to entering
medical students in a public forum the importance of humanism,
professionalism, ethical behavior and integrity in the practice of
medicine. During the ceremony students are ‘cloaked’ in their first white
coats, hear a keynote address by a physician role model, collectively
recite an oath of obligation, receive a copy of a student publication
focused on values, and, additionally, receive an honor code pin after
signing the IUSM Honor Code document in front of invited guests and fellow
students.
The White Coat Ceremony was first initiated in 1993 by
the Arnold P. Gold Foundation. This medical school ritual has become
widespread; today more than 90% of U.S. medical schools and all four
medical schools in Israel celebrate this important event with some type of
ceremony. For further information, please contact
Carlene Webb-Burton or Mary
Alice Bell.
The IUSM chapter of the Gold Humanism Honor Society was established during
the 2005-2006 academic year as a neasns of formally recognizing medical students
who demonstate exemplary behavior that promotes humanism in medicine.
Creation of this GHHS chapter was made possible by a grant from the
Arnold P. Gold Foundation. By encouraging the creation of chapters in medical
schools around the country, the Gold Foundation seeks to honor senior medical
students, residents, role-model physicians teachers and other exemplars who
demonstrate excellence in clinical care, leadership, compassion and dedication to service.
Approximately 10 percent of the graduating class was selected through a process
including peer and faculty nomination follwed by a review of each student’s
required essays, clerkship comments, and record of community service. Learn more about the
Arnold P. Gold Foundation and the Gold Humanism Honor Society at
humanism-in-medicine.org or visit the
website at
meca.iusm.iu.edu/resources/GHHS2007.html
Questions regarding the induction ceremony of the IUSM GHHS chapter may be
directed to Angie Graves at
angdgrav@iupui.edu