In 2003, the Institute of Medicine (now, the National Academy of Medicine) published a report, Health Professions Education: A Bridge to Quality, highlighting the reforms necessary for healthcare professionals to be adequately prepared for 21st century medicine and beyond. As part of their program of research in professional preparedness, The Carnegie Foundation for the Advancement of Teaching produced a series of works that included Educating Physicians: A Call for Reform of Medical School and Residency (2010). Educating Physicians, rooted in Flexner’s (1910) seminal work, argued for key educational practices medical schools would need to adopt in order to produce the next generation of physicians, including an intentional integration of clinically applied biomedical sciences, early exposure to experiential learning and professional identity formation, an emphasis on healthcare teams, social accountability and cultural awareness.
To this end, the University of the Incarnate Word School of Osteopathic Medicine (UIWSOM) Doctor of Osteopathic Medicine (DO) curriculum was developed from the ground up as a competency-based, integrated undergraduate medical education curriculum designed to support osteopathic medical students in their acquisition of the knowledge, skills and abilities expected at each level of training culminating with entry into graduate medical education programs.
Grounded in the principles of adult learning, the UIWSOM model of curriculum delivery is case-based and learner-centered. All engagements with faculty facilitators are designed to foster the integration of higher-order learning through interactive, Socratic dialogues and experiential learning. The application of biomedical knowledge and clinical skills lives in every part of the UIWSOM DO curriculum, whether it is in a large- and small-group (SIGS) sessions, structure and clinical (DOCS) labs, or directly within our surrounding community.
The curriculum components and threads support the UIWSOM mission promoting the principles and practices of osteopathic primary care, social accountability and community service. The curriculum is organized by units, starting with the essentials of applied biomedical sciences built around national emergency medical technician training curricula. Students in Phase I learn the basic clinical skills of an EMT, which will enable them to contextualize biomedical sciences in an authentic patient care setting. The units that follow are organized by system in the same order in which they are introduced in the Essentials/EMT unit.
The UIWSOM curriculum integrates areas of biomedical sciences and disciplines related to osteopathic medicine including the principles, history and practice of osteopathic medicine, human anatomy, biochemistry, pharmacology, genetics, physiology, pathology, microbiology, physical and differential diagnosis, medical ethics and legal aspects of medicine; internal medicine, family medicine, pediatrics, geriatrics, obstetrics and gynecology, preventive medicine and public health, psychiatry, surgery, radiology, and the components of research.
The UIWSOM curriculum is divided into four phases. Phases I and II consist of three curricular components:
- Applied Biomedical Sciences integrates the mechanisms of health, disease and intervention by including normal and abnormal molecular, cellular, and organ physiology; pharmacology and therapeutics; normal and abnormal anatomy, histology, embryology, pathology, and imaging;
- Osteopathic Clinical Applications includes Developing Osteopathic Clinical Skills (DOCS) which contains OPP, OMT, and clinical skills; early clinical and interprofessional education experiences; medical humanities; health delivery science; patient safety and quality improvement; opportunities to learn basic medical Spanish; and clinical applications of technology
- Professional Identity Formation includes opportunities for reflection; longitudinal mentoring, coaching and advising; collaborative learning environments; and formal ethics instruction.
The six threads weaving throughout the curriculum are as follows:
- Mental Health and Wellness
- Social Accountability, Service and Scholarship
- Student Success, Mentoring and Advising
- Board Preparation
- Evidence-based Medicine
Phase I begins with 9 weeks of Essentials/EMT, and continues with the following units organized by systems:
- MSK, Touch and Personhood
- Molecules, Cells, Compassion
- Host Defense and Communication
- GI System, Nutrition, Appetite
Phase II consists of Units 5 through 7. Unit 8 is a capstone, which is followed by a continuation of board preparation which, as noted previously, is a thread throughout Phases I through IV.
5. Cardiovascular, Respiratory and Renal
6. Metabolism and Reproduction
7. Brain and Behavior
8. Capstone (Spirituality, Mental Health and Wellness)
9. COMLEX Level 1 Preparation/Examination
In Phases I and II, each week is defined by a specific theme and anchored by case-based learning. The curriculum is delivered through sessions organized in a variety of environments: small group, medium- and large group interactive settings, an applied biomedical science laboratory, online modules, self- and faculty-directed learning activities, osteopathic clinical skills lab, simulation lab, as well as in community health care, service-related and scholarly activities.
At the end of each unit, students participate in a week of reflection, integration and assessment including individual and group examinations, laboratory practical examinations, OSCEs, osteopathic clinical skills evaluations, simulation assessments, completion of specified numbers of board questions, and essays.
Phase III consists entirely of required six-week core rotations. A Reflection, Integration and Assessment week is scheduled every 12 weeks between every two rotations. The following core rotations are required:
- Family Medicine
- Internal Medicine
- General Surgery
- Hospital Medicine
- Women’s Health
- Medically Underserved (rural or urban)
In addition, an integrated OPP/OMM longitudinal integrated clerkship (LIC) component is integrated through Phase III.
Phase IV consists of a required four-week Emergency Medicine core rotation, three selectives, and five elective rotations.
What about COMLEX? At the end of Phase IV, students participate in COMLEX Level 2-CE and PE preparation and travel for the examination. Student engage in a three week Ready for Residency unit, during which they are assessed for the entry-level ACGME PGY1 Entrustable Professional Activities (EPAs).