UNC School of Medicine Asheville

Information about Longitudinal Integrated Curriculum

Introduction:

UNC School of Medicine Asheville is pleased to offer an alternative curriculum for the adventurous student.    This program began in academic year 2009-2010 with the support of UNC School of Medicine, Mission Health, and Mountain AHEC and now brings ten students to Asheville for their third and fourth year. The foundation of this program and our innovative curriculum is similar to the longitudinal “Cambridge Model.” The fourth year curriculum reverts to block schedules  and presents opportunities to participate in rotations in rural WNC, as well as, Chapel Hill, across the state, nation, or internationally. Please view this video for an overview of the program.

What students say about the program:

Laura Cone

Hey there! My name is Laura Cone, one of the medical students doing my 3^rd year as part of the Asheville Program.  I was born and raised on the coast in Jacksonville, NC.  I went to undergrad at NCSU and am still a huge Wolfpack fan at heart.  In fact, I still made it back to Raleigh for many football games this year.  I studied Biomedical Engineering in undergrad and decided about halfway through that medicine was a better fit for me.  I couldn’t be happier about my decision to go into medicine and to spend my 3^rd year in Asheville.

Having lived in the piedmont and on the coast, I thought I would give the mountains of NC a chance.  I’m so glad I did because I have absolutely fallen in love with the community here.  The program was very attractive to me because of the ability to form relationships with patients as you would as a practicing physician.  You get to know their stories and can truly impact their lives even as a 3^rd year student.  I have been also able to personalize my curriculum to fit my interests and learn from incredible attendings in a one-on-one setting.  The ethics curriculum and ED rotations are also such unique opportunities that have truly enriched my experience.  Next year, I will be heading back to Chapel Hill for my MPH and will likely pursue a career in Family Medicine.  Asheville itself is such an amazing city with great food, beautiful views, outdoor activities, and people.  I highly recommend it to anybody ready for an amazing adventure for the 3^rd year of medical school!

See what other students have to say | 2011-2012 students’ comments

Longitudinal Integrated Curriculum:

For many years, the U.S. medical educational system has fallen short in training physicians in community settings, producing sufficient numbers of primary care physicians, and training doctors in outpatient settings where the vast majority of physicians practice.    Several medical schools, such as Harvard, have introduced a new curriculum that helps to address these deficiencies in medical education.  In 2004, Harvard restructured the third year clerkships to place a cohort of students in outpatient settings for the majority of the year, thus allowing students to follow “their patients” in all health care settings. (Reference:  Ogur B, et al.  The Harvard Medical School-Cambridge Integrated Clerkship: An Innovative Model of Clinical Education.  Acad Med. 2007; 82:397-404.)

The Asheville community is well suited to this type of curriculum because of its robust primary care services and diverse specialty practice settings.   The longitudinal integrated curriculum utilizes a smaller number of dedicated teachers and a greater reliance on outpatient teaching.   Students have more exposure to experienced practicing physicians and a much greater likelihood of seeing the same patients over an extended period of time and through the continuum of care.

Admissions Process:

The admissions process is designed to ensure success of the students and the program.  Although the longitudinal curriculum should be well suited to any student, we are deliberate about selecting students for the program because of the small group of students and close long term relationships with their core faculty.

The ideal student for this program:

• demonstrates flexibility, self-reliance, and internal motivation
• has a strong academic record
• brings life experiences in self directed learning and/or work
• has connections to  Western North Carolina
• expresses interest in primary care, surgery, psychiatry and/or rural practice goals

Longitudinal Integrated Curriculum at Asheville:

The third year academic calendar at Asheville is comprised of two types of clinical experiences. See Table 1 below. Beginning in July there are three months of surgery and OB-Gyn block rotations. Because of the need for more intense experiences in surgery and obstetrics, students will take traditional six week rotations in both specialties.

Table 1.  Third year schedule

Starting in October, students begin the longitudinal portion of the curriculum. Each student is assigned one half-day per week to a community practice in each of five core specialties, (internal medicine, pediatrics, family medicine, neurology, and psychiatry). At their weekly outpatient sites, the students see a panel of their “own” continuity patients and work-ins.  The attending physician supervises their student and reviews each case and care plan. If their patients are admitted or referred to another provider, the student makes every effort to accompany their patients in the hospital or other sites.  See sample week below.

Table 2.  Weekly student schedule

Additional experiences are gained through bi-weekly both inpatient and outpatient cardiology clinic.  Emergency Medicine experience consists of two shifts per month and affords students many opportunities for procedures. During the nine month continuity schedule, students will also have two one-week inpatient experiences in both pediatrics and internal medicine and a one week inpatient neurology experience for a total of five inpatient experiences.

Other Curriculum Components:

Orientation: Asheville students will complete the last two days transition course in Asheville.  This will include an orientation to Mission Hospital and its ancillary services, training in all pertinent electronic health records, surgery skills lab, and orientation to surgical scrub/OR procedures.  Other student services include access to MAHEC library, UNC-A student health and gym services, and finally getting to know the community itself.

Case conferences and didactics: Students meet weekly as a group for a variety of didactic sessions consisting of case studies, problem based learning sessions, core lectures, skills labs, and radiology conferences.  Each student will be required to present one case for the monthly interdisciplinary Master Clinician session during their third year. This student led case presentation includes specialty consultations and interested clinicians in collegial interchange.

Art of Medicine and Ethics Curriculum: The Asheville curriculum also has two enhanced components. First, there are bimonthly Art of Medicine meetings where students and faculty gather informally to discuss various topics related to the practice of medicine such as “Characteristics of an Effective Physician” or “Achieving Balance.” In addition, ethics is a purposeful part of the curriculum led by an experienced medical ethicist. The curriculum includes monthly ethics case studies and participation in the hospital ethics committee.

Testing and evaluations:  All students will take the same standardized testing as their cohorts in Chapel Hill, including OSCE exams and NBME shelf examinations. These will be administered at or near the end of the third year for the longitudinal components.  The surgery and OB shelf exams will be administered at the end of their rotations.   Students will be evaluated regularly by their faculty.

Fourth Year Curriculum: The fourth year curriculum will revert to block months. Because of the relatively small amount of hospital experience, students will be required to take an additional acting internship in addition to the four required 4^th year selectives.   All the major specialties will be offered to students.  At least two months in the fourth year will be required in rural WNC.  A one month rotation in global health through Shoulder to Shoulder will be available to all students without additional fees and can fulfill the Science of Medicine requirement.   Students will also be able to do other away rotations if desired.

Student Services: Students will need to find housing in the community but there is ample affordable housing.  We have a reciprocal agreement with UNCA for student health services and access to the gym and library.

To learn more feel free to contact:

Norma Beaty, MS MAEd,  Director of Curriculum, at norma.beaty@gmail.com or Robyn Latessa, MD, Campus Director, at robyn.latessa@mahec.net