UNC School of Medicine Asheville

Information about Longitudinal Integrated Curriculum

Introduction:

• UNC School of Medicine Asheville began with its first class of 4 students in July 2009 with the support of UNC School of Medicine, Mission Health, and Mountain AHEC.
• Ten students will come in July 2013 to complete their third and fourth year of training.
• 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 or across the state, nation, or internationally.

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:

• In 2004, Harvard restructured the third year clerkships to place a cohort of students in outpatient settings for the majority of their curriculum, which allows 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:

• Given the unique features of the Asheville program, we invite applicants to Asheville for interviews in October of the second year.
• 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
• Also taking into consideration, but not required:
• Has connections to  Western North Carolina
• Expressed 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. Beginning in July there are ten weeks of inpatient experiences which includes six weeks of surgery, one week each of inpatient medicine, pediatrics, neurology, and OB L&D. The surgery clerkship will consist of two weeks general surgery in a rural setting, one week general surgery in Asheville, one week of trauma, GYN oncology, and a surgical subspecialty.

Table 1. Yearly Overview

• Beginning in late September, students begin the longitudinal portion of the curriculum. Each student is assigned to a community practice in each of the core specialties, (internal medicine, OB, pediatrics, family medicine, neurology, and psychiatry), where they see a panel of their “own” continuity patients and work-ins at their weekly outpatient sites.  OB is also a longitudinal clerkship now. Student will follow patients every other week in the outpatient setting. Students are supervised by their attending physician, who reviews each case and the plan of care with them. If their patients are admitted or referred to another provider, the student will see their patients in the hospital or accompany them to that visit as well.  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 three shifts per month and affords students many opportunities for procedures. During the nine month continuity schedule, students will have another one-week inpatient experience in pediatrics, internal medicine, and OB L&D.

• Unique features of the program also include:
• Bimonthly Art of Medicine meetings where faculty and students discuss other aspects of being an effective physician, dealing with ethical issues and finding personal balance to avoid burnout.
• A purposeful ethics curriculum interwoven with clinical practice with the goal of producing physicians who are empathetic and caring.
• Monthly Master Clinician sessions where students lead an interesting case presentation followed by discussions from consulting specialists on the case.
• Participation in ABCCM free clinic for medically underserved, working with 2 faculty or residents and in collaboration with pharmacy students and residents and medical ethicist.
• Unique radiology course which meets bimonthly.

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.

Outcomes:

• Asheville Campus students have scored above the national average and at least equal to  their peers at UNC in both the SHELF exams administered in core clerkships and STEP 2 clinical knowledge and skills exams administered during the 4^th year.
• Asheville students are able to obtain their first choice of residency programs
• Already we have two students completing their residency in WNC and more have expressed they are planning to return after training.

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