History

The Office of Regional Medical Education (ORME) was created September 1, 2002 as a reorganization of the Office of Primary Care Education in the School of Medicine. Its creation reflects the growing regionalization of undergraduate medical education in the US, and the increasing importance of coordinating university-based and community-based components of that education. The concept of regional medical education (RME) refers to an emphasis on partnering between medical schools (including their full-time faculty and university hospital) and health care providers and supporters in the community (including community hospitals, practitioners and community resources such as Area Health Education Centers [AHECs]). At UTMB, this concept is designed to meet the guidelines of the School of Medicine Curriculum Committee, the UTMB Mission Statement, and the evolving standards of medical education and patient care across the US.

The Curriculum Committee of the SOM acknowledged the role of regional education in its Principles and Guidelines for Year 3 and 4 Curriculum Revision (2001). The UTMB Mission Statement also supports the cooperative efforts of the university with the community through the Office of Community Outreach. Blending medical school campus-based education with experiences in the community is now  the  rule  rather  than  the exception in US medical education, both with medical schools which have community-based teaching as their heritage (Southern Illinois University, Michigan State University) as well as more traditional medical schools (Harvard, Johns Hopkins).

Regional approaches to medical education cut across disciplinary boundaries, and typically seek to capitalize on community-based strengths in ambulatory care. Both primary care and specialty-based disciplines typically include substantial ambulatory teaching in their clerkships in most US medical schools, and most schools rely on community-based sites to provide part of student education.

Mission and Personnel

The mission of ORME is to support UTMB’s core values of community and education by contributing to the School of Medicine’s mission of training competent, caring physicians through development of strategic partnerships between community and university-based regional medical education contributors. The Office works closely with the East Texas AHEC, Office of Educational Development, Curriculum Committee and medical school courses in its activities.

The ORME is engaged in a range of activities which focus on community-based medical education.

The activities span the four years of the curriculum (from Year 1 preceptorships to clerkships and advanced electives), and include interaction with individual physicians in a town or city, to more comprehensive efforts such as those that encompass all Year 3 and Year 4 clerkships in Austin.

A Regional Approach at UTMB

Two major factors influence the School of Medicine’s approach to regional education.

Patients: Although the overall patient population at UTMB remains strong, this critical factor  in student education is becoming strained in some areas. As referral and reimbursement patterns evolve, assuring the school has an adequate number of patients in all disciplines, in primary and specialty areas, and in inpatient and outpatient sites, has become increasingly difficult. Some departments need additional or complementary education experiences off-campus.

 Teachers: Although the size of the basic science faculty in the School of Medicine compares favorably to other medical schools in Texas, the number of clinical faculty is relatively small. Not all clinical faculty are engaged in direct patient care activities, and relatively few do so on a full-time basis. As in all academic medical centers, the multiple demands on faculty time result in limited time for faculty to dedicate to teaching students in a clinical setting.

A regional approach to education also implies a structured and reasoned approach to selecting and maintaining regional education sites. Such sites should (a) fulfill a specific need of the medical school, complementing experiences available in Galveston, and filling areas least available locally, (b) take advantage of efficiencies available through regional clustering of activities, as opposed to activities spread randomly throughout the state, and (c) seek potential partnerships in the community that will strengthen the educational and research missions of the university, with both local care providers and with compatible health-care and educational organizations. Finally, such approaches should be sensitive to the needs and priorities of the communities they impact, anticipating their concerns and working to build coalitions that provide advantages for all participants.

The regional approach envisioned by the School of Medicine does not include introduction of Galveston-based faculty into local communities to generate patient care income, nor does the ORME function to foster specific career choices, or emphasize the importance of one medical discipline over another.

ORME Ongoing Projects

In addition to direct support of student educational programs, the ORME has responsibility for the following ongoing projects.

Institutional Affiliations/Program Agreements:
ORME has negotiated agreements with the following institutions:

UT-Austin, Austin State Hospital, VA System
Central Texas Medical Foundation
Universidad de la Frontera – Temuco, Chile
Cebu Institute of Medicine - Philippines
University of Nigeria
Doctors Hospital of Laredo
SCCI Hospital of Victoria
University of South Alabama
Corpus Christi Medical Center
Williams Family Practice
Texas Gulf Coast Medical Group
Brownwood Regional Medical Center
 

Professionalism Project:
Approved by the SOM Curriculum Committee in September 2000, the Professionalism Project's objectives are to lead efforts to define and measure professionalism, coordinate longitudinal tracking of students who demonstrate shortcomings in this area, and to develop methods to assist students who need further professional skills development.  The office maintains a database of "Early Concern Notes", documents submitted by faculty and staff related to their concerns about professional behavior of students, and intervenes with counseling and other forms of assistance for identified students.

Clinical Skills Assessment:
The Curriculum Committee has also charged ORME with long-term planning for evaluation of the medical students' clinical skills, with emphasis on standardized patient-based assessments.  The office currently directs the Integrated Curriculum Evaluation Exercise, a Year 4 summative examination as a graduation requirement.  Current focus of development includes improving longitudinal assessment and tracking of student skills through the numerous existing skills examinations, development of a comprehensive Year 3 formative examination, and coordination of efforts to prepare students for the USMLE Step 2 Clinical Skills Exam for licensure, recently approved for implementation by the National Board of Medical Examiners in 2004.

School of Medicine Electives Program:
ORME coordinates all elective course offerings within the School of Medicine, including approval of new courses, revisions to existing courses, and web-based publishing of the electives offered to students in each academic year, including the elective period recently approved for Year 3 students.

Year 3 and Year 4 Class Scheduling:
ORME conducts class scheduling with the University Registrar for all Year 3 and Year 4 courses, including class meetings and brochures, and serves as the liaison with SOM departments. These responsibilities include oversight of courses at other medical schools, and community/international sites.

Faculty recruitment for small group teaching:
All SOM Year 1 and Year 2 courses are interdisciplinary in structure and include an average of 6 hours/week of small group, problem-based, tutorial format sessions. Success of these courses depends on the generous participation of faculty across all SOM departments and the Institute of Medical Humanities. An average of 250 faculty contribute over 14,000 student contact hours in this teaching effort. The ORME is responsible for coordination, tracking and documentation of this teaching effort.

HCMP:
The ORME serves as the liaison for the SOM with the Health Careers Mentorship Program, a student interest group from the University of Texas-Austin. Membership in this group is determined by academic achievement and community service as well as motivation towards a career in medicine. The ORME sponsors yearly visits by members of the group to UTMB to participate in a sampling of SOM courses, to visit with faculty, and to hear about SOM admission practices.

Future Directions

The immediate task ahead for ORME is to transition its support of community-based education from the Multidisciplinary Ambulatory Clerkship (MAC) to department-based efforts in Internal Medicine and Pediatrics. Although these departments are still developing their respective programs, it is likely that ORME will be expected to assist with preceptor development, coordination of student assignments and liaison with AHEC and community physicians in each program, much as it does now with the MAC. 

The 2003-04 academic year will be a period of substantial planning for the Year 4 Ambulatory Community Medicine electives approved for 2004-05. Given the approval of these rotations for both primary care and specialty disciplines,  ORME expects to work with all SOM departments in identifying appropriate community-based opportunities. The Office will also continue efforts at the institutional level to define opportunities that exist for developing stronger relationships with Seton, Austin State Hospital, VA and UT-Austin at the undergraduate (MD-PhD combined degree program), graduate (affiliation of existing GME residency training programs) and continuing education levels.

Future Challenges

As with any regional program, major challenges remain in defining and implementing the necessary level of local resources and oversight for effective education and accreditation purposes. Additional personnel in Galveston and Austin will be needed as programs expand.

Financial implications of securing long-term commitments of community faculty time, effort and ongoing support will be equally challenging. Student housing, currently a major expense, may be modified with a larger contingent of Austin-based students (who provide their own housing) but the feasibility of that scenario remains unknown. Student services, currently provided on a comprehensive basis only to Austin-based students, will need to be defined more fully for all students who complete rotations away from Galveston. Finally, strengthening long-term relationships with community partners will be a key component of UTMB’s success in regional medical education.