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
The Office of Regional Medical Education (ORME) is engaged in a range
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
ORME Ongoing Projects - OCE
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.
Health Careers Mentorship Program:
The ORME serves as the liaison for the SOM with the Health Careers Mentorship Program (HCMP), 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.
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.
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.
Office of Clinical Education (OCE)
Responsible for all the clinical aspects of medical student education,
which is centered around the last two years of medical school. All
clerkship rotations are coordinated in this office, including summer
preceptorships for first and second year medical students.