Reflections on the First Accreditation at The University of Tokyo Faculty of Medicine Mary Y. Lee, MD, MS, FACP March 27, 2015 UTokyo Lee March 2015 平成２6年度文部科学省大学改革推進事業（基礎・臨床を両輪とした医学教育改革によるグローバルな医師養成）公開シンポジウム 「国際基準に対応した医学教育認証制度の確立」 「国際基準に対応した医学教育認証制度の確立」 −医学教育認証評価制度発足に向けて− −医学教育認証評価制度発足に向けて− 開催日時：平成27年2月20日（金）13：00∼17：30 会 場：東京医科歯科大学鈴木章夫記念講堂（Ｍ&Ｄタワー2階） ࠉ 開会の辞 奈良信雄 雄 教授 教 教授（東京医科歯科大学） 授（東 （東京 東京医 東 京医 京 医科 科歯科大 歯科 科大 科 大学） 省挨拶 省挨 省 挨 挨拶 拶 ࠉ 文部科学省挨拶 寺門成 寺門成真 寺門 寺 門成真 門 門成 成真 成 真 課長 課 課長（文部科学省医学教育課） 長（ （文部科 文部科 部科学 部科 学省医 省医 医学 医 学教育 教育課） 全国医学部長病院長会議挨拶 長病 長病院 長 病院 院長会議挨 院長 挨拶 ࠉ 全国医学部長病院 甲能直幸 甲 甲能 能直幸 能 直幸 幸副 副会 副会長（杏林医科大学付属病院） 会長 会 長（杏林医 杏林医 杏林 杏 林医 林 医 医科大学付 大学付 大 学付属病院） 学付 presen nt s sta st stat state tat atte a an and nd prospect prospe pe p ectt o off tth the he a ac accrediation ccrediation in medical education ࠉ The present by WFME and and dA AMEWPR MEWPR Michael Mich hael ae el Field Field 教授（AMEWPR 会長） 座長：田邊政裕 座長：田 ：田邊政裕 特任教授（千葉大学） ：田 ࠉ 医学教育質保証に向けての経緯と計画 奈良信雄 教授（東京医 教授（東京医科歯科大学） （東京 （東京医 （東 （ 東京医 東京 東 京医 京 医科歯科大 大学） 学） ࠉ（休憩） トライアル認証評価総括 ル認証評 認証 認証評 認 証評価総括 証評 価 ࠉ トライアル認証評 東京慈恵会医科大学 東京慈 京慈恵 京慈 京 慈恵 慈 恵会 会医科 会医科大 会医 医科大 科大学 中村真理 中村真理子 村真理 村真理 村真 真理子 准 准教授（東京慈恵会医科大学） 教授（東京 （東 （東京 東京 京慈 慈恵会 恵会医 会医 会医科 会 医科 医 科大学 大学） 大 学） 学 ） 千葉 千葉大 千葉大学 千 葉大 葉大学 葉大 大学 学 市川智 市川智彦 市 川智彦 智彦 彦教 教授 教授（千葉 教授（千葉大学） 授 葉大 葉 大学） 学） 4校 校全 校全体 校全体の総括 全体 全 体の の総括 の総 総括 総括 福島 福島 統 島 統 島 島 統 統教 教授（東京慈恵会医科大学） 授（東京慈恵会医科大学） 分野別認証評価受審の準備 野別 野別 別認 認証 証評価受 評価受 価受審の準 価受 審の の準 準備 準備 ࠉ 分野別 鈴木利哉 教授（新潟大学） 質疑応答 応答 応 答 ࠉ 質疑応 の辞 の辞 ࠉ 閉会の辞 北村 聖 教授（東京大学） 参加費無料 １号館西 館 ３号 g Buildin No.3 Building No.1 West １号館東 Building No.1 East 7 号館 g No.7 Buildin 8 号館北 Building No.8 South 8 号館南 Building No.8 South ワー er M&Dタ Tow M&D g 棟北 歯科 Buildin rth No try ntis of De ご参加申し込み： メールかFAXにて、１．ご氏名、２．フリガナ、３．ご所 属・役職、４．連絡先、５．メールアドレスをご記入の上、下記までお申し込 みをお願いします。 Feb 20, 2015 National Symposium on Accreditation at Tokyo Medical and Dental University .10 10 号館 ng No Buildi 棟南 lding th Bui Sou try ntis of De 歯科 ■ JR中央・総武線 御茶ノ水駅下車 徒歩3分 〒113-8510 東京都文京区湯島 1-5-45 国立大学法人 東京医科歯科大学 ■ 地下鉄丸ノ内線 御茶ノ水駅下車 徒歩2分 医歯学教育システム研究センター ■ 地下鉄千代田線 電話 03-5803-4543・4519 新御茶ノ水駅下車 徒歩5分 FAX 03-5803-0282 E-mail: [email protected] UTokyo Lee March 2015 Accreditation involves… • • • • • • Continuous quality improvement (CQI) Providing evidence of outcomes Using data to provide evidence Having a robust IR to provide data Using data for CQI Engaging the community in the process IR = Institutional Research unit UTokyo Lee March 2015 WFME* accreditation standards 1. 2. 3. 4. 5. 6. 7. 8. 9. Mission and Outcomes Educational Program Assessment of Students Students Academic Staff/Faculty Educational Resources Program Evaluation Governance and Administration Continuous Renewal *WFME = World Federation forMedical Education UTokyo Lee March 2015 Std 1: Mission and Outcomes 1. Define what is distinctive about your university Clinical, research, education mission What sets your graduates apart now/future? 2. Regardless, accreditation requires “an appropriate foundation for future careers in any branch of medicine” 3. Clarify and elaborate on your outcomes UTokyo Lee March 2015 1. Standard 2: Educational Program Move from fact-based teaching (faculty delivering content) to outcomes-based education (students learning competencies) 2. Articulate core concepts, principles Use mixed teams of BS and Clinical faculty Each concept defensible as a building block 3. Increase vertical and horizontal integration 4. Make faculty-student face-to-face time count! UTokyo Lee March 2015 Standard 2: Educational Program 5. Provide students with direct patient care Enable students to fully engage with training Need to apply knowledge how they will use it Communication skills in non-hospital settings Address faculty time with peer training, team approaches, core faculty Cultivate affiliated clinical training sites UTokyo Lee March 2015 Standard 3: Assessment of Students Key message: Assessment drives learning 1. Cannot change curriculum without change in assessment Increase active, formative methods More proactive in own learning More accurate self-assessment Build self-directed learning skill Faculty can identify gaps earlier/correct UTokyo Lee March 2015 Standard 3: FDs on Assessment Key message: Create faculty teams 2. Create teams, department- or topic-based Become resources for each other Come with a problem to solve • More engaged with new methods • More effective development, implementation Share workload, flexible time schedule Share best practices, new collaborations FDs = Faculty Development sessions UTokyo Lee March 2015 Standard 3: Implementation Key message: Pilot in phases 3. Discover what works best before committing major resources Many moving parts, causes of failure Need multiple iterations to refine Carefully evaluate what worked, why UTokyo Lee March 2015 Standard 4: Students Key message: Move beyond scores 1. Identify students with “entire package” of intelligence, emotional intelligence, humanism 2. Encourage student voices Formalize membership on committees Key to success during change 3. Increase international exposure UTokyo Lee March 2015 Standard 5: Academic Staff/Faculty Key message: Maximize your talent pool 1. Low ratio of women, students and faculty No progress without clear programs 2. Provide clear evaluation, promotion system 3. Need to value faculty’s contributions 4. Incentives to assume leadership positions UTokyo Lee March 2015 Standard 6: Educational Resources Key message: Need tools to achieve outcomes 1. Curriculum tracking and management Vertical and horizontal integration Each faculty can integrate in context 2. Content management and delivery Maximize face-to-face time 3. Enable detailed feedback to refine from a unit to entire curriculum UTokyo Lee March 2015 Standard 6: Educational Resources Key message: Need a resource budget 4. Cost-sharing across multiple user groups Simulation Library Hardware (rolling replacement) Personnel 5. Research before you buy 6. Buy only what you need UTokyo Lee March 2015 Standard 6: Educational Resources Key message: Design flexible learning spaces 7. Keep rooms and furniture flexible Lecture-style rooms have limited use Wifi Electricity UTokyo Lee March 2015 Standard 7: Program Evaluation Key message: Use longitudinal data 1. Need an Institutional Research function 2. Online collection is a must 3. Layers of data from all stakeholders Student performance Course and clerkship outcomes Postgraduate performance Admission policy changes UTokyo Lee March 2015 If you order a test on a patient, it should affect your management. Likewise, the evaluation you conduct on your course or program should affect how your course or program is conducted. In other words: Make your evaluations count! UTokyo Lee March 2015 Learning Analytics (as a subset of Academic Analytics) “...is the measurement, collection, analysis, and reporting of data about learners and their contexts, for purpose of understanding and optimizing learning and the environments in which it occurs.”* International Conference on Learning Analytics and Knowledge, 2011 Importance cited in 2012 Higher Education Horizon Report UTokyo Lee March 2015 How to make analytics count Know what you want as outcomes Decide what is key evidence Involve key stakeholders throughout Pilot your questions and methods Ensure that feedback loops are active Keep it simple! UTokyo Lee March 2015 General structure for evaluation Steering Cmte Evaluation Cmte AAC MISSION FMUT OUTCOMES DATA On Processs (Outcomes x Course/CC) And Students COURSE/CC MATRIX CURRICULUM MATRIX Institutional Research Continuous Continuous p Improvement (Objectives x Unit/Activity) Faculty CC = Clinical Clerkships Cmte = Committee AAC = Academic Affairs Committee UTokyo Lee March 2015 In Institutional nstituttionall On On Process Prrocess ocess (Outcomes x Course/CC) CC) OutcomeAnd X Research Resea arch h A1nd 1.1 Students Students COURSE/CC MATRIX RIX Objective (Objectives x Unit/Activity) vityy) Objective 1.2 Outcome 2 X X Objective 2.2 X Faculty F aculty acul X X X X Objective 2.1 X Continuous C ontinu uous IImprovement mproveme ent nt X X PHARMA PATHOPHYS ANATOMY OUTCOMES X FMUT OUTCOME OUTCOMES ES COURSES DATA CURRICULUM MATRIX RIX YEAR ONE MISSION ISSION PHYSIO BIOCHEM Steering g Cmte Evaluation E valluattion n Cmte Cmtte AAC AAC C YEAR TWO Curriculum Matrix X X X X X X UTokyo Lee March 2015 DATA D ATA X In Institutional nstitu n utiona al X On On Process Process (Outcomes es x Course/C Course/CC) CC) Objective 1.1.1 X earch Research Rese h And And A nd Objective X Students Stu ude1.2.1 ntss COURSE/CC MATRIX TR RIX 2.1 Objective 2.1.1 Objective 2.1.2 CLIN CASE 1 Objective 1.1 CURRICULUM ULUM MATRIX MAT TR RIX (Objectives x Unit/Activity) vittObjective y)) CLIN CASE LABS LECTURE 1 LECTURES LECTURE 2 OBJECTIVES MISSION X UNIT/ACTIVITY FMUT OUTCOMES ES Ste eering gC mte e Steering Cmte Eva aluatio on Cmte Cmtte Evaluation AAC C AAC LAB 1 Course/Clinical Clerkship Matrix X Contin Continuous nuous X IImprovement mprovement X X X X Faculty F aXculty X X X X X UTokyo Lee March 2015 Use of matrices in process of Tufts’ 3-year evaluation cycle 30-person Curriculum Committee 1/3rd of entire required curriculum is reviewed each year Use context of both matrices, determine whether objectives are being met Results to faculty, depts and students UTokyo Lee March 2015 Example of clinical curriculum Aug Year One Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul CAP training Each component receives in-depth NBME Competency-based Apprenticeship in Primary Care Part I Clerkships start peer evaluation NBME Part II every 3 years Interviewing and Physical Diagnosis Year Two Year Three Core Clerkships Year Four Sub-I’s start Sub-internships and electives UTokyo Lee March 2015 Elements examined during the three-year cycle review Content Methods • Syllabus, etc. • Activities • Assessments All linked to objectives in matrices • Student representatives Student Evaluations • End-of-unit evaluations Peer Evaluation • Generalist • Content expert UTokyo Lee March 2015 Fruits of Tufts’ 3-year cycle Peer discussion of best practices Feedback to students on what changed Complements annual evaluation process Longitudinal data to steer programs Systematic data ready for accreditation Enables continuous quality improvement UTokyo Lee March 2015 Curriculum Mapping of competencies across multiple levels UTokyo Lee March 2015 Competency cascade National associations, specialty societies National Institution School Course Program Session Course Clerkship Activity Assessment UTokyo Lee March 2015 Competency Visualization Tree National School Course Session UTokyo Lee March 2015 2015 “Patient Care” shown in Visualization Tree National School Example showing “Patient Care” with its national competencies, and school-level competencies UTokyo Lee March 2015 2015 “Patient Care” through course level National School Course UTokyo Lee March 2015 2015 “Patient Care” in table form National School Course UTokyo Lee March 2015 2015 “Patient Care” thru session level, with activity and OSCE assessment National School Course Session Method/ Activity OSCE Assessment UTokyo Lee March 2015 2015 OSCE assessment entry in academic calendar OSCE Assessment UTokyo Lee March 2015 OSCE management page automatically generated from calendar Summative or Formative Assessment Link to content Link to session objectives and course competencies UTokyo Lee March 2015 2015 Link OSCE/assessment to Course Competencies Select which course competencies to link to OSCE UTokyo Lee March 2015 Design OSCE/each assessment from desired learning outcomes* Learning Outcomes • Identify desired competencies, objectives at course level Learning Assessment *Based on McTighe and Wiggins: Stages of Backward Design from Understanding by Design • Determine acceptable evidence of achieving competency Learning Methods • Plan activities and instruction UTokyo Lee March 2015 Map assessment and activity back to Course competency National School Course Session Method/ Activity Portfolio/log Peer Assessment OSCE UTokyo Lee March 2015 2015 Feedback from assessments Meeting the mission Accreditation Current needs Grad competencies Student Institutional Assessment Assessment Program Assessment Meeting needs Worthy of funding Faculty Assessment Check for ways to improve Teaching quality Promotions UTokyo Lee March 2015 Link data to accreditation and strategic planning Steering Cmte Evalu Eva Eval E Evaluation valuation u Cmte AAC AAC MISSION FMUT OUTCOMES National Accreditation n DATA D ATA CURRICULUM MATRIX O On Process e s (Outcomes x Course/CC) And Students d ntt COURSE/CC MATRIX (Objectives x Unit/Activity) Institutional itutional Research Research arch Co Continuous Continuous Continuou o uo IImprovement p Improvement St t i Strategic Planning Faculty Fa F aculty a c UTokyo Lee March 2015 Standard 8: Governance, Administration 1. Critical to manage entire curriculum 2. Cannot be coordinated through depts 3. Need someone responsible for education who thinks about it full time, not part time 4. Vice dean for education or equivalent 5. Need clear connection with IR, Evaluation Committee, Steering Committee, and AAC UTokyo Lee March 2015 Standard 9: Continuous Renewal Key message: Continuous improvement 1. Expose faculty to other methods, universities 2. Serve on accreditation teams 3. Attend conferences to share best practices Share with peers across institutions Add to education portfolio Benefit to faculty, institution, students and ultimately to our patients, society UTokyo Lee March 2015
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