The Colleges of University of Washington School of Medicine

History

The UWSOM College Program began in 2001 as part of a curriculum review, with the goal of enhancing clinical skills training throughout the 4 years of medical school education linked to a robust mentoring program.  While we had had a strong history of early clinical skills training at the UWSOM, it was increasingly difficulty to ensure truly excellent skills training for all students. In addition, we have a large medical school with students dispersed over a 5 state region and students can become isolated and lost in our system. 

As part of the WWAMI program, students who are residents of one of the 5 WWAMI states – Washington, Wyoming, Alaska, Montana, and Idaho – spend their first year at one of 6 regional sites (2 in Washington state at Spokane, WA, and Seattle, WA; a combined Washington/Idaho site; and one in each of the other 3 states).  Historically, they have all come to Seattle for the second year of their pre-clinical curriculum, and then are dispersed throughout the region for their clinical training. This year for the first time, we have a pilot program, delivering the second year curriculum to 19 students at the site in Spokane, WA.

The Colleges were named for natural wonders in the 5 state region. We started with five Colleges – Rainier (WA), Wind River (WY), Denali (AK), Big Sky (MT), and Snake River (ID). As the class size increased, we added a sixth College – Columbia River; and, with the addition of 4 College faculty in Spokane as part of the second year pilot, we added a seventh College – Palouse.

Program Goals

From the beginning, our goal has been to create, deliver, and support a four year integrated developmental curriculum of clinical skills and professionalism linked to a consistent and robust mentoring program.  Last summer we developed a new vision and mission statement that outlines our key goals. We define our central values as collaboration, excellence, community, respect, and service to others. We describe our mission beginning with the statement: The UWSOM College Program combines a clinical skills and professionalism curriculum with a mentoring program to train compassionate, expert physicians to practice outstanding patient-centered care.  (Full mission statement in appendix A)

Structure

There are six Colleges within the School of Medicine, each with six to seven faculty mentors, one of whom serves as the head of the College.  Students are randomly assigned upon matriculation to one of the six Colleges, and specifically to one faculty mentor within that College.  Each College mentor is assigned six students and works with them throughout their medical school career.  Each College has a total of 144-150 students.  Student assignments are independent of specialty interest, and each group is balanced between students who spend their first year in Seattle and students from other regional sites. This year, for the Spokane second year pilot, a seventh College was created with 4 faculty in Spokane, one of whom serves as the College head, with 5 students assigned to each of the 4 faculty members.

Each College faculty member receives .25 FTE support, and each College head (who also has the roles and responsibilities of the other College faculty, with additional responsibilities as a College head) receives .5 FTE support.  The Associate Dean for the Colleges receives .75 FTE support (and is also a College faculty member and head).  The College Program is within the UWSOM Academic Affairs office and the Associate Dean for the Colleges reports to the Vice Dean for Academic Affairs.  All of the College faculty, with the exception of Palouse College, are regular UWSOM faculty and are based in Seattle.

College faculty members have some initial contact with their first year Seattle students in person, and with their first year regional students via email, phone, and/or videoconference. In the second year, when all of the students are in Seattle, the College faculty have teaching sessions with their second year students one morning a week throughout the entire second year curriculum.  These sessions start with clinical skills review sessions and then move to bedside teaching sessions with students performing complete history and physical exams on hospitalized patients, with direct observation by their faculty mentor, followed by bedside oral case presentations and write-ups submitted to an online portfolio for review and comment by their faculty mentor.  Small group teaching at the medical school of “advanced physical exams” based on agreed upon benchmarks are interspersed throughout the year, and where possible, coordinated with the students’ organ system curriculum.  College faculty are also involved in teaching professionalism and special skills content throughout the year.

In the third and fourth year, the College faculty maintain regular contact with their students as they go through their clinical rotations. College faculty are notified when clerkship grades are uploaded to their students’ online file. They are also involved in general career advising, and work with students in preparing their residency application. There are quarterly “peer advising” sessions with the students of a pair of College faculty mentors and including students from all 4 years of the curriculum. There are also other informal social gatherings of students and faculty mentors throughout the year.

The College faculty members all adjust their schedules so that they are consistently free on their “College morning” once a week, as well as every Tuesday afternoon. The College faculty meets as a whole group one Tuesday afternoon a month, and in individual College groups once a month. The College heads meet every other Tuesday afternoon.  The College faculty assists in the development and administration of the two major clinical skills exams (OSCEs) for the medical students. They also participate in the Transition to the Clerkships, and the fourth-year Capstone Course.

Leadership

  • Associate Dean for the Colleges (and founding director): Erika Goldstein, MD, MPH
  • Director of Operations, Colleges and ICM: Julie Calcavecchia, MA

College/ICM Office
University of Washington School of Medicine,
Box 357430, Seattle, WA,
98105
Phone: (206) 658-1202

College heads (additional College faculty listed in appendix B):

  • Big Sky College: Mark Whipple, MD, head, Associate Professor, Otolaryngology, Head and Neck Surgery
  • Columbia River College: David Losh, MD, head, Professor, Family Medicine
  • Denali College: Raye Maestas, MD, head, Associate Professor, Family Medicine
  • Palouse College (Spokane): Matt Hollon, MD, head, Clinical Associate Professor, Internal Medicine
  • Rainier College: Erika Goldstein, MD, head, Professor, Internal Medicine
  • Snake River College: Rick Arnold, MD, head, Clinical Professor, Internal Medicine
  • Wind River College: Hugh Foy, MD, head, Professor, Surgery

Activities Showcase

Benchmarks

We developed, and regularly review “benchmarks” for core clinical skills including organ system physical exams (with demonstration videos); these link to the 2nd year OSCE exams that students must pass before entering 3rd year.

Monthly all College faculty meetings focus on a wide variety of topics to enhance teaching skills, explore aspects of the curriculum, and develop areas of our work in the broader SOM community. Monthly individual College faculty meetings focus on planning and developing materials for teaching sessions, in-depth discussion of College related topics (both administrative and teaching), and discussing individual student issues.

Faculty Development

Monthly all College faculty meetings focus on a wide variety of topics to enhance teaching skills, explore aspects of the curriculum, and develop areas of our work in the broader SOM community. Monthly individual College faculty meetings focus on planning and developing materials for teaching sessions, in-depth discussion of College related topics (both administrative and teaching), and discussing individual student issues.

Working Groups

We have 9 working groups with each College faculty serving on one or two groups, and in some cases with members from outside the Colleges focusing on all aspects of our work from clinical skills development to mentoring and advising, and including a working group on evaluation and scholarship.

Broader College faculty engagement at UWSOM

College faculty are involved in a large number of other activities throughout the SOM. These include: College faculty chairing the ICM 1 and 2 courses; the 4th year Capstone course; serving as the  founding director of the OSCE program; chairing the school-wide Continuous Professionalism Improvement Committee; leading the UWSOM Service Learning Advisory Committee; heading the school wide Curriculum Renewal Steering Committee. In addition, the leadership of the College program is represented within Academic Affairs in the role of Associate Dean for the Colleges.

College faculty partners

Over the last 12 years, several of our faculty have stepped away to take on other responsibilities and we have created the role of “College Faculty Partners” to enable them to continue to engage in College activities.Scholarship — a number of papers have come from the work of the Colleges, including:

Scholarship

A number of papers have come from the work of the Colleges, including:

  • Goldstein EA, MacLaren CF, Smith S, Mengert TJ, Maestas RR, Foy HM. Wenrich MD, Ramsey PG. Promoting fundamental clinical skills using a competency-based College approach at the University of Washington School of Medicine. Academic Medicine, 2005; 80:423-433.
  • Whipple ME, Barlow CB, Smith S, Goldstein EA. Early clinical skills training improves confidence in clerkships.  Academic Medicine 2006;81 (10 Suppl):S40-S43.
  • Goldstein EA, Maestas R, Fryer-Edwards K, Wenrich MD, Amies-Oelschlager A, Baernstein A, Kimball H. Professionalism in medical education: an institutional challenge. Academic Medicine 2006; 81:871-876.
  • Jackson MB, Keen M, Wenrich MD, Schaad DC, Robins L, Goldstein, EA. Impact of a pre-clinical clinical skills curriculum on student performance in third-year clerkships. JGIM 2009; 24:929-933.

Lessons Learned

  • Importance of both teaching and mentoring components to our success
  • Need to play down the limited “evaluation” role in the ICM 2 course, and focus on coaching
  • Challenges of connecting with our first year students in the region
  • Challenges of staying connected with students during their 3rd and 4th years (easier once the relationship is established)
  • Critical importance of providing adequate salary support for College faculty and heads, and need for explicit discussion with those applying for positions about what specific parts of their current job they will give up when they join the College faculty
  • Importance of adequate logistical support
  • Importance of being able to engage in continuous improvement process and to adapt to external changes