Paul J Hartung, Ph.D.
Course Director

John D. Sutton, M.D.
Clinical Assistant Director - Medicine

Janis J. MacKichan, Pharm.D.
Clinical Assistant Director - Pharmacy

The Longitudinal Course - includes three modules:

1. Prologue
2. Doctoring/Pharmacist Patient Care Experiences
3. Capstone

Read below to discover the history, purpose, model, goals, timing, course topics, and curriculum themes of the Longitudinal Course.
Click here to view the Integrated Themes of Medicine Team Roster.

Overview

History

In 2003, NEOUCOM embarked on a major initiative to transform its medical education program. This process yielded an “Integrated Steps” curriculum model structured around “five Cs,” of medicine: Communication, Competence, Caring, Character, and Community. The innovated model entailed a basic shift from separate, disciplinary-based courses to integrated, interdisciplinary-based courses delivered in five blocks over four years with bridges linking the steps. Integral to the revised curriculum is a longitudinal course charged with fostering student development in each of the five C’s in a way that strengthens the clinical relevance of the entire curriculum to the professional development of the student.

Content Design Team. From October 2004 through March 2005 a Longitudinal/Intersession Content Design Team developed the initial architecture, content, goals, and objectives of the longitudinal course. The work of this group proved highly complex given the four-year nature of the course; the intent to highly integrate this course into all other course work; the need to broadly represent the interests of all of the NEOUCOM constituencies in creating content for the course; the intent to avoid allowing this course to become a “dumping ground” for content that does not seem to fit well elsewhere in the curriculum; and, perhaps most importantly, the strong desire on the part of all members of the Content Design Team to ensure that this course strengthened the entire NEOUCOM curriculum and allowed each student to derive the greatest meaning from her or his development as a physician.

From its work, the Content Design Team concluded that the longitudinal course should engage the student in active, independent, and self-directed learning that includes continuity, clinical, and service experiences in the community. This learning should also promote self-reflective practice and assure that students come to understand their role in the community and the role they play in improving the health of that community. The Design Team also concluded that critically important to the success of the course would be the extent to which it assists the student to achieve by the end of the four-year course the following five overarching course goals:

1. Establish an initial identity as a physician.

2. Appreciate, know, and show how to provide competent and compassionate medical care for individuals, families, and communities.

3. Uphold the virtues of professionalism and be ready for entry into the profession of medicine.

4. Adopt a public health and primary care perspective on medical care.

5. Embody an ethic of service to society and the medical profession.

The Design Team also identified the following five guiding principles for the course:

1. There should be a longitudinal, continuity ambulatory primary care experience for each student throughout the four-year curriculum, or at least until the student begins to do clinical electives in the final step of the curriculum.

2. There should be a longitudinal off-campus community health/population medicine experience for each student that spans the four-year curriculum. This experience would embed groups/teams of students in communities.
3. Each student should be expected to participate in community service activity throughout the four years, perhaps linked in a preceptor relationship with PDAT advisors, and ultimately culminating in a scholarly project around service toward the end of the curriculum.

4. Some of the structured College of Medicine campus-based hours for the course must be spent in the delivery of curriculum in history-taking, physical exam skills, behavioral, social, and community health sciences, humanities, ethics and philosophy of medicine, as well as other areas identified on the course topics list seen in Table 1 and developed by the Content Design Team. This time would be integrated and the content delivered in concert with each step of the Integrated Steps curriculum.

5. Some of the campus-based hours for the course should also be spent engaging in critical reflective exercises related to the student’s ambulatory primary care and community health and service experiences, as well as other aspects of the curriculum.

Longitudinal Advisory Group/Integrated Themes of Medicine Team. A final meeting of the Content Design Team in March 2005 reached consensus for the need to transition from this design group to a clearly defined course leadership group that could guide actual development and implementation of the course. Consequently, Paul J. Hartung, Ph.D., Course Director and Joseph Zarconi, M.D., Clinical Assistant Director were designated by Mark A. Penn, M.D., Senior Vice President and Executive Associate Dean for Academic Affairs, to lead a Longitudinal Advisory Group in developing and implementing the longitudinal course.

Table 1. Longitudinal Course Topics and the NEOUCOM Curriculum Themes

Dinah Fedyna, M.D., Family Medicine
C. William Keck, M.D., Community Health Sciences
Starla Martinez, M.D., Pediatrics
Anita Pokorny, M.Ed., Student Affairs
J.G.M. Thewissen, Ph.D., Basic Medical Sciences
Steven Radwany, M.D., Internal Medicine
Joseph Zarconi, M.D., Clinical Assistant Director
Laurie Zupp, Course Coordinator
Paul J. Hartung, Ph.D., Course Director; Behavioral Sciences

As the NEOUCOM curriculum committee structure evolved during academic year 2005-06, the NEOUCOM administration renamed the Longitudinal Advisory Group the Integrated Themes of Medicine Team, which expanded in March 2006 to include additional members who have specific roles in the longitudinal course.

The Integrated Themes of Medicine Team now meets regularly to develop, plan for the implementation of, and evaluate the course content, methods, and materials across the segments of the course. Subgroups of the Integrated Themes of Medicine Team also meet regularly during the year to plan for specific components of the course such as Prologue, which begins the course and the academic year; the Intersessions, which occur during Step 4 of the M3 year; and Capstone, which occurs during M4 and culminates the longitudinal course.

During the 2006-07 academic year the longitudinal course expanded and was revised to incorporate pharmacy education. On August 27, 2007 the Prologue segment of the longitudinal course was the first course delivered to the combined medical and charter pharmacy classes of 2011. This proved to be a milestone that realized launching of the new NEOU College of Pharmacy.

Purpose

Timing and Sequencing

Course Model

To structure and guide development and implementation of the longitudinal course, a conceptual model was developed early in the design of the course. This model contains five integrated themes: Professional Identity, Patient Care, Professionalism, Population Health, and Service. A summary of the course themes appears in Figure 1.

Figure 1. Longitudinal Course Themes.

Professional identity means possessing a clear and stable picture of one’s goals, talents, values, and interests related to career choices and decision making. This theme prompts students to consider the questions “Who am I?” and “Who shall I become?” Patient care denotes diagnosis, prevention, and management of illness and injury for individuals, families, and communities across the lifespan. This theme prompts students to consider questions such as “Who is my patient?”, “How do I care?”, and “What is my privilege as a health-care provider?” Professionalism refers to the attitudes, behaviors, values, virtues, and character expected of physicians and pharmacists and placing patient interest above self-interest. Professionalism deals with questions of “What are my obligations?” and “How do I shape my profession and how does it shape me?” Population health comprises the prevailing health level of the population, measured by health status indicators and influenced by a host of physical, biological, behavioral, social, cultural, economic, and other factors. The medical discipline most concerned with population health is Preventive Medicine. This theme prompts students to consider questions such as “What is the world of my patient?” and “How is the community my patient?” Service concerns promoting the welfare of the public and the health professions through volunteerism, acts of charity, and assistance to needy and vulnerable populations. This theme considers the question “How can I serve?”

As depicted in Figure 1, clinical encounters and community-based experiences provide anchor points for teaching across the five course themes. The themes serve as lenses through which to view clinical encounters and community-based experiences in the course. Using the Colleges’ Wasson Center as a virtual ambulatory care center, the early phase of training in Y1 from August to December engages students primarily in simulated clinical encounters (SCE) with standardized patients to learn basic interviewing and introductory vitals assessment (medical students will continue to learn expanded screening physical exam skills). These encounters then, too, provide the basis for small-group, whole-class lecture-based, and reflective teaching across the course themes.

For medical students, as they develop basic knowledge, attitudes, and skills across the five themes, Primary Ambulatory Care Experiences (PACE) and Area Health Education Center Experiences (AHEC/E) commence. PACE places medical students in the office of the same primary care physician on three occasions during Y1. AHEC/E immerses medical students in the community of their PACE physician’s office to describe, assess, diagnose, and improve that community’s health. SCE, PACE, and AHEC/E continue throughout students’ four-years at NEOUCOM.

For pharmacy students, as they develop basic knowledge, attitudes, and skills across the five themes, Pharmacist Patient Care Experiences (PPCE) ensue. PPCE places pharmacy students in various pharmacy practice sites to develop patient interaction, medication distribution, and medication safety skills. PPCE continues throughout students’ four years at NEOUCOP.

Rationale for the five themes. Contemporary streams in medical education collectively call for offering medical students curricula that foster their development in the core domains of physician identity, patient care, professionalism, population health, and public service. Doctoring, and the entire longitudinal course, promotes acquisition of the fundamental attributes of altruism, knowledge, skill, and dutifulness that students must possess upon graduation from medical school as indicated by the Association of American Medical Schools’ Medical School Objectives Project (1998). Doctoring also attends to the Accreditation Council for Graduate Medical Education’s six core competencies that resident physicians must meet in the areas of (a) patient care; (b) medical knowledge; (c) practice-based learning; (d) communication; (e) professionalism; and (f) systems-based practice.

Ultimately, through its segments of Prologue (M1), Doctoring (M1-M3)/PPCE (M1-M4), and Capstone (M4), the longitudinal course teaches students about how biological, behavioral, social science, and humanistic processes interact to determine health outcomes in the following domains identified by the Institute of Medicine:

1. Mind-body interactions in health and disease (psychophysiology, human life-cycle development, chronic illness, pain management);

2. Patient behavior (lifestyle, health risk behaviors, principles of behavior change);

3. Physician role and behavior (professionalism; physician self-awareness of values, beliefs, and behaviors; community mindedness);

4. Patient-physician interactions (communication skills, medical interviewing, challenging situations);

5. Social and cultural issues in health care (health disparities, social determinants of health outcomes, population medicine, cultural context of medical care, CAM/integrative medicine);

6. Health policy and economics (U.S. health care system, cost effectiveness)

The course aims to promote students’ personal and professional development in all domains of medicine and pharmacy from the biotechnical, informatic, psychological, social, and humanistic to the cultural, spiritual, and ethical/moral. The course also resonates with and advances the central tenets of narrative medicine, which conceptualizes effective medical practice in terms of four essential narrative situations: (a) patient and physician; (b) physician and self; (c) physician and profession/colleagues; and (d) physician and society.

Longitudinal Course Goals

1. Establish an initial identity as a physician or pharmacist.

2. Appreciate, know and show how to provide competent and compassionate health care for individuals, families, and communities.

3. Uphold the virtues of professionalism and be ready for entry into the profession of medicine or pharmacy.

4. Adopt a public health and primary care perspective on health care.

5. Embody an ethic of service to society and the medical or pharmacy profession.

In year 1, the longitudinal course aims to develop foundational attitudes, knowledge, and skills relative to (a) students’ emerging identity as a physician or pharmacist, (b) patient care giving, (c) professionalism and anticipated entry into medicine or pharmacy, (d) population health, and (e) service to the community. Each subsequent year builds upon this foundation drawing on the five themes to both structure the course and appropriately advance students’ progress and involvement in it. With development and increasing identity shift toward students’ becoming physicians, pharmacists, and a health-care team, appropriate course adaptations ensue in students’ roles and responsibilities.