In preparation for our April 2024 LCME accreditation visit, in the upcoming weeks, we will be featuring the top 12 most-cited elements, based on recent data from the LCME and how this is addressed at NYMC.
Element definition: A medical school ensures that the learning environment of its medical education program is conducive to the ongoing development of explicit and appropriate professional behaviors in its medical students, faculty, and staff at all locations. The medical school and its clinical affiliates share the responsibility for periodic evaluation of the learning environment in order to identify positive and negative influences on the maintenance of professional standards, develop and conduct appropriate strategies to enhance positive and mitigate negative influences, and identify and promptly correct violations of professional standards.
NYMC Response
The professional attributes that are expected of medical students are made known to students, faculty, residents, and other members of the medical education community through the NYMC SOM Graduation Competencies and Education Program Objectives, the SOM Student Handbook, and review of the Student Code of Academic Integrity and Professionalism for Medical Students. A statement describing the optimal learning environment is included in course/clerkship syllabi, the SOM Student Handbook and Catalogs, the learning management system, posted in the Medical Education Center, and distributed at all affiliated clinical sites.
Within Phase 1 of the curriculum, the assistant dean of basic sciences has primary responsibility for the learning environment. In Phases 2 and 3 of the curriculum, the responsibility is shared by the assistant dean of clinical sciences and the associate dean for academic affiliations and clinical programs. Methods used to evaluate and monitor the learning environment include:
The SOM has several mechanisms for students, faculty, and/or residents to report observed incidents of unprofessional behavior, including:
Any and all forms of retaliation are strictly prohibited. Any report of retaliation is taken seriously, and if found, is subject to disciplinary action.
Element definition: The faculty of a medical school, through the faculty committee responsible for the medical curriculum, are responsible for the detailed development, design, and implementation of all components of the medical education program, including the medical education program objectives, the learning objectives for each required curricular segment, instructional and assessment methods appropriate for the achievement of those objectives, content and content sequencing, ongoing review and updating of content, and evaluation of course, clerkship, and teacher quality. These medical education program objectives, learning objectives, content, and instructional and assessment methods are subject to ongoing monitoring, review, and revision by the responsible committee.
NYMC Response
The process for formal review of the phases of the curriculum includes annual evaluations of the pre-clerkship and clerkship phases conducted by the Education and Curriculum Committee (ECC) after the conclusion of each academic year. A set of comprehensive data and information sources are reviewed by groups of select reviewers from the curriculum committees. These review groups assess the curriculum across multiple domains using a standardized curricular review tool and submit their analysis and recommendations for review at relevant curriculum subcommittees. Recommendations are then presented to the ECC for action planning and curriculum quality improvement.
The process used to evaluate the curriculum as a whole (CaaW) involves an annual review conducted by the ECC that reviews multiple outcomes, curriculum mapping data, medical education program objectives, and other key features of the curriculum. Items for review include, but are not limited to AAMC GQ data, curricular phase review recommendations, graduation rates, match rates, Step performance, and student satisfaction with electives. Approved action plans and recommendations from the ECC’s CaaW review are delegated to identified individuals or respective subcommittees for curriculum enhancement as appropriate.
Element definition: A medical school collects and uses a variety of outcome data, including national norms of accomplishment, to demonstrate the extent to which medical students are achieving medical education program objectives and to enhance the quality of the medical education program as a whole. These data are collected during program enrollment and after program completion.
NYMC Response
Because all NYMC SOM courses and clerkships are based on the NYMC SOM medical education program objectives (MEPOs), successful completion of a course or clerkship indicates student achievement of each MEPO. A task force of senior educators also evaluates a variety of outcomes data related to each MEPO as part of the annual curriculum as a whole review. Using internal benchmarks set by the Office of Undergraduate Medical Education (including student performance and national norms of accomplishment), the task force evaluates whether students in aggregate are achieving each MEPO upon graduation.
For MEPOs not achieved by students, the task force may recommend the following: 1) the MEPO should be reevaluated 2) the assessment measure may not be appropriate 3) the benchmark’s target may be inappropriate and/or 4) the curriculum needs to be re-assessed to ensure achievement of the MEPO as written. Results of this review are presented to the ECC to determine the next steps to address areas of suboptimal performance.
Continuous quality improvement of the educational program objectives of the MD curriculum is among the functions of the ECC and development of specific action steps are facilitated by the annual curriculum as a whole review process.
Element definition: A medical school has in place an institutional body (i.e., a faculty committee) that oversees the medical education program as a whole and has responsibility for the overall design, management, integration, evaluation, and enhancement of a coherent and coordinated medical curriculum.
NYMC Response
The Education and Curriculum Committee (ECC) is the faculty committee with primary responsibility for the oversight and management of the curriculum. As stated in the School of Medicine Bylaws, it is responsible for the design, implementation, management, assessment, and enhancement of the medical school curriculum to ensure that it meets the mission, vision, and values of the SOM, and that the program is in compliance with all applicable accreditation standards. The ECC is comprised of 15 voting faculty members, and four voting student members with two each from the pre-clerkship and clerkship years. The ECC has representation from both NYMC basic science faculty and clinical faculty, representation from each affiliate site and three or more faculty senators. Faculty members are nominated by the Nomination and Election Committee for election by majority vote of the Faculty Senate.
The ECC has the following reporting subcommittees:
Element definition: A medical school provides its medical students with effective financial aid and debt management counseling and has mechanisms in place to minimize the impact of direct educational expenses (i.e., tuition, fees, books, supplies) on medical student indebtedness.
NYMC Response
NYMC SOM has a longitudinal student financial planning program managed by the Office of Student Financial Planning (OSFP). The OSFP administers financial aid and proactively educates students about medical school cost, budgeting, financial wellness, debt management, loan repayment, and loan forgiveness programs, as well as scholarship opportunities. Throughout the MD program, students are encouraged and taught to manage their financial planning via seminars that address real-life financial scenarios, web resources, educational videos and podcasts, and one-on-one meetings with OSFP staff. The high quality and accessibility of the financial aid counseling services have consistently been recognized on both the AAMC GQ and internal student surveys.
NYMC also recognizes the importance of raising funding for scholarships and grand support for medical students. Key initiatives providing fundraising for student scholarships are the Founder’s Dinner, Dean’s White Coat Campaign, Annual Fund Campaign, Annual Golf Tournament and Dinner, as well as the upcoming annual Days of Giving on March 26 and March 27, 2024. In partnership with the Office of Diversity and Inclusion, there has been a targeted effort to raise funds for students underrepresented in the medical profession to maintain a diverse student body.
Element definition: A medical school has an effective career advising system in place that integrates the efforts of faculty members, clerkship directors, and student affairs staff to assist medical students in choosing elective courses, evaluating career options, and applying to residency programs.
NYMC Response
The SOM recognizes the importance of a comprehensive career advising program that provides each student with coherent, cohesive, and longitudinal guidance in exploring and evaluating career options, choosing electives, and applying to residency programs. This system spans all four years from pre-matriculation to graduation and includes general career advising to determine the most appropriate career path based on student preferences, strengths and interests, and concludes with specific specialty guidance.
The deans of the Office of Student Affairs (OSA) provide leadership and oversight for student career advising, which includes the House Advisory Dean (HAD) program, the Career Specialty Advisor Program, and the NYMC alumni mentor program. The HAD program is the cornerstone of career advising efforts in the SOM. The NYMC House Advisory Dean Program includes 11 Houses, each with a dedicated Advisory Dean, who provides ongoing academic and career guidance throughout each student’s NYMC experience. Career specialty advisors offer guidance specific to their specialty and provide recommendations on how best to enhance the prospects for matching in the chosen field. OSA Deans work collaboratively with students, faculty, course and clerkship directors, house advisory deans, specialty advisors, and alumni mentors to deliver an effective, comprehensive, and accurate advising program to ensure students’ personal and academic success.
The SOM also began an integrated Career Planning Curriculum Thread during AY 2021-22, with coordinated career-related activities aligned with key student milestones. Woven across all four years, the thread includes more career-focused activities at earlier stages in the curriculum and creates more opportunities for students to engage with advisors, alumni, and community specialists. In addition, the OSA delivers focused class meetings and workshops throughout the academic year to review materials about programs and medical specialties, discuss application and interview strategies, and receive guidance regarding the ERAS system and residency match programs.
Element definition: A medical school has an effective system of academic advising in place for medical students that integrates the efforts of faculty members, course and clerkship directors, and student affairs staff with its counseling and tutorial services and provides medical students academic counseling only from individuals who have no role in making assessment or promotion decisions about them.
NYMC Response
The SOM has a robust academic advisory system and process that incorporates both formal and informal components to identify students experiencing academic difficulty. These students are followed longitudinally by multiple departments (including the Office of Student Academic Support, Office of Student Mental Health and Wellness, and the SOM student affairs deans) to ensure success. Students identified to be at risk receive guidance and support to help them improve, which can be in the form of peer tutoring, clinical skills remediation, academic counseling, assigned study coaches, electronic resources, and referral to other student services.
Element definition: A medical school ensures that the medical education program has a single set of core standards for the advancement and graduation of all medical students across all locations. A subset of medical students may have academic requirements in addition to the core standards if they are enrolled in a parallel curriculum. A medical school ensures that there is a fair and formal process for taking any action that may affect the status of a medical student, including timely notice of the impending action, disclosure of the evidence on which the action would be based, an opportunity for the medical student to respond, and an opportunity to appeal any adverse decision related to advancement, graduation, or dismissal.
NYMC Response
The School of Medicine ensures that a single set of core standards for promotion, advancement and graduation is applied to all students through the guidelines outlined in the NYMC SOM Policy on Student Promotions. To make satisfactory progress towards the M.D. degree, each student must satisfy academic, professional, and technical standards on an ongoing basis. The Student Advancement, Promotions, and Review Committee (SAPRC) makes decisions regarding student advancement based on all three standards.
A student may appeal a decision made by the SAPRC, as per the NYMC SOM Policy on Adverse Action Appeals. The criteria for an appeal requires evidence of incorrect evaluation such as: suggestion of bias, calculation/other error, or suggestion of mistreatment. The first level of appeal is to the Dean of Undergraduate Medical Education and the second level of appeal is to the Dean of the School of Medicine. The decision of the Dean of the School of Medicine is final.
Element definition: A medical school has in place a system of fair and timely summative assessment of medical student achievement in each course and clerkship of the medical education program. Final grades are available within six weeks of the end of a course or clerkship.
NYMC Response
The LCME expects that students in all phases of the curriculum will receive course grades within six weeks of the end of the course. While completing the continuous quality improvement review process of the 2022-23 academic year, we identified that not all pre-clerkship courses met this required timeline. In strategizing ways to address this gap, the Office of Undergraduate Medical Education recognized that it could provide additional support to faculty to fulfill this requirement. Thus, beginning in AY2023-24, the Office of Undergraduate Medical Education improved its process of monitoring timely pre-clerkship grade submission by applying the same monitoring process used to ensure clerkship grade timeliness (as outlined in the NYMC SOM Policy on Grade Timeliness and Feedback on the SOM Policies page). Timeliness of pre-clerkship and clerkship grade submissions are also standing agenda items at the monthly Phase 1 Curriculum Subcommittee and Phase 2 & 3 Curriculum Subcommittee, respectively, and included as part of the annual phase reviews.
Element definition: In a medical school, residents, graduate students, postdoctoral fellows, and other non-faculty instructors in the medical education program who supervise or teach medical students are familiar with the learning objectives of the course or clerkship and are prepared for their roles in teaching and assessment. The medical school provides resources to enhance residents’ and non-faculty instructors’ teaching and assessment skills and provides central monitoring of their participation in those opportunities.
NYMC Response
In recognition of the vital role residents and fellows play in the education of NYMC SOM students, the School developed the UME Policy on Residents and Fellows Preparation for Teaching, describing the requirement that residents and fellows who teach or supervise NYMC SOM students receive appropriate training for those roles. The policy indicates that the associate dean for academic affiliations and clinical programs is responsible for the annual tracking of compliance by all sites.
All residents and fellows who teach or supervise medical students must be familiar with the following:
These policies are shared at the beginning of each academic year, with residents signing an attestation that they have received and reviewed those policies.
Element definition: The faculty of a medical school ensures that the medical curriculum includes self-directed learning experiences that allow medical students to develop the skills of lifelong learning. Self-directed learning involves medical students’ self-assessment of learning needs; independent identification, analysis, and synthesis of relevant information; appraisal of the credibility of information sources; and feedback on these skills from faculty and/or staff.
NYMC Response
What is the intent of this element?
The LCME seeks to ensure a medical school prepares students for:
It is expected that the methods of instruction and assessment used in courses and clerkships will provide medical students with opportunities to develop these life-long learning skills. To qualify as self-directed learning (SDL), a given experience must include all the following:
How is the SOM teaching students the skills of self-directed and life-long learning?
SDL activities in the M1 year of the redesigned curriculum consist of Critical Reasoning Exercises (CREs). The CRE program consists of two-stage, small-group, problem-based learning exercises scheduled throughout the year, which integrate foundational science coursework being taught concurrently. For the M1 year, CRE exercises are integrated into the Patient Care domain and utilize clinicians as faculty facilitators. In the M2 year, students work with their individual preceptors.
Each exercise provides students with opportunities to self-identify knowledge gaps; access, analyze, and synthesize relevant information resources; present information to faculty and peers; and receive feedback from faculty regarding their research questions, research quality, and critical appraisal of information sources in a unified sequence. Student achievement of these skills is assessed, and feedback is provided through a rubric to aid faculty and students in determining student acquisition of SDL skills at the midpoint and endpoint of the CRE curriculum.
In the M2 year, students work with their individual preceptors to practice these skills, thereby ensuring they are ready to apply these skills in their clerkships.
Element definition: A medical school develops effective written policies that define mistreatment, has effective mechanisms in place for a prompt response to any complaints, and supports educational activities aimed at preventing mistreatment. Mechanisms for reporting mistreatment are understood by medical students, including visiting medical students, and ensure that any violations can be registered and investigated without fear of retaliation.
NYMC Response
How do we define mistreatment?
Mistreatment is any behavior that is abusive, discriminatory, or unprofessional. Examples of mistreatment, include: public humiliation (e.g., verbal abuse, such as yelling, cursing and/or threats); physical punishment or threats; sexual harassment or asking to exchange sexual favors for grades or other rewards; grading used to punish a student; or requiring or requesting the performance of personal services (e.g., shopping, babysitting).
Examples of behavior that might be unpleasant for a learner, but not considered mistreatment include: embarrassment, (e.g. pointing out that a student’s summary of a patient is incomplete in front of a group of her or his peers); pointing out that a student’s presentation is difficult to follow in front of a group of her or his peers; or asking a student to stand for 45 minutes observing a surgical procedure.
What mechanisms exist to ensure a prompt response?
Students, faculty, and residents can report verbal or written incidents of alleged mistreatment in the learning environment anonymously or confidentially through the Professionalism Accolades and Incidents Reporting (PAIR) system, direct reporting to faculty, deans, or peers, or through anonymous evaluation of courses or clerkships. All reported mistreatment events are triaged by the dean of students and investigated and addressed.
What educational activities are aimed at preventing mistreatment?
Medical students, residents, and faculty all receive education regarding mistreatment in a variety of ways, including web-based modules and small group, interactive, case-based sessions. NYMC SOM takes all reports of mistreatment and unprofessional conduct seriously. Any and all forms of retaliation against any victim or individuals associated with, or involved in the report of mistreatment or unprofessional conduct under this policy is strictly prohibited.
