1. 37th Annual STFM Conference on Medical Student Education
Creating a Family Medicine Learning Community to Increase Family Medicine Career Choice for Medical Students
Bower D, Hulbert K, Morzinski J, Hughes P, Chandler T, Klehm D, Havas N, Diehr S, Nelson K, Bedinghaus J
Dr. Bower
MCW Department of Family & Community Medicine
January 21, 2011
37th Annual STFM Conference on Medical Student Education
Houston, TX
Support for PreDoc initiatives referred to here, partially funded by the U.S. Department of Health and Human Services, Health Resources and Services Administration, Grant # D56HP10304

2. Session Goals and Objectives:
Describe structures and functions of Learning Communities (LC’s) in medical schools
Describe our MCW Family Medicine Learning Community (FMLC), including the rationale and key steps in development, implementation, and sustainment
Evaluate the viability/feasibility of developing a FMLC at your home institution as a strategy to increase Family Medicine career interest among medical students

3. Learning Communities (LC’s)
Purpose: LC’s are intentional communities for students and/or faculty designed to enhance and maximize student learning
Definition: Learning communities (LC’s) are cohorts of students with similar beliefs and a common purpose, actively engaged in learning from and with each other
As an Educational Method:
Education is most successful as a social process (Bandura – Social Learning Theory)
Creates a support environment (academic, social)
Collaborative learning
Delivery of curriculum
Ferguson 2009 Acad Med
hogwarts – Hopkins – Med Teacher:

4. Literature Based Benefits of Learning Communities
There is a growing literature demonstrating the benefits of LC’s in higher education
Improve student satisfaction and retention
Improve student involvement and motivation
Higher academic achievement
Improved quality of thinking
Better understanding of self

5. Learning Community Types/Terms
Types (see bibliography):
Residential (living area, e.g. Harvard College)
Classroom (e.g. college courses)
Curricular
Houses for curriculum deliver (e.g. JHUSOM, Hogwarts)
Houses for professional development , engagement, connection, advising, service learning (e.g. UICCOM)
Student-type/common theme (e.g. shared specialty interest)
Terms:
Houses, colleges, societies
CELLS (Connection, Excellence Learning, Leadership Service)

6. Learning Communities in Medical Education
2006 survey of all US and Canadian medical schools *
18 medical schools with LC’s (AAMC, 2009)
13 medical schools considering LC development
Most medical schools use “house models” (16 of 18)
Focused on student support and enhancing the learning environment
2 of 18 medical schools organize LC’s by common theme
Student self-selected by career interest
MCW model = “Shared specialty interest”, “student-type”
Family Medicine Learning Community (FMLC)
Pilot strategy to enhance specialty choice
* Ferguson K J et al, Acad Med 2009; 84:

7. FMLC Development: Pertinent FM Specialty Choice Literature
Positive curriculum factors:
FM Pathways/Tracks
Positive role models (Arizona study, 2004)
Longitudinal primary care experience
Strong Family Medicine clerkship (6 weeks)
Hidden curriculum antidotes
Positive student factors:
FM interest at matriculation
Social orientation/interest in service to underserved

8. FMLC Development Student Enrollment Faculty Enrollment FMLC Goal:
FM Career Choice/Values
Infrastructure – Organization Physical/Virtual Space
Faculty
Enrollment
Curriculum/ Activities
Student Enrollment
Dr. Hulbert
Infrastructure
Physical spaces – Department – no home base
ANGEL virtual –
DATABASE – Student and Faculty
ACTIVITSE
DATABASE –
Expectations – AEE Logs, # of events/activities, visits for faculty, contacts..

9. FMLC Development: Clear Goals
Goal: The MCW Family Medical Learning Community (FMLC) is to provide a purposeful, formalized environment for engagement of students with interest in a Family Medicine Career, with each other (within their class and across the four years of medical school) and with Family Medicine faculty.
Formalize and manage the informal (hidden) curriculum
Integrate into existing MCW curriculum (e.g. AEE)
Promote avenues for student development, engagement and connection to Family Medicine and its values

10. FMLC Development: Infrastructure/Organization
50% Coordinator
Faculty Leader/broad faculty support
Existing faculty course/clerkship leadership
Integration into regular curriculum with rewards (AEE with certificate of completion)
No ideal existing physical space (e.g., after hours study/gathering)
Virtual space
Electronic learning platform (ANGEL, ELF)

11. FMLC Development: Student/Faculty
Students
Early identification of FM interest
Create supportive community for students
Create vertical connection between students
Opportunity for longitudinal faculty relationships
Faculty
Positive clinician role models
Faculty matched to students for advising/mentoring
Faculty participation incentives

12. Elements of MCW FMLC: Curriculum/Activities/Connections
AEE Students
Pathways
Community
Faculty/
Residents/
Staff
FMSA
Elements of MCW FMLC: Curriculum/Activities/Connections
Family Medicine
Learning Community
Tess Chandler

13. M1-M2 FM Academic Enrichment Elective (AEE) and the Family Medicine Learning Community
Elements of the Family Medicine Academic Enrichment Elective
Two visits with assigned Family Medicine Advisor
Reflections on three Family Medicine related articles
Three Service Learning experiences
Six Clinical Continuity experiences
One Family Medicine Seminar
Four Family Medicine Learning Community events
Family Medicine Learning Community Events
Saturday Free Clinic Family Medicine Day
Poverty Simulation
Vertically integrated events with M1 – M4 students
Softball game
Luncheon learning presentations

14. FMLC Student Activities Across All Four Years
M1-M2 HOME Project
M3 Walking thru the Match
M3 rural option for clerkship
M3-M4 Participation in vertically integrated events
Saturday Free Clinic
Luncheon Learning Presentations
Poverty simulation
Softball game

15. Identity with FMLC FMLC Logo Email signature Email communications:
Douglas J. Bower, M.D.
Associate Professor
Director, Predoctoral Education
Director, M3 Family Medicine Clerkship
MCW Department of Family and Community Medicine
8701 Watertown Plank Road
Milwaukee, Wisconsin
Phone
A Member of the Family Medicine Learning Community
communications:
“Greetings Family Medicine Learning Community members, The Saturday Free Clinic is scheduled for …”

16. Student Perspective Mentor: “most valuable aspect of the AEE program”
SFC: “A day for students and family physicians to help underserved patients in the area and learn from each others cases”
Softball Game: “It was a fantastic break from studying and I really enjoyed interacting with people at all levels of family medicine”
Procedure Fair: “a chance to practice procedures common in family medicine not covered in our first two years of schooling”
Lunch lectures (come to the poster)
Community service experiences
Pamela Hughes

17. Identify with FMLC Student Quote:
“Overall, I felt I was a member of a group of students and doctors that were interested in Family Medicine and teaching and preparing us for Family Medicine …
A Learning Community … I didn’t know what that meant.”

18. Enrollment MCW student body: 200 x 4 years = 800 students
Students with primary care connection (e.g. FMSA members, stated interest, etc.) estimate = 256 students
FMLC “enrollees” = 88
M4 = 31
M3 = 11
M2 = 32
M1 = 14
Total faculty committed to FMLC = 27 (Department N=52)
25 MCW teaching faculty
2 Community faculty
Dr. Morzinski

19. FMLC Students (n = 88) Self-declared, or Faculty identified, and/or
A series of identifiable activities (3 or more)
FMSA membership
FMSA activities
FM academic enrichment elective
Vertical integration activities (Saturday Free Clinic, etc.)
Family Medicine residency sponsored activities
Tracking in FMLC student database

20. Student Ability in Six Goal Areas: Self & Advisor Ratings
Scale:
6 = Highest
1 = Lowest

21. Mentor Evaluation of FM-AEE (6 = Highest, 1 = Lowest, n=13)

22. Student Written Comments: FM-AEE (end of year survey, n=24
Student Written Comments: FM-AEE (end of year survey, n=24. M1 unless noted)
Strengths
Weaknesses
Advice
Shadowing my mentor was the best part
Log time and get credit for being committed to FM … and lots of different activities available
Offered a unique experience and perspective on how patient care is delivered
Bringing students and faculty together on a less-strictly educational basis (M2)
Students and faculty with same interests come together to learn from one another (M2)
Exposure to different people and areas of specialty within FM (M2)
My mentor (taught me) simple conversations that can make a huge difference in patients’ lives
Difficulty contacting our advisors – some don’t use
Some mentors have their students acting on their own, others just have us shadowing
Second year less organized and (was not as strong) an extension of our first year (M2)
Communication could have been stronger (M2)
Learning about the medical home didn’t add significantly
The ELF program [data / report entry] was hard to navigate
Explain to 1st year students all of the different options for getting involved. We need to be told how things fit together
Create a “bank” of FM physicians willing to be shadowed
At times, mentors are extremely busy and don’t have time to meet with us: have alternatives to advisor visits
Start earlier in the year… earlier and more physician contact!

23. Student Written Comments: FM-AEE (end of year survey, n=24
Student Written Comments: FM-AEE (end of year survey, n=24. M1 unless noted)
Strengths
Weaknesses
Advice
Shadowing my mentor was the best part
Log time and get credit for being committed to FM … and lots of different activities available
Offered a unique experience and perspective on how patient care is delivered
Bringing students and faculty together on a less-strictly educational basis (M2)
Students and faculty with same interests come together to learn from one another (M2)
Exposure to different people and areas of specialty within FM (M2)
My mentor (taught me) simple conversations that can make a huge difference in patients’ lives
Difficulty contacting our advisors – some don’t use
Some mentors have their students acting on their own, others just have us shadowing
Second year less organized and (was not as strong) an extension of our first year (M2)
Communication could have been stronger (M2)
Learning about the medical home didn’t add significantly
The ELF program [data / report entry] was hard to navigate
Explain to 1st year students all of the different options for getting involved. We need to be told how things fit together
Create a “bank” of FM physicians willing to be shadowed
At times, mentors are extremely busy and don’t have time to meet with us: have alternatives to advisor visits
Start earlier in the year… earlier and more physician contact!

24. MCW Family Medicine Match
2007
2008
2009
2010
2011
(est) FM
13-15%
12% 7%
10% (21)
7% (14)
13% (24) IM
12-16%
16%
10%
Peds
9-15%
11%
14% 9%
15%
Med/Peds
2-4% 2% 3%
Total
40-44%
37%
40%
32%
35%

25. Your Turn: FMLC at Your Institution
Facilitator will ask for a spokesperson / scribe
All: look over / use worksheet
Discuss FMLC “opportunities”, “barriers” and “ideas for resolving” at your institution
Come to consensus on top ideas
Stay on time
Report back – your group’s main findings

26. MCW Lessons Learned
Important to successful FMLC (relationships/social networking/formalized/purposeful/planned)
Faculty role model engaged with student
Longitudinal student and faculty relationships
Vertical integration of students/peer support
Face-to-face interactions
Identifiable faculty leader
Identifiable coordinator
Integration with overall curriculum
Student database
Challenges
Student and faculty identity with FMLC
Consistent faculty engagement
Physical space (studying/gathering space)
Acceptable/useful virtual space
Dr. Bower

27. National Suggestions to Successful Implementation & Sustainment of a Learning Community
Clear and well-understood mission and goals
Committed leadership
Identity and wide connection
Purposeful and well-implemented curriculum; appropriate, ubiquitous assessment
Well-subscribed formal and informal development for both faculty and staff
Staff and faculty rewards and incentives
Attention to implementation issues such as student identification, recruitment, marketing, advising, and student assignments

28. Annotated Bibliography
Ferguson K J et al, Defining and Describing Medical Learning Communities: Results of a National Survey Acad. Med. 2009; 84: [2006 survey to academic deans of all U.S. and Canadian medical schools to identify those that had implemented a LC. 18 schools reported student learning communities; 13 schools were considering developing LC’s]
Hafferty FW, Watson KV, The Rise of Learning Communities in Medical Education: A Socio-Structural Analysis Journal of Cancer Education : [Discussion of structure of LC’s and addresses “educational compartmentalization and disjointedness”, and “health professions training.”]

29. Annotated Bibliography
Rosenbaum ME et al, Medical Student’s Perception of Emerging Learning Communities at One Medical School Acad. Med ; 82: [In 1999, the University of Iowa Carver College of Medicine (UICCOM) established four student-style LC’s.]
Steward RW, The New and Improved Learning Community at John Hopkins University School of Medicine resembles that at Hogwart’s School of Witchcraft and Wizardry, Medical Teacher : [In 2005, JHUSOM divided the student body into four colleges.]