Curricular Threads

Biomedical Informatics

Information technology has become an indispensible tool for the effective practice of medicine. Ensuring patient safety and best outcomes, finding the best evidence, practicing cost effective medicine, enabling systems-based care, and providing tailored decision-support for individual patients cannot be accomplished without sophisticated information technology. 
 
Biomedical Informatics is the discipline that fosters the development and implementation of complex technological interventions designed to improve medical care and patient outcomes. 
 
A four-year Biomedical Informatics Thread provides an opportunity for students to master the knowledge, skills and attitudes of the discipline. The major themes and topics of the thread are listed below as well as their location in the curriculum: Fundamentals (FND), Major Clinical Year (MCY), or Differentiation and Integration (D&I).
 
Theme Topic Location in Curriculum Phase
Knowledge Representation Mapping medical concepts Molecular Mechanisms FND
Information Retrieval Information Needs Fundations of Clinical Medicine FND
Information Retrieval Information Resources Mechanisms & Practice MCY
Information Retrieval Searching Skill Assessment Back to the Classroom D&I
Decision Analysis Decision Analysis Mechanisms and Practice MCY
Decision Analysis Sensitivity Analysis Back to the Classroom D&I
Decision Analysis Conditional Probability Back to the Classroom D&I
Clinical Applications Clinical Decision Support Back to the Classroom D&I
Clinical Applications Safety and Quality Back to the Classroom D&I
Clinical Applications Privacy and Security Back to the Classroom D&I
Clinical Applications Usability Back to the Classroom D&I

Medical Decision-Making

In the clinical setting, the decision-making process employed by “expert” physicians is one that aims to be as reflective, unbiased and as purposefully thoughtful as is humanly possible. This decision-making process is informed by the specific circumstances of each individual patient, is calibrated by relevant findings of evidence, and is mindful of the pitfalls of cognitive biases and conflicts of interest. The College of Physicians and Surgeons is committed to providing students opportunities to develop the knowledge, skills and attitudes of effective medical decision-making. Over the four years of medical school students participate in educational activities focused on one or more learning objectives of the Medical Decision-Making curriculum. These educational activities are organized as a thematic thread that is woven into the curriculum. 
 
There are four major themes of the medical decision-making thread: Clinical Reasoning and Decision Analysis are the processes utilized in nearly every patient encounter to make a diagnosis and choose an appropriate therapy; and Conflicts of Interest and Cognitive Biases are the unconscious influences that routinely threaten to undermine optimal decision-making. The Table below lists the thread themes, objectives and location in the curriculum: Fundamentals (FND), Major Clinical Year (MCY), or Differentiation and Integration (D&I).
 
Theme Topic Location in Curriculum Phase
Clinical Reasoning Introduction Foundations of Clinical Medicine FND
Clinical Reasoning Slow and fast thinking Mechanisms & Practice MCY
Decision Analysis Decision Trees Mechanisms & Practice MCY
Decision Analysis Sensitivity Analysis Back to the Classroom D&I
Cognitive Biases Recognition of biases Mechanisms & Practice MCY
Cognitive Biases Managing biases Back to the Classroom D&I
Conflicts of Interest Overview Foundations of Clinical Medicine FND
Conflicts of Interest Managing conflicts Mechanisms & Practice MCY
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Public Health
 
The Public Health curricular thread was developed in response to several trends:
 
  • Topics relating to emerging epidemics, chronic disease epidemiology, global health, and social determinants of health are highly relevant to physicians and medical students. 
  • Public health education is increasingly recognized as an important component of medical education, and integrated public health curricula have been successfully implemented.
  • The Mailman School of Public Health is a premier site of teaching and research, with a broad array of strengths in various public health realms. Located on the same campus as the College of Physicians and Surgeons, the school can be an invaluable resource for P&S students. 
 
The Public Health thread is designed to provide P&S students with the scaffolding to explicitly identify public health-related curricular content throughout the pre-clinical curriculum, and to incorporate the principles, methods, and overall perspective of public health disciplines during their major clinical year. In these sessions students will learn how public health disciplines relating to the context of care can inform clinical practice, medical decision-making, and research. They will also learn of opportunities to incorporate public health into their training and professional development.
 
Theme Topic Location in Curriculum Phase
Social Determinants of Health Health Equity lecture Foundations of Clinical Medicine FND
Social Determinants of Health

Context of Care and Social Determinants writeup

Foundations of Clinical Medicine FND
Social Determinants of Health Health Promotion section Foundations of Clinical Medicine FND
Epidemiology Evidence-Based Medicine section Foundations of Clinical Medicine FND
Social Determinants of Health Social determinants patient write-up Medicine Away MCY
Social Determinants of Health Social determinants patient write-up Primary Care MCY
Public Health Harlem Public Health Commute Major Clinical Year MCY
Public Health Public Health and Your Career lecture Mechanisms & Practice MCY
Public Health Non-Evidence-Based Medicine: the Physician’s Role and Responsibility Mechanisms and Practice MCY
Public Health Clinical Research, Global Health, Population Health Scholarly Project D&I
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Systems, Leadership, Integration and Management (SLIM)
 
P&S Graduates as Leading Agents of Health System Transformation
 
Overview: In June of 2012, based on a proposal from P&S, IBM delivered funding to Columbia to develop a unique new course, designed to provide all P&S graduates with the ability to become agents of health system transformation through exposure to performance improvement theory and practice, additionally armed with insights into U.S. health system function and health policy creation. Informed by input of a P&S student focus group and by prior experience teaching component topics, Course Directors for each element of curriculum related to Systems, Leadership, Integration and Management (SLIM) training have convened and developed a proposed approach to delivering SLIM preparation to P&S students across their four years of education, as follows:
 
Mission Statement: P&S graduates will possess the background knowledge and essential problem-solving skills to lead healthcare into the future, and will personally embrace the responsibility to do so. 
 
P&S graduates becoming transformation agents: Students will accomplish the below course objectives:
  • Objective 1:  What is the system?  Students will know various approaches to U.S. healthcare delivery at macro and micro levels, as well as approaches of other countries distinguished by favorable healthcare performance and cost.
  • Objective 2:  Why this system?  Students will know the process of U.S. health policy formation, which shapes healthcare delivery in the trenches.
  • Objective 3:  How will physicians, working collaboratively in multi-disciplinary teams, lead transformation in the healthcare delivery system?  Students will grasp principles of performance improvement and principles of organizational psychology which catalyze effective, efficient and sustainable change; and will have classroom-based hands-on experience in performance improvement techniques.

The Learning Process:

Objective 1:  Three two hour sessions.  Speakers followed by small group sessions.  Speakers will include individuals from CMS, health system leadership, and major stakeholder industries. (Bridging early FCM1 and into FCM2) (CD:  Dr. Taylor)

Objective 1 and 2:  Seven two hour sessions.  Again, speakers followed by small group sessions.  Speakers will include individuals actively involved in health policy development.  (During FCM2) (CD:  Dr. Taylor)

Objective 3:  Students will be taught principles of performance improvement and organizational psychology, including classroom exercises to embed core concepts.  Further, they will make environmental observations of systems challenges; and they will define the problem in one instance of an environmental issue and propound a solution.  (Four two hour sessions in early FCM3; one M&P intersession half day; and seven two hour sessions in Back-to-the-Classroom)  (CD:  Dr. Sideli)

Objective 4 (Electives):  For those students wanting advanced training in performance improvement, electives and a Scholarly Project array of choices will be offered (CD:  Dr. Sideli, Dr. Weil)

Assessment:  Under auspices of CERE, pre and post course SLIM knowledge, skills and attitudes will be assessed, and benchmarked against the RIME developmental paradigm.