Learning Program

The first year of medical school begins with an orientation day which helps students transition from the pre-medical years to medical school. During this day:

The administrative team and faculty members at AUBFM and AUBMC welcome the students. The vision, mission, philosophy and structure of the Impact Curriculum are shared with them, as well as the applicable rules and regulations, and the students’ rights and responsibilities.
The students take the Medical Student Pledge and sign a copy of it which is kept in their records as a commitment to uphold the principles of professionalism and ethics (see section II in this manual).
Students make an orientation visit to the medical school and the medical center
Students are introduced to some specific approaches in learning (e.g. team based learning) through a dedicated workshop.
The first meeting with student advisors is held usually within the first or second weeks of medical school. See section XII – student advising.

Years 1 And 2

Following the orientation day(s), the formal curriculum begins. First year is composed of 2 broad sections (see figure 1):

An initial Foundations Block, in which the basic principles and the language of the medical sciences are learned through specific courses. This block is subdivided into 3 periods: the first explores normal structure and function at the gross and cellular level in an integrated manner; the second explores host defense processes (immunology and diseases related to the immune system) and basic pathological mechanisms; the third section explores basic microbiology and related infectious diseases. Starting in sections 2 and 3, the integration between the basic and clinical sciences becomes more apparent in the courses of immunology and infectious diseases, and this becomes fully fledged in the second block of year I and all of year II. In addition to the basic biomedical sciences, a course in fundamentals of medical research presents the empirical and scientific basis of medical knowledge through learning about epidemiological principles and approaches, biostatistics and the principles of evidence based medicine.
A second Organ-Systems Block, which uses an organ-system based approach to learning that integrates all the basic sciences horizontally. This approach continues throughout Year 2. The principles learned in the Fundamentals of Medical Research course get integrated into the organ system modules, which achieves 3 objectives:
- It revisits the principles of epidemiology and biostatistics learned in Block 1 from a more applied perspective, thus reinforcing them
- It complements the knowledge about the organ system being studied
- It trains students in evidence based medicine (EBM) by emphasizing primary sources in the literature.

This course also requires the students to conduct a group research project that applies the principles learnt.

These two sections, the Foundations Block and the Organ-System Block, thus constitute the Science of Medicine thread of the students’ education during the first 2 years.

Duration	Year 1		Remainder of Year 1 and All Year 2*
Thread	Foundations Block		Organ-System Based Integrated Courses
The Science of Medicine	Topics include: Gross Anatomy Histology Biochemistry Genetics in Health and Disease Basic Cell Physiology and Biophysics Basic Pathological Processes Principles of Drug Action Microbiology Immunology		e.g. The Blood	e.g. The Cardiovascular System	e.g. The GI System
	Fundamentals of Medical Research - Epidemiology Biostatistics and Evidence Based Medicine		Epidemiology, Biostatistics and EBM (includes group research project)
The Art of Medicine	Becoming a Doctor	Clinical and Communication Skills	Becoming a Doctor	Clinical and Communication Skills
Socio-cultural/ moral context & professional development		Ethics, Professionalism, and Humanities		Ethics, Professionalism, and Humanities
		Global Health and Social Medicine		Social and Preventive Medicine
		Personal and Professional Development		Personal and Professional Development

General Structure of the Curriculum in years 1 and 2. (*: With full integration, the borders between threads disappear)

In addition, throughout Years 1 and 2, students will also be engaged in courses and learning activities that will develop and mold their

clinical and communication skills
ethical sensitivity and understanding and problem-solving
appreciation of the social context of illness and healthcare
overall professional formation, including abilities to self-reflect, self-assess, and self-improve.

This is delivered through the thread entitled Becoming a Doctor, which has 4 component courses corresponding to the other threads and pillars of medical education:

A clinical and communication skills component (the Art of Medicine)
A social and preventive medicine and global health component (the Socio-cultural and Moral Context)
A medical ethics, professionalism and humanities component. (Moral Context of Medicine)
A professional and personal development component (the Professional Formation of the Individual Physician)

This course is also intimately integrated with the organ systems being studied in Block 2 of Year 1 and in Year 2, such that each organ system module will highlight at least one important principle in these domains, using real examples.

Daily Schedule and Contact Hours: Students spend, on average, not more than 24 hours a week in contact with an instructor in all the forms of teaching/learning that are used, with some variation in load among different sections of the year. In general there is a balance between didactic lecturing and active student-centered learning exercises such as problem based learning (PBL), team based learning (TBL), laboratory exercises and case discussions. Ample time is left for independent self-directed learning and for preparation for the small group sessions. A representative week is depicted in figure 2.

	Monday	Tuesday	Wednesday	Thursday	Friday
8:00	Lecture	Lecture	Lecture	Lecture	Lecture
9:00	Lecture	Lecture	Lecture	Lecture	Lecture
10:00
10:30	Small Group Case based Or Lab Lunch	Ethics Humanities Social Medicine	Small Group Case based Or Lab	Small Group Case based	Small Group Case based Or Lab Lunch
11:30		Ethics Humanities Social Medicine		Small Group Case based
12:30		Lunch		Lunch
13:00		Clinical Skills Section 1	Lunch	Clinical Skills Section 2
14:00			Learning Communities
15:00
16:00

A typical week in years 1 and 2. Actual times may differ depending on the course.

Year 3 and 4

In Years 3 and 4, the 4 threads started in Years 1 and 2 continue; however the format adopted in these 2 years is different in that there are no structured classroom courses. In Year 3, students pass through 6 clerkships, wherein the core competencies in clinical medicine are learnt: Internal Medicine, Surgery, Pediatrics, Obstetrics and Gynecology, Psychiatry, and an initial exposure to low acuity Emergency Medicine (figure 3).

Thread	Year 3
Science of Medicine	Internal Medicine 12w	Pediatrics 8w	Surgery 9w	Obstetrics and Gynecology 8w	Psychiatry 4w	Anesthesiology 3w	Vacation 4w
		Evidence Based Medicine
Art of Medicine	Becoming a Doctor	Clinical and Communication Skills
Socio-cultural/ moral context & professional development		Ethics, Professionalism, and Humanities
		Social and Preventive Medicine
		Personal and Professional Developmen

General Structure of Year 3

In year 4, students reinforce their knowledge and skills in internal medicine (where they serve as acting interns), pediatrics, emergency medicine, and primary care (Family Medicine), and are given the chance to explore their interests through electives and subspecialty rotations (figure 4).

During Year 4 as well, students will gain an understanding of the role of the health care system in the overall delivery and quality of care through a rotation in Public Health, in which they engage in a scholarly group project that addresses an aspect of public health, community practice, or the health care system in Lebanon. In addition, the principles of epidemiology become directly intertwined with practice through sessions in Evidence Based Medicine.

Thread	Year 4
Science of Medicine	Internal Medicine 8w	Pediatrics 4w	Emergency Medicine 6w	Neurology 4w	Family Med 4w	Public Health 2w	Selectives: 8w (Ophthalmology, Otolaryngology, Radiology, Dermatology, Surgery)	Electives 8w	Capstone Course 1w	Vacation 4w
		Evidence Based Medicine
Art of Medicine	Becoming a Doctor	Clinical and Communication Skills
Sociocultural/ moral context professional development		Ethics, Professionalism, and Humanities
		Social and Preventive Medicine
		Personal and Professional Development

General Structure of Year 4

During both Years 3 and 4:

Students become more directly involved in the community of practice at AUBMC.
Emphasis is placed on developing the students’ diagnostic and management skills, and further honing their communication skills, history taking and physical examination.
Students learn to interact with patients and their families and to work within the multidisciplinary health care team.
Despite the focus on clinical science, basic science education remains essential in order to reinforce what has been learned in the previous years, and to solidify the basis on which the students’ clinical knowledge and decision making are predicated.

Furthermore, the students will continue to explore, in a more complex manner, and within a real and more relevant setting, the social, cultural and moral aspects of healthcare, and to develop their reflective skills in order to better understand their role as physicians. Thus, the thread entitled Becoming a Doctor will continue through Years 3 and 4, but in different formats such as:

Activities that are imbedded within the clerkships and directly related to patient-centered care and education (e.g. ethics rounds), thus making these topics more intimately tied to the actual clinical experience of the student
Structured activities that bring the whole class together to address specific topics
Mentoring sessions.

Finally, despite the primary emphasis on students’ experiences as the focus of their education, a standardized and uniform education is ensured through special learning activities that are designed to achieve all the learning objectives and competencies. These include, among others:

Standardized patients
Electronic simulations
Case scenarios
Clinical conferences
Occasional lectures
Problem Based Learning or Team Based Learning exercises

Learning Activities

Lectures: cover the main learning objectives of the course. They serve to introduce topics, explain complex processes and concepts, and direct the students to focus on the essential and important aspects of a topic. They are not meant to be comprehensive presentations of a topic and do not replace the required reading assignments. In addition, some material on lectures may not be found in textbooks as teachers continually update their lectures with recent research findings or use resources other than the assigned textbook(s). For these reasons, and in order to benefit from the student-instructor interaction that takes place in a lecture, students are expected to attend all lectures.
Laboratory sessions: these sessions aim to enable the student to:
- Learn the anatomy of the human body through dissection and through examining prosected specimens
- Analyze a histological or pathological slides or virtual images and describe the various components of cells, tissues and organs
- Conduct experiments or procedures/techniques illustrating principles being learned in the lectures or readings
- Analyze results of experiments
- Correlate laboratory findings with clinical findings and reasoning
Team based learning (TBL) sessions: engage the students in team work that aims to solve complex, real, and usually clinically-oriented or experimental problems related to the topics being studied. Students apply the knowledge that they have gained through lectures and readings to solve these problems. TBL exercises may integrate basic and clinical sciences and cover all disciplines including molecular biology, genetics,histology, pathology, physiology, pathophysiology, pharmacology and clinical medicine. Students are expected to come prepared having read the assignments and reviewed the relevant lectures. In class, the TBL process involves 3 activities: an initial individual test to ensure that students have prepared their material; this is followed by having the team of students take the same tests with immediate feedback to their responses. The last phase is the bulk of the exercise where students are provided with problems/cases and are required to provide specific answers. This process requires interaction within teams, among teams and between teams and the instructor.
Case or problem-based learning: like TBL, involve small group work (sometimes large groups are involved), and clinically based cases and scenarios or experimental studies that require reasoning skills, but involve more open ended questions and discussion. Students are provided the cases and questions in advance and are expected to come the session prepared to answer the questions and engage in discussion.
Clinical Skills sessions: These are hands on sessions in which students learn the art of history taking, physical examination, communicating with the patient and clinical reasoning. Students are also exposed to various diagnostic procedures (e.g., radiography, blood withdrawal). Reading material is distributed ahead of the session for students to prepare.
Reflective discussion sessions: conducted in small groups (or occasionally in large groups) these sessions allow student to reflect on experiences, events and ideas, express opinions, and argue and defend positions. This approach is particularly employed in sessions related to ethics, humanities, and personal and professional development
Teaching Rounds: Students rounding on the wards conduct rounds with the resident in charge and with the attending physician in which they present and discuss their patients focusing on their problems, the diagnostic and management plan followed and the bases for their decisions that integrate scientific, social, economic, cultural and other factors. Students are required to prepare for these teaching rounds and may be asked to make presentations about specific topics.
One-on-one teaching: in ambulatory settings and on the wards, students interact with attending physicians and residents in one-on-one encounters during which patients are presented and discussed.
Clinical Conferences: focus on presentations of patients seen on the ward or in ambulatory settings or medical topics: include OPD conferences, mortality and morbidity conferences, grand rounds…

Student Assessment and Feedback

Learning objectives and competencies are clearly defined for each component of the curriculum, and students must pass each component. The student assessment approaches are aligned with the objectives and competencies of medical education and are, therefore, multiple. They include:

Assessment of knowledge: mostly through objective written or oral tests
Assessment of skills: through observed structured clinical examinations or other forms of direct observation.
Assessment of attitudes and behaviors: through use of essays and instructor evaluation using specific behavior based rubrics.
Narrative and/or questionnaire-based assessment are provided by mentors based upon the student portfolios which contain their reflections, accomplishments, experiences, exam results, formal and informal evaluations, patient encounters…

In all aspects of education and at all levels of the program, students have a chance to evaluate themselves, their peers, their teachers and the program of study. This process develops their self-reflection and self assessment skills and their ability to give and receive constructive criticism.

Student Assessment Methods

Written quizzes or examinations
Written examinations are mostly objective, single-answer, multiple-choice questions that aim to test the cognitive abilities of the students, i.e. knowledge acquisition and application in problem solving, synthesis, analysis and judgment. Check policy on examinations in the appendixes.
Oral examinations
Oral examinations are less commonly used than written examinations to test knowledge, application of knowledge, problem solving and clinical reasoning skills
Practical Examinations
These assessments are used to demonstrate mastery of anatomical knowledge, histo-pathological and radiological skills.
Observed structured clinical examinations (OSCE’s)
OSCE’s are used to test specific skills (clinical skills and reasoning, procedural skills, communication skills, professional conduct, ethical reasoning) in students, particularly during the clinical years and also in the clinical skills courses in years 1 and 2. They consist of multiple stations in which students are instructed to perform specific tasks (e.g. history taking, physical examination, communication with patient…), involving simulated or real patients.
Direct observation of performance
Daily performance of students during the clinical rotations in years 3 and 4 or during case-based discussion sessions, TBL or laboratory work is assessed by their seniors, their peers, and others they interact with, through direct observation of performance and through examination of their written records. Assessors provide descriptive prose and/or pre-set questionnaires using rubrics with specific behavioral anchors that pertain to the course objectives, e.g., history taking, physical examination, clinical reasoning, professional behavior, presentation skills, communication, teamwork….Mini clinical examinations (miniCEX) are special applications of this method in which a faculty member assesses the full clinical encounter between as tudent and a patient.
Essays
Short essays or papers, contributions to discussion forums, and similar approachesare used to assess students’ethical and professional sensitivity and understanding, and theirattitudes, personal development and reflective skills.
E-portfolio and logbook
In most clinical clerkships, student must fill a logbook describing the patients/cases they have encountered and managed, and the procedures they have performed. E-portfolios consist of a repository of all the students’ learning experiences and reflections, arranged by the students to demonstrate achievement of the required learning objectives and competencies and development of scholarship.
Assessment of professionalism
Specific rubrics are used to assess professionalism using direct observation and achievement of targets within the classrooms and laboratories, on the wards, and in the clinics. Assessment of professionalism is a component of every course and clerkship, and consists of monitoring performance, fulfillment of duties, and overall attitudes and behavior using multisource feedback.

Formative feedback is provided to students to point out their strengths and weaknesses. In the basic science years this is frequently built into the instructional and assessment approaches used (e.g. team based learning individual and group readiness assessment tests). In clinical years, clerkship coordinators have designated sessions for providing feedback, but also this can happen after every encounter with attending physicians or seniors. Students are encouraged to actively request feedback from seniors.

Grading

In years 1 and 2 of the Impact Curriculum, courses are graded as Pass/Fail. The Pass/Fail score is set for each examination or assignment based on its content and difficulty. Thus, students are compared to an absolute standard determined by the professors designing the examination and are not scored relative to each other. Students will receive their numerical grades on tests and will have a chance to know how well they performed relative to the standard. In years 3 and 4, 4 grade categories are adopted using norm-based grading: Excellent (top 10-15%), Good (next 35-40%), Pass (the remaining 50%) and Fail (those distinctly below the class distribution).

Numerical grades will be documented in students’ records and may be used for providing a descriptive account of student performance and for recommendation letters by the Dean’s Office.

Professionalism, communication skills and personal development scores are incorporated into course and clerkship grades. Students must demonstrate competence in these domains as well, separately from the overall course or clerkship grade. Those who fail to do so may be asked to repeat a course, repeat the year or to leave the Faculty, even if they have performed satisfactorily otherwise.

Attendance is expected at all learning activities and mandatory at defined activities, and contributes to the final grade (see attendance policy).

Grading policy will continue to be reviewed and modified as the Impact Curriculum is implemented in later years of the program, with the following guiding principles:

All students admitted to medical school have already proven their high academic standards and achievement and have competed hard to be part of AUBFM
The spirit the curriculum nurtures is one of cooperation and teamwork rather than competition and individualism; the grading system must reduce negative competition and enhance collaboration. The aim is for the students to be the best they can and help others achieve the same, rather than to “be better” than their peers
A competency based curriculum ensures that students have achieved the minimum necessary knowledge, skills and attitudes to be able to proceed further in their education
A curriculum that aims to produce excellence must recognize and give incentive for students; the grading system is one way of so doing
A written narrative should accompany the overall grade assignment to summarize the students’ strengths and weaknesses and fill in important gaps left by merely assigning a grade

Alternative Scholarship Track

A future goal of the Impact Curriculum is to ensure that students who are interested in pursuing in depth scholarship work in defined areas are offered an alternative track to the regular 4-year program, whereby they can spend at least 1 year after year 2 doing scholarly work under the mentorship of a faculty member. Students are also encouraged to pursue formal degree work during this time (M.A. or M.S.), which may take a longer time. This scholarly work can be in the form of original research or projects in, among others, the basic medical sciences, clinical sciences, nutrition, public health, social medicine, history and philosophy of medicine or science, medical education, medical ethics, medicine and culture (e.g. art and literature), business administration, management, economics, medical engineering, and medical anthropology. The Faculty of Medicine will work with other faculties to further explore these possibilities and to develop structured programs in these or other areas.

American Univesity of Beirut