Learning Communities at MCW - Building on the REACH Curriculum and the 4C Program

 From the 5/21/2021 newsletter

Learning Communities at MCW - Building on the REACH Curriculum and the 4C Program

Kurt Pfeifer, MD; Marty Muntz, MD; and Cassie Ferguson, MD

The team reviews MCW’s experiences with the REACH Curriculum and the 4C Program, each of which has elements of the proposed Learning Community model …

The challenges of training in medicine have never been greater. Medical students are expected to develop a larger fund of knowledge in hectic clinical environments burdened by great financial, social, and public health pressures. This creates can have numerous consequences, including burnout and increasing rates of psychiatric disease. To better support students and reduce these potential problems, many medical schools have implemented learning communities (LCs).

LCs are comprised of faculty members and students who regularly meet together for community-building, academic and personal support, professional development, and curricular activities. Since the early 2000s, many medical schools have implemented these types of programs, and according to the most recent survey of US medical school have LCs or are developing them . LCs have been shown to improve faculty engagement, student well-being, and professional development.

.
In the last few years, MCW has embarked on its own exploration of LCs and has implemented programs which, although limited in scope, are based on the philosophy of LCs.

MCW’s REACH Well-Being Curriculum 

LCs can positively impact student well-being, which has become a major priority for US medical schools. In 2018, with the support of the MCW School of Medicine and the Kern Institute’s Student Pillar, Dr. Cassie Ferguson implemented a well-being curriculum aimed at teaching skills related to well-being and providing opportunities to talk with and learn from peers and faculty members. Utilizing longitudinal groups of faculty, staff, and students, the structure of the REACH (Recognize, Empathize, Allow, Care, Hold Each Other Up) Curriculum incorporates a LC model.

REACH consists of didactic sessions followed by facilitated small-group sessions which focus on the content and objectives covered in the didactic sessions. When first implemented, the program included three sessions in the spring semester of M1 year and three in the fall semester of M2 year. Each small group has eight medical students (ten in the first two years of the program) and two volunteer facilitators. One of the facilitators is a clinical faculty member and the other is a behavioral health clinician or a student support staff member. Using session guides with learning objectives and suggested discussion questions, facilitators conduct two-hour sessions with their students. The objectives of the REACH curriculum are to describe how the well-being is integral to becoming a caring and competent physician and practice skills that will help students thrive in medicine. 

Evaluation of the curriculum was accomplished through a seventeen-question survey made up of Likert scale and open-ended questions. Sixty-two students at MCW-Milwaukee (30%) completed the survey. 85% of respondents believed that what they were asked to learn in REACH was important and 70% would recommend that other medical schools adopt REACH. The REACH small group sessions played a significant role (>70%) in building relationships with peers and faculty. Students commented on the benefits of getting to know their peers, realizing they were “not alone” in how they felt, and feeling faculty were genuine and cared about them.

Following its successful first two years, the REACH program was expanded into the Fall M1 semester starting in August 2020. Now the program uses the same groups of students through the first three semesters of medical school, but in the first semester small groups, volunteer M2 students are utilized as facilitators. Evaluation is ongoing but early subjective feedback has been strongly positive.

MCW’s 4C Program 

The Coaching for Character, Caring, and Competence (4C) Program was launched in August 2019. 4C is structured around the core concept of LCs where groups of students and faculty cultivate professional growth within longitudinal relationships. Within this framework, multiple different components can be implemented to meet specific objectives (Figure). 

Roughly fifty students volunteered for the program during AY2019. Thirteen volunteer faculty were grouped with three to four students each, and these groups meet monthly covering character and professional development topics. In addition, faculty meet individually with each of their students every other month. The program is directed by Kurt Pfeifer, a faculty member in the Student and Curriculum Pillars of the Kern Institute. 

Initial data showed great support for the program as a whole. There was a strong impact on development of mentorship, support for students, and a sense of faculty engagement. Students in the program were less likely to have feelings of isolation and reported strengthening of several character traits, including perspective, self-regulation, perseverance, and social intelligence. 

For AY2020, a new group of volunteer students was sought and the response was overwhelming. Greater than 55% of the incoming class desired to enter the program. Based on available resources, the program was able to enlist fifty-six new students along with fourteen new faculty coaches. The program also added a program of near-peer coaching in AY2020 which paired volunteer M3 near-peer coaches with each group of M1s and M4 near-peer coachs with each group of M2s. Furthermore, MCW-Central Wisconsin and MCW-Green Bay incorporated adaptations of the 4C program for their campuses. 

Evaluation of the 4C program is also ongoing, but subjective feedback from students and coaches alike has been strongly positive. 

Next steps

REACH and 4C both continue to move forward with planning expanded activities and refined content with the coming academic year. These programs have been pivotal for informing MCW’s curricular re-design process, and the hope of their directors and coordinators is that they will form the basis for a comprehensive LCs program at MCW in the future.

For further reading:

Smith S. Acad Med. 2014 Jun;89(6):928-33. 

Eagleton S. Adv Physiol Educ. 2015;39(3):158-66. 

Smith SD et al. Acad Med. 2016;91(9):1263- 9. 

Rosenbaum ME et al. Acad Med. 2007;82(5):508-15. 

Wagner JM et al. Med Teach. 2015;37(5):476-81.

 

Kurt Pfeifer, MD, is a Professor of Medicine (General Internal Medicine) at MCW. He is a member of the Student and Curriculum Pillars and a 4C Faculty coach for the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Marty Muntz, MD, is a Professor of Medicine (General Internal Medicine) at MCW. He is Director of the Curriculum Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Cassie Ferguson, MD, is an Associate Professor of Pediatrics at MCW. She is the Director of the Student Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.