A: The main benefits of COSMIC, our LIC model, is that our students experience the benefits of patient and preceptor continuity. Students have the opportunity to follow patients longitudinally across health care systems to experience a patient-centered perspective on health care. For example, students may follow a pregnant patient, help in the delivery of her baby, and then follow up in clinic with both the mother and newborn for postpartum care and well-child check-ups.
Typically, CSB students also get to work with the same attending in each specialty throughout the entire year. As a result, the CSB students are the primary learner for each attending, since there are very few residents in Colorado Springs. The attending preceptor, who can also serve as a mentor, can participate in the student’s knowledge and skill development over the course of the year and can provide progressive levels of health care team and patient care responsibility to the student. The other main benefit for CSB students is having 2-3 half-days per week of Clinical Enrichment time. During this self-directed learning time, students can participate in longitudinal patient care or schedule additional clinical opportunities for career exploration.
The main challenge of COSMIC is a clinical schedule that is quite variable at the beginning of the year. Students have a different inpatient experience every week during the course of the first 2 months and then experience a different specialty every half-day throughout the remaining 10 months during. Although this is challenging at the beginning, most students in LIC models become comfortable with their schedules in about 3-4 months. Following the first 2-3 months of the year, the schedules for CSB students are fairly stable among required experiences, but retain the flexibility for students to add clinical enrichment experiences.
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A: CSB students during Phase III will participate in the Colorado Springs Mentored Integrated Curriculum (COSMIC). COSMIC is a version of a Longitudinal Integrated Clerkship (LIC) model. Although the structure of COSMIC is quite different from the traditional specialty block model for most Anschutz Medical Campus (AMC) students, all CSB students are evaluated based on the same learning objectives, goals, competences, and clinical conditions as AMC students. To meet LCME accreditation standards, CUSOM must ensure that all CSB and AMC students receive comparable experiences during Phase III.
AMC students in the third-year block model learn a single specialty at a time in blocks ranging from 2-8 weeks in duration. In COSMIC, CSB students spend approximately the first 2 months in “inpatient immersion” rotations. These are 1-2 week rotations in surgery, anesthesiology, internal medicine, pediatrics, labor and delivery and psychiatry. During the remaining 10 months of COSMIC, CSB students complete all 10 of the core Phase III specialties at the same time throughout the year. Students spend 2-4 half-days per month on average in each specialty, mostly in the outpatient setting, depending on the length of the specialty block during Phase III. Additional required and selective inpatient experiences are scheduled throughout the year.
A: CSB students have the same experience during Phases I and II as the remaining CUSOM students on the Anschutz Medical Campus. CSB students do not move to Colorado Springs until the beginning of Phase III. CSB students are assigned to Problem Based Learning (PBL) groups with other CSB students (total 8 students per group) and are assigned to select Advisory Colleges that contain both CSB students and AMC students from all classes. CSB leadership make scheduled and as-needed visits to the Anschutz Medical Campus to answer questions and provide support to CSB students during Phases I and II.5
A: National Board of Medical Examiners (NBME) subject (shelf) exams are taken by all CUSOM students in the following subjects: Ambulatory Medicine, Clinical Neurology, Medicine, Obstetrics and Gynecology, Pediatrics, Psychiatry, and Surgery. There are two additional pass/fail exams in Emergency Medicine and Musculoskeletal Medicine. In COSMIC, CSB students take all exams starting about 5 months into Phase III and complete their last exam at the end of month 12 with each exam spaced between 2-4 weeks apart.
Although most exams are taken prior to completion of all clinical experiences in each particular specialty, performance on each exam mostly reflects test preparation through the recommended reading material rather than actual clinical experience (which is true both for students in LIC and block models). For the CSB Class of 2018 (inaugural class), this class mean scores on all NBME subject exams exceeded the national mean scores and the mean scores for the Anschutz Medical Campus students.
The added benefit of taking exams early in the year in the COSMIC model is that students can continue to apply the knowledge learned from exam preparation in their clinical settings throughout the remainder of the year.
A: Most CSB students spend their inpatient clinical time at Memorial Central and North Hospitals, which are operated by UC Health (the same system that runs University Hospital on the Anschutz Medical Campus). Some students spend time at Penrose Hospital and St. Francis Medical Center, which are operated by Centura Health. Some students also receive clinical experiences at Evans Army Community Hospital (EACH). EACH is located on the Fort Carson Army Base and serves a local population of about 75,000 active duty and retired military. In 2019, Children’s Hospital of Colorado will open a brand new Children’s Hospital in Colorado Springs, which will serve as the primary location for inpatient pediatric education for CSB students.
Outpatient experiences during the COSMIC occur at the above institutions and at many other group and private practice locations throughout the Colorado Springs area. Key outpatient partners include the VA, Peak Vista, Aspen Pointe, DaVita, and Mountain View Medical Group.
The CSB is grateful to all of its clinical partners and physicians for volunteering their time to educate our future physician leaders in a community-based fashion.