Johns Hopkins University School of Medicine

The Johns Hopkins University School of Medicine (JHUSOM) is the medical school of Johns Hopkins University, a private research university in Baltimore, Maryland. Founded in 1893, the School of Medicine shares a campus with the Johns Hopkins Hospital and Johns Hopkins Children’s Center, established in 1889. It has consistently ranked among the top medical schools in the United States in terms of the number/amount of research grants/funding awarded by the National Institutes of Health, among other measures.

The Colleges Advisory Program

In January 2019, the ABIM Foundation launched its Trust Practice Challenge, an initiative to address the “trust gap” in health care by identifying practices that foster trust and trustworthiness in various aspects of the health care system. The Foundation would later launch Building Trust to build on this open call.

The Colleges Advisory Program (CAP) is an appreciative advising framework that models leadership and communication skills necessary for positive mentoring relationship between students and faculty. Each incoming class (120 students) is randomly sorted into groups of 30, and distributed to one of four colleges. Colleges consist of student cohorts from each class year, facilitating vertical integration. Once in a college, students are subdivided into learning units of five, and each unit, referred to as a ‘molecule,’ is paired with a CAP faculty advisor. The 24 molecules of each entering class form the learning teams for the immersive 16-week CAP first-year course, Clinical Foundations of Medicine (CFM), which covers communication skills, history and exam skills, and professionalism, with emphasis on team process and reflective practice.

Once CFM ends, the molecules meet quarterly over the next three years for advisor-facilitated small group discussions to reflect on their journeys and emergent roles and identities. Faculty advisors also meet their students at least three times per year for academic and career advising, using a learner-centered, appreciative advising framework.¹ Faculty host students at their homes to deepen connections across class years. Class-wide advising programs hosted by the CAP at curricular and developmental transitions recognize and celebrate student milestones across the four years.

Peer-to-peer connections are fostered through the social and service programs in the learning communities. Each college has a student leadership structure and hosts a variety of social, community service, and peer advising events to foster connections, vertical integration, and support among students. JHSOM full-time faculty comprise the 24 CAP faculty positions, each receiving 0.2 FTE support from the School of Medicine to make a three to five year commitment serve in these longitudinal teacher-advisor roles. There is a competitive selection process for these positions, and students play a large role in selecting CAP faculty. We feel that this flattened hierarchy promotes transparency and trust, and yields a passionate, high-performing diverse faculty. With the program’s relationship-centered culture, the CAP faculty have become their own LC, sharing common values, passions, and teaching practices, and co-mentoring each other. Monthly faculty development meetings offer enormous opportunities for sharing of experiences and co-creating knowledge about best practices in student advising, and have formalized this practice as the Advising Case Conference.^2,3

Skills/Competencies:

Relationship-centered communication and leadership
Adult and learner-centered teaching and advising
Small-group facilitation
Reflective practice
Collaborative and experiential learning

Proof of Concept:

We believe that the CAP LC has had an important impact on students’ experience of the learning climate and sense of trust at JHSOM, as CAP faculty provide personalized advising and mentorship to support their professional development and success in medical school, and as a program, CAP offers a scaffolding of social and academic support. A published study regarding the JHSOM student experience in the CAP found that students reported higher quality advising, an enhanced sense of community, and better social integration as compared to a graduating cohort that had not participated in the LC.⁴

In 2017-18, CAP faculty held 2,159 individual advising meetings, for a mean of 3.6 meetings per JHSOM student. A recent survey of JHSOM students’ experiences (N=351) with their CAP advisors showed that most students are forming trusting relationships, with 96 percent and higher agreeing or strongly agreeing that their advisor is genuinely interested in their welfare and well-being, that meetings meet their needs, and that their advisor is non-judgmental and embraces their uniqueness.

CAP faculty devote on average 4.5 years as advisors in the program, and one-third of the current 24 members faculty been affiliated for 10 or more years. Faculty describe the value of their participation in the CAP as ‘finding my people’ and connecting deeply with the other faculty, the students and with their teaching roles.⁵ This is consistent with a study by Wagner and colleagues of LC faculty at several medical schools (including JHSOM) reporting comparatively higher levels of work satisfaction in their LC roles relative to clinical and other teaching roles.⁶ Individual annual meetings provide opportunities for bi-directional feedback, followed by a letter to the department chair describing their accomplishments along with appreciative student comments as evidence of the importance of their work.

Replicability/Scalability:

The practice of constructing smaller communities in medical school providing longitudinal learning and advising relationships between students and faculty seeks to mend fragmented and isolating learning environments, to offer greater opportunities for continuity, intimacy and trust in the education of physicians. LCs embody a relationship-centered educational system to enhance social and informal learning as well as the formal curriculum, and support each student in their professional formation.

LCs in undergraduate medical education have gained in popularity over the past 10-15 years.⁷ To support this growing movement, a coalition of medical school faculty founded the not-for-profit Learning Communities Institute (LCI) in 2012 to foster collaboration for LCs across institutions and support other medical schools in developing similar programs. In 2017, the LCI formed a research network to build evidence for the use of LCs in medical education and allied health professional schools.

References:

1. Bloom JL, Hutson BL, He Y. The Appreciative Advising Revolution. Champaign, IL: Stipes Publishing, LLC, 2008.

2. Levine R, Cayea D, Shochet RB, Wright SM. The mid-clerkship crisis: Lessons in advising a medical student with career indecision. Acad Med 2010; 85: 654-659.

3. Shochet RB, Cayea D, Levine R, Wright, SW. Using medical student case presentations to help faculty learn to be better advisors. Acad Med 2010; 85: 578-579.

4. Levine RB, Shochet RB, Cayea D, Ashar BH, Stewart RW, Wright SM. Measuring medical students’ sense of community and satisfaction with a structured advising program. Int J Med Ed. 2011; 2: 125-32.

5. Ngo TL, Whipple M. Faculty benefits from medical student learning communities: A junior and senior members’ perspectives. J Med Educ Curr Devel. 2019; 6: 1-2.

6. Wagner JM, Fleming AE, Moynahan KF, Keeley MG, Bernstein IH, Shochet RB. Benefits to faculty involved in medical school learning communities. Med Teach. 2014 Aug 27: 1-6.7. Smith S, Shochet R, Keeley M, Fleming A, Moynahan K. Learning Communities in Undergraduate Medical Education. Acad Med 2014; 89(6): 928-33.