Why renew the curriculum?

The following are factors influencing the development of the new curriculum:

Society

  • Aging, chronic disease
  • Disease prevention, maintain functionality
  • Health disparities

Individuals

  • Students more technologically adept than faculty
  • Continued specialization within medicine
  • Continued feminization of medicine

Health Care Reform

  • Implications are uncertain
  • Multi-professional/disciplinary delivery of care

Technological Advances

  • Human genome and personalized medicine
  • Higher resolution functional imaging
  • Emergence of telemedicine
  • Information science- just in time learning and application
    • Available to patients, faculty and students
  • Simulation science and quality improvement

Emerging Themes

The Steering Committee identified the following overarching questions to be considered during the curriculum review process:

What should a Carver College of Medicine education prepare its graduates for?

What scientific concepts are essential to the practice of medicine? What skills and attitudes are essential to the practice of medicine?

What curricular structure would best promote integration of these concepts, skills and attitudes?

What is the optimum organization and function of Student Affairs, Curriculum Management and Faculty Development necessary to achieve these goals?

The Steering Committee identified these emerging themes:

  • Capstone Course
    A single block of time typically occurring toward the end of the fourth year to address: topics heretofore not covered; provide updates on critical advances in medicine; prepare graduates for residency; and/or provide summerative assessment. It may occur in isolation or as a final intersession.
  • Continuity of care experience (COCE)
    The objectives of COCE include: early clinical exposure and identification with role models; provision of longitudinal exposure to patients over time to promote development of skills and relationships with patients; enhanced appreciation for the progression of the natural history of medical conditions over time; a better appreciation of the socio-economics of medical care; and the importance of pre-emptive prevention. A variation of this theme is student assignment to accompany selected patients throughout the day during which the patient is scheduled for multiple health care visits.
  • Core Clinical Problems Curriculum
    A curriculum based on the explicit identification of a core (limited) set of contextually rich clinical problems defined as having broad integrative potential and which can typically be revisited (spiraled) over time. Such curricula may provide greater consistency of content and may promote knowledge representation for later recall and application. This requires definition of learning outcomes in order to identify and reach consensus about the core problems. As a consequence, Core Clinical Problems tend to promote greater central oversight of the curriculum, and improve alignment and attainment of collegiate educational objectives.
  • Foundations Course
    A block course that introduces core language, organizing principles, concepts, and skills that appear repeatedly in the curriculum. It can be used to review and/or consolidate prior knowledge so that students begin at the same starting point.
  • 4P and the future of medical practice
    Refers to the premise, iterated by systems biologist Lee Hood, that the future of medical practice will be increasingly individualized: Personalized—i.e. genome based; Predictive— based on genome information; Preventive—to reduce the predicted risks; and Participatory—patients will have greater stake and involvement in the well being at all levels.
  • Integrated Curriculum
    Organizationally simple integration occurs within courses as well as among courses in a semester, across semesters and across years. The most organizationally complex integration occurs when there is intentional blurring of the traditional “2x2” curriculum in order to deliberately interweave the basic and clinical sciences throughout all four years. The primary educational goal of integration is to provide a conceptual structure of the content to be learned so that student ability to recall and apply the information is enhanced. Other effects include a variety of efficiencies, promotion of basic and clinical faculty interaction in the educational arena, and improved central oversight/alignment of the curriculum with educational objectives.
  • Intersessions
    Short blocks of time interspersed at intervals in the curriculum in order to present specific "orphan" topics or integrate material across disciplines. They are typically used during the clinical years but can be employed throughout the curriculum. Organizationally different from standard courses with respect to pedagogy, themes, synthesis, reflection, and potential to include different levels of learners.
  • Scholarly project
    These projects typically involve student selection of a topic/project from a wide menu of options to align the exercise with individualized interest and education. Goals may include in-depth exposure to scientific method and thinking, acquiring greater competency in evidence based medicine and enhancing written and verbal communication skills.
  • Simulation
    Refers to a spectrum of programs ranging from computer based education, to manikins, to robotic simulation, to standardized patients (both lacking and having medical conditions). Its goals are to provide training, especially for interactions which: confidence/competence requires repitition; there is a lack of clinical material to gain experience; the procedure is potentially dangerous to the patient or student. Depending on the type of simulation efficiencies in time and space may be achieved though some sacrifice of authenticity.
  • Spiral Curriculum
    Spiral refers to a method for the deliberate integration/revisiting of core topics/principles/skills/attitudes over time within a curriculum. Each revisiting reviews and builds on previously introduced material and extends its depth, breadth, and application.

In addition, the Steering Committee noted that the exponential growth in medical knowledge underscores the need to identify essential principles that form the core for curricular organization, delivery and sequencing- those types of knowledge being:

  • Core: changes little (e.g., structure/function)
  • Current: practice changes with discovery of new information
  • Future: information not yet known but which students will need to know how to access, assess, and utilize.