Design Groups Report Progress in Med Ed Reform

Since 2002, HMS has been developing a new curriculum for the School’s medical students, who will be practicing in a field very different from the one for which the present curriculum was designed. The new curriculum will be phased in for next year’s incoming class.

On Nov. 22, the School held a Medical Education Retreat in which the design groups for the restructured programs outlined their plans and discussed ways to improve them.

One theme that was stated repeatedly is that too little time is available: more and more information is being introduced in the same four-year time frame. “We can’t teach all the medical students everything they need to learn,” concluded Peter Howley, head of the Department of Pathology at HMS. “We need to teach them how to learn and how to learn on their own.”

Introduction to the Profession
One of the goals of Medical Education Reform is to give students an understanding of what it means to be a good doctor on more than a scientific level. The first step toward this goal in the current reform plan is the Introduction to the Profession course for first-year students, which will take place in the two weeks before classes begin. “What we hope to do,” said Kate Treadway, HMS assistant professor of medicine at Massachusetts General Hospital and co--director of this design group, “is give the students a sense of what it means to enter a profession.” As part of this introduction, students will work with a medical simulator, evaluate fictional medical cases, and observe third-years on rounds. Through these and other activities, the course aims to teach the students about how to work in groups, handle stress, and act professionally.

Fundamentals of Medicine
After the two-week introduction, students will enter the Fundamentals of Medicine component of their education. This portion of the curriculum is for the Schools’ dental students as well. New courses will be introduced in social and population science, along with the mentored casebook project, and the biological science courses will be reorganized so that less content will be repeated (some lessons are slated to be eliminated altogether). This restructuring is due to a perceived need to educate students in areas such as medical ethics and social medicine while working within a decreased period of time.

“We thought that it would be really unwise for anyone graduating from medical school in this century to not have skills in analysis and not be able to appraise the literature,” said Barbara McNeil, head of the Department of Health Care Policy at HMS and co-director of the fundamentals design group. To understand the environment in which medicine is practiced, students need an understanding of the history of the profession and its specialized ethical framework as well as a background in epidemiology, population health, and health policy. Courses in these subjects will be taught in the first two years that a student spends at HMS.

Howley, the design group’s other co-director, concedes that the years’ reorganization is not perfect: reducing course content will mean less reinforcement and the increased student workload will mean less time for electives and independent student preparation. But the sacrifices, he said, will be outweighed by the new design’s benefits.

Principal Clinical Experience
One of the Medical Education Reform Initiative’s biggest challenges has been recreating the clinical component of the curriculum so that students stay at one clinical site for their core clerkships, where their work can be more thoroughly assessed.

Currently, the principal clerkship experience lasts for 48 weeks, a period that the design group had considered reducing to allow students more flexibility, only to be daunted by the amount of instruction required during that time. Although a variety of 44-week models were considered, none of them were able to provide enough flexibility. “I don’t think we really resolved all of the things we need to resolve,” concluded Stephen Calderwood, HMS professor of medicine (microbiology and molecular genetics) at Massachusetts General Hospital and co-director of the Principal Clinical Experience design group.

The Principal Clinical Experience will consist of a longitudinal curriculum made up of multidisciplinary, case-based sessions that integrate basic science and clinical medicine. Longitudinal assessment and mentoring will be emphasized, so that students receive consistent and reliable oversight and feedback.

Advanced Experiences in Clinical Medicine and Science
In the spring of their third year, students will begin taking electives at other hospitals and working in subinternships. Their experiences will likely serve as auditions for the next year’s internship selection, allowing them to work with people in the hospital departments they hope to join as interns.

Advanced Experiences in Clinical Medicine and Science stretches 14 months, and, said Robert Dluhy, HMS professor of medicine at Brigham and Women’s Hospital and co-director of this design group, it is the students’ last opportunity to study subjects outside of their designated career path. What the design group wanted to build, he said, is “a varied group of elective experiences that has as a goal dealing with a broad basis of medical knowledge and science.”

Currently, the focus on auditioning at different hospitals takes priority over getting a broad educational experience, and students frequently retake the same electives at different hospitals. Under the new curriculum, students will take “elective clusters”—groups of preselected electives relevant to their specialty and spread out across different hospitals.

In-depth Experiences
The fifth design group, In-depth Experiences, is different from the others in that it describes a series of activities throughout a student’s medical education. The experiences will focus on the themes of biology in medicine, patient-oriented research, and medicine in society, and will allow students to study certain topics in depth. The design group emphasized incorporating a longitudinal mentored experience and written scholarly reports into the students’ education. Students studying within the biology in medicine theme will focus on biomedical research; those studying within the medicine in society theme will analyze social and ethical problems in medicine; and those focusing on patient-oriented research will concentrate on practical training in subjects such as translational research and clinical epidemiology.

Overview
Though more details have been ironed out and the first two parts of the new medical education system will be put into place next year, the reform process is far from over. “We’re not going to do this perfectly,” said Jules Dienstag, HMS dean for medical education. “What we’re going to come up with … in the first iteration will, I hope, be really good, but not perfect.” The process of reforming medical education, he said, will continue for many years.

—Rebecca Tinkelman

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