Fundamentals of Medicine, Semester 1: A Bridge to Physician Training

Photo by Graham Ramsay Randall King

Entering students’ first few months at HMS will look considerably different than in the past, with new and rearranged courses, said Randall King, HMS assistant professor of cell biology and head of the committee planning Fundamentals of Medicine for year 1, semester 1.

To begin, the medical curriculum will have a new, two-week course, Introduction to the Profession (see Focus, April 21). King maps the progression from there: his reconfigured course on cell biology and chemistry, tentatively titled “The Molecular and Cellular Basis of Medicine and Development,” will run for six weeks, followed by anatomy for seven weeks, and then genetics for three. Throughout t he semester, students also will take a new class, Medical Ethics and Professionalism (see next vignette), and a revitalized Patient–Doctor I.

“Many of the changes that are occurring in the first two years are being driven by changes that are happening later in the curriculum,” said King. “The second year is ending earlier”—to allow students onto the wards earlier in the third year—“and new courses have been added to the curriculum in the first two years. Throughout the entire first two years, there ’s a fairly significant amount of compression.”

But if practical concerns shape HMS’s initial months, it is also true that the planners are steering this train along a deliberate pedagogical track. Before, students took King’s old course, Chemistry and Biology of the Cell, after anatomy; that has been flipped, with his new course coming first. This will allow the instructional path “to build from molecules to cells to organisms,” said King. Anatomy used to include histology; now King’s course will introduce students to that subject, and it will continue through the anatomy course.

The new order makes his course a “bridge from undergraduate study to medical school. We have some students who have a strong background in biochemistry and cell biology and others who’ve never taken a course in it. So that’s a real challenge for us to level the playing field. ”

King’s class also contains new material on early development. “There are nice connections between basic aspects of cell biology and the behavior of cells, and then how cells interact and develop to form an organism,” he said. Instruction will now follow a logical continuum—basic principles of biochemistry to cell organization to early development to anatomy’s embryology and organ development.

Tutorials will be “reinvigorated” in the new curriculum, King said. His will shift the focus from the particulars of a patient case to basic principles of biochemistry and cell biology. “In the past, I think the approach has been more of let’s just throw them into the deep end, throw them into the clinical cases.”

With so many moving parts, course directors have been meeting often to ensure cooperative planning. “We’ve looked for opportunities to integrate aspects of Patient–Doctor I into our course, also potentially into the anatomy course,” said King. His class probably will include some patient presentations, partly as a jumping-off point for the interviewing skills and other communication skills that are taught in Patient–Doctor I. And genetics will raise issues relevant to the new medical ethics course and will be linked, in turn, with Patient–Doctor sessions on taking a family history.

—Rich Barlow

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