Fundamentals of Medicine, Semester 2: Integrating Competencies

Photo courtesy of BIDMC Richard Schwartzstein

In the old HMS curriculum, Richard Schwartzstein said, courses were like silos—self-contained, stand-alone structures. In fact, many have natural overlaps that the curriculum failed to stress.

“Students would complain,” he said, “‘Gee, what you’re covering, we covered in the last course. This is redundant. Don’t you guys ever talk to each other?’”

Now they have, indeed, been talking to each other. “Course directors are working together in a way that never really happened before,” Schwartzstein explained, integrating class content in the new curriculum. That philosophy guides the Fundamentals of Medicine for year 1, semester 2, designed by a working group that Schwartzstein heads.

The semester will start in February with Schwartzstein’s six-week course in Integrated Human Physiology, followed by eight weeks of Immunology and Infectious Diseases. A new semester-long required course on social medicine, along with the second semester of Patient–Doctor I, rounds out the calendar.

The old Genetics, Development and Reproductive Biology course has been dissected, its pedagogical limbs sewn onto other, appropriate courses. Schwartzstein will teach reproductive physiology, a good fit with his endocrine physiology content. Other content has been grafted onto the first semester course on cell biology and biochemistry, while embryology has been incorporated into anatomy, and the first semester now ends with a new course in genetics.

The goal is “to reinforce what’s going on across the curriculum, in some cases, readdress a topic with a slightly different slant, in some cases, foreshadow something that they’re going to get next month,” said Schwartzstein.

“When I’m teaching some sessions in physiology, I’m going to try to make some explicit links to the Social Medicine course,” including coteaching sessions with a faculty member from that course.

He brings several patients into his six-week course, for example, to demonstrate the relevance of physiology principles in real life. The problems and challenges faced by these patients could tie in to policy issues that Social Medicine considers: “Why is it that the government pays for dialysis for every patient in this country, but other important medical procedures are not covered? What are the implications of such decisions for the patient and her family?”

Schwartzstein said he may bring in some pathology as well, introducing it by saying, “In the next few months, you’re going to start seeing some of this pathology—and by the way, when you look at the lung under the microscope, remember what you learned in anatomy two months earlier.”

“The first number of years I taught the course, I did feel a bit like an island,” Schwartzstein said, contrasting the former organization with the pleasure he has derived from collaborating with colleagues in reform planning. “Now there’s much more sense of collective responsibility for the education of the students.”

Integration carries another benefit. Some students focused on the hard science of medicine do not appreciate the importance of social medicine and population science. According to Schwartzstein, making explicit links between them will help HMS students master the range of competencies, from science to communication skills to understanding the mechanics of the health care system to issues of professionalism demanded by the Accreditation Council for Graduate Medical Education. “You can have the smartest guy in the world, but if he’s incompetent in some of these other areas, you don’t want him for your doctor.”

—Rich Barlow

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