Education Columns

Lauren Fine, MD

The Nova Southeastern University Kiran C. Patel College of Allopathic Medicine (NSU MD) will welcome its inaugural class in July 2018. The process of developing our curriculum has been an exciting one as we have had the unique opportunity to build an innovative curriculum that draws from the experience of many different educators of various backgrounds. Our goal has been to create a learning environment and curriculum that allows students to be active learners who not only absorb information, but also understand how to apply and build upon it. This curriculum is very different from that of the first class of the University of Pennsylvania in 1765.¹

Over the past 250 years, our medical compendium has expanded, and as a necessity, medical curriculum has become more complex. In fact, 50 years ago, nearly 200 years after the initial class at the University of Pennsylvania began their journey, it was recognized that the volume of medical information was exploding at a rate that schools were unable to keep up with. Schools needed to adjust their curriculum and shift the focus from teaching a finite volume of information to teaching students how to continually add to and apply their knowledge.²

Although the length and breadth of medical school has expanded in order to accommodate this growing amount of information, medical students are still graduating without a clear understanding of the integration of the multiple aspects of health care and science that are involved in each patient’s case. The founding educators at NSU MD have been confronted with this question: How do we translate our students’ knowledge into a longitudinal comprehension of the patient’s personal and medical journey in a way which allows them to process, interpret, and apply what they know? The exposure to an integrated and longitudinal vision of a patient’s case may not be offered to students until they reach their third-year clerkships. Even in the third year, traditional block clerkships do not offer medical students many opportunities for continuity of care experiences with their patients.

It is true that medical students have thousands of facts to master, and that clinical encounters alone could not teach them what they need to learn in a systematic or efficient manner. As such, traditional medical education continues to focus on laying the foundations of basic science and medical knowledge during the first 1 1/2 to 2 years, during which clinical experiences are often limited.

At NSU MD we have created a didactic shift in curriculum delivery. During the first semester of their medical school journey, our students will participate in a human structure and function (HSF) lab each week. During the lab students will integrate anatomy, histology, pathology, pathophysiology, radiology, and clinical medicine using a patient case scenario. Students may apply their knowledge to order tests, read results of labs and imaging, view pathology, and discuss a care plan. For example, one scenario involves a man with a knife wound to the chest. Students will discuss the anatomy likely injured by the path of the knife, the pathophysiology of a traumatic pneumothorax, review imaging of a normal chest x-ray as compared to that of a pneumothorax, as well as the histology of the lungs. These labs are temporally correlated with standardized patient sessions where they will apply their knowledge from the lab to help them differentiate between two different diagnoses in a hypothesis-driven physical exam. We would like these integrated cases to become longitudinal so that the students may revisit these patients later in their curriculum as they follow up or develop further complications of their diseases. Although this is an idealistic picture of medical education with many barriers such as curriculum reform and time and monetary resources, its integrated and longitudinal approach has the potential to give students earlier exposure to the complex nature of common medical problems that require delivery of coordinated medical care.

References

1. University of Pennsylvania. Medical Class of 1889: Historical Development of Curriculum. http://www.archives.upenn.edu/histy/features/1800s/1889med/curricdev.html. Accessed June 26, 2018.
2. Turner TB. The medical curriculum in evolution. J Med Educ. 1967;42(10):926-929.