The Fine Art of Curriculum Enhancement
By Thomas Kohout
Since the 1910 publication of the Flexner Report, Abraham Flexner’s famed assault on the state of medical education, two years of basic sciences followed by two years of clinical rotations has been the standard prescription for physician training among U.S. medical schools. But much has changed in health care since the dawn of the 20th century, and faculty leaders at the George Washington University School of Medicine and Health Sciences (SMHS) believe it’s time medical education evolved as well.
Associate Professor of Medicine Matthew Mintz, M.D. ’94, RESD ’97, who leads the M.D. program curriculum revision and implementation process, along with a team of SMHS faculty and administrators, has been taking a closer look at the school’s curriculum — as well as those of other medical schools — in an effort to develop a revised and enhanced M.D. program that reflects the challenges facing tomorrow’s health care professionals.
The early plans they’ve developed seek to provide more time for independent learning while emphasizing active-learning pedagogies and early clinical experiences. Mintz says the curriculum will still focus on the traditional medical education fundamentals. The difference, he says, will come in the order in which some of that information is presented.
The most obvious change to the curriculum will be a shortened and integrated preclinical curriculum. Currently students cover the basic sciences, then take discipline-based courses, and then move into the clerkships. The idea for the revised curriculum, according to Mintz, is to reduce that preclinical period and get students started on the wards earlier.
“We believe that students learn medicine best when they are directly in contact with patients,” he says. “Early medical ward experience is a real benefit to the development of clinical skills and reasoning.”
Mintz adds that SMHS is not just shortening the preclinical curriculum, but also integrating it. Incorporating some of the basic science training into the clerkship experience is expected to add relevance to the information. “When you look at a patient, you don’t just see their anatomy or their biochemistry; you think of all of these things as a whole,” explains Mintz. “Hopefully, by aligning these basic science topics in the clinical context, it will help integrate these important competencies as well as help students to start thinking like doctors.”
The reduction in class time is also expected to leave more time for independent learning, research, or special educational experiences that are uniquely available thanks to GW’s Washington, D.C., location.
Elements of the current curriculum, such as the school’s popular track program, will remain in the revised curriculum, according to Mintz. “However, there also will be some additional offerings in the revised curriculum, such as public health, diversity, and professional development.”
Senior students will continue to have acting internships, rotations in emergency medicine, and electives, as well as an intensive, one-month capstone course. The course, previously called Practice of Medicine IV, will continue to prepare students as they get ready for their residencies. It will focus on the refinement of many technical skills and reinforcement of essential clinical competencies.
Faculty members have already begun experimenting with some of the new teaching methodologies, such as team-based learning and other active-learning techniques, contained in the new curriculum. New instructional technologies, such as video- and audio-recorded lectures and tablet computing in the classroom, have already entered the testing phase and will be available for all students as the revised curriculum is introduced.
“We conducted a lot of site visits,” says Mintz of the early days of curriculum development. “We found many interesting ideas at a number of different schools, but we never identified one particular school whose model fit our needs. I believe that while many other schools have done, or are doing, what we’re doing — shortening the preclinical training period and integrating the basic sciences — the way in which we accomplish that will have a unique GW spin to it.”