As described in the prior edition of EdUpdate, the Curriculum Architecture Consensus Team has been working intensely over the last 6 months to develop the large-scale framework for the new Gateway Curriculum. This was accomplished by taking the ideas and concepts built by the original architecture teams and incorporating the massive and helpful feedback obtained at the Curriculum retreat in January.
General Curriculum Schematic (click to enlarge)
The group has now completed its charge and we are enormously grateful for all their hard work. An overview of Phase 1 was provided last month but will be briefly summarized again here and Phase 2 and 3 will be described.
As we discuss the proposed new curriculum, it is important to remain grounded in our guiding principles for renewal. These principles include the critical transformation to competency-based education where student outcomes are clearly defined not just for each course but throughout training and with clearly defined expectations regarding milestones that must be achieved prior to progression to the next phase of study. A second critical guiding principle is that the curriculum must be integrated throughout with recurrent exposure to the basic, clinical and social sciences that becomes more individualized as the curriculum progresses. Both of these concepts are grounded in the learning sciences and critical areas of focus for the LCME. Other key principles are to be learner and learning centered– using best practices and evidence-based educational methods- and sustainable for students, faculty, staff and the institution. Click for further details and explanations of these principles.
Phase 1 of the curriculum will be 16 months in length and include integrated blocks of basic, clinical and social sciences. Phase 1 will begin in mid-summer with a 2-week prelude or gateway to ease the transition into medical school. This will be followed by an overview of the human and society: how genes, cells, organs and systems work together to support life; how people live and work together in communities and society; and how social determinants and the health care system are related to health and disease. Phase 1 will then continue with 6 – 8 foundational units of varying length (44 weeks total), organized around the form and functions of the human body. Phase 1 will also contain three 4-week clinical immersion periods. The immersions will feature meaningful and authentic clinical experiences in various clinical settings. These immersions will afford a much earlier opportunity for medical students to apply what they are learning in the clinical environment and to experience the actual practice of medicine. Students will complete Phase 1 in November of their second year.
The curriculum continues with Phase 2, consisting of six, 8-week clerkship periods (52 weeks total inclusive of vacation time) dedicated to Internal Medicine, Neurology, OB/Gyn, Pediatrics, Psychiatry, and Surgery. The clerkships are intended to impart the core clinical knowledge, skills, and attitudes necessary for the success of every medical school graduate. As is currently the case, medical students will be apportioned to all clerkships throughout the phase and students’ individual schedules will vary. Each clerkship will begin with 1 – 3 weeks of mainly specialty-specific foundational material that will purposely reiterate and build on the material presented in Phase 1. This material will be presented using a signs and symptoms framework to intentionally build clinical reasoning skills. This will be followed by specialty-specific clinical experiences, very similar to what the current curriculum provides but students will no longer be pulled from their clinical duties to attend didactics or other responsibilities. Each clerkship will end with a 1-week period dedicated to assessment, reflection, coaching, and communities. Four weeks of unscheduled time is included as winter and summer breaks. It is expected that most students will take the USMLE Step 1 and 2 examinations after the completion of Phase 2. Recent experience from doing this at peer institutions has resulted in improved scores, reduced stress and enhanced student engagement in the curriculum. Students strongly considering a research career who are not a part of the Medical Scientist Training Program (MSTP) may elect to exit Phase 2 after the first 8-week clerkship (in January) and complete 8 – 16 weeks of research and then rejoin Phase 2. MSTPs may exit immediately after Phase 1 or after completing some of the clerkship blocks.
Phase 3 is designed to allow substantial opportunity for students to individualize their personal curricula and prepare for their chosen career pathway. It will consist of 19, 4-week periods, 9 of which will be required. All students will be required to complete a 4-week Internal Medicine Subinternship during the first ten, 4-week periods. Additionally, all students must take 4 Advanced Clinical Rotations (ACR- similar to current sub-internships) prior to graduation, 2 of which must be completed within the first ten, 4-week periods. ACRs are rotations that provide students with substantial direct patient care experience and must be rigorously evaluated/graded—this includes away rotations that meet the requirements. A unique and exciting feature of Phase 3 will be the Keystone Integrated Sciences Courses (KISC). KISCs will feature 4-week in-depth returns to the foundational sciences, inclusive of the social and health systems sciences. Each KISC will focus on an important and engaging medical topic, highlighting the most current science in the area and its relevance to patient care. Examples could include topics such as precision medicine, pain management and the opioid crisis, emerging infections, artificial intelligence in medicine, the impact of climate change on health, and trauma and violence. These are just a few of the many possibilities and it is hoped that these courses will allow for the showcasing of some of the most exciting science happening at WUSM. Students will select at least 3 KISCs that most appeal to their career interests and passions and they may be taken any time during Phase 3. Finally, all graduating students will participate in a required capstone experience, similar to what exists in the current curriculum but inclusive of more comprehensive assessment to ensure competency attainment prior to graduation. The remaining ten, 4-week rotations of Phase 3 are entirely elective (the same as the current 4th year) and include the option for 4-8 weeks of designated USMLE study time, 16 weeks of dedicated research time, and up to 4 weeks of unscheduled time (in addition to normally scheduled breaks). It is anticipated that many, if not most, students will complete a scholarly project during their elective time.
Additional degrees, year-long research and the MSTP program were all carefully considered in the planning of the curriculum. The modular design creates significant flexibility for leaving and returning any time after Phase 1. The return of MSTP students to the medical curriculum after the completion of the PhD portion will need to be carefully timed, just as it currently is. We are still discussing how many elective weeks MSTPs will be able to eliminate from Phase 3 and we hope to allow students in dedicated research time in any program to take KISC blocks during that time. Our dedication to science and innovation is unchanged and we plan to expand opportunities to train students to be future leaders in academic medicine in domains of research, clinical care, education and advocacy.
In April, a call went out for Phase 1 integrated curriculum designers. Faculty from multiple departments have been selected to participate in 4 design teams focused on: 1) Basic-Clinical Science Integration, led by Dr. Sabrina Nunez, Assistant Dean; 2) Clinical Skills/Immersions, led by Dr. Steve Lawrence; 3) Assessment, led by Dr. Amanda Emke, Director of Medical Student Assessment; and 4) Community Engagement/Social and Health Systems Sciences, led by Dr. Laurie Punch, Director of Medical Student Community Engagement. These groups will be working diligently over the next 6 months to produce integrated content maps, curriculum delivery plans, assessment structures, and meaningful patient care experiences for Phase 1 of the Gateway Curriculum. The curriculum architecture as described above has been presented to all department chairs and was approved to move forward by Academic Affairs at the end of May. We will be hosting town halls and departmental and student presentations over the next few months so we can hear any concerns and identify issues we may not have considered. Although the overall template and concepts are firm, the exact content, duration of blocks and order of blocks will still need to be flexible until the design teams have the opportunity to dive deeply into the content and begin mapping it carefully to the blocks. A second phase of design beginning no later than January of next year will focus on the production of actual content to roll out with the entering class in the summer of 2020.
Further updates will be provided as new details emerge. General information regarding the renewal can be found on the Gateway Curriculum website, including the guiding principles of the renewal effort.