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Charting a new course

Second-year medical student Rob Fraser spends his Wednesday mornings shadowing doctors at clinics throughout the Twin Cities as part of a 12-week preceptorship program. (Photo: Richard Anderson)

Revamped curriculum makes medical school real, right from the start

By Emily Jensen

On Wednesday mornings, second-year medical student Robert Fraser drives right past the University of Minnesota campus on his way to Creekside Clinic in St. Louis Park. There, he sees patients, interacts with residents and attending physicians, and puts his physical exam skills to the test.

Fraser’s experience, part of a 12-week rotation that brings him to the clinic once a week, reflects a major change in the Medical School’s curriculum that was implemented last fall. In years past, students didn’t get this type of hands-on experience until their third and fourth years of medical school. Now, they’re seeing patients and shadowing doctors in the first two years as well.

As far as Fraser is concerned, the new approach is paying off.

“Seeing patients and working in a clinical setting really helps you retain information, and it allows you to apply what you’re learning in the classroom to patients and to medicine itself,” he says.

So what sparked the change?

Linda Perkowski, Ph.D., the Medical School’s associate dean for curriculum and evaluation, points to the recent dialogue on health care reform, which caused medical educators across the country to reflect on how they’re training physicians.

She says medical educators asked, “How can we be more effective and more efficient while also providing students a quality education?”

The thought, she says, was to revamp the Medical School curriculum to better accommodate the evolving health care landscape while applying the latest research on how people learn best. “We’re learning how people learn. And today, neuroscience tells us that people learn best through active learning and reflection.”

Not only that, but the information explosion has hit medicine hard.

“Our students need to be wellgrounded in the knowledge we have today, and they need the skills to be able to learn independently over a long career,” says Medical School Dean Aaron Friedman, M.D. “Being a lifelong learner is the way to prepare for such a future.”

Armed with that understanding, Medical School leaders responded by developing a curriculum focused on individualized, active, and patientcentered learning.

 Recently Fraser shadowed pediatric hospitalist Dave Hanson, M.D. Connecting medical students with patients earlier in their training is part of a major change to the Medical School's curriculum this year. (Photo: Richard Anderson)

Preparing for patient-centered practice

Today, all first-year students enroll in a new course called Essentials of Clinical Medicine that not only teaches technical skills, like how to interview patients and how to administer a physical exam, but also explores the physician’s role in society.

After spending the fall and winter in the classroom and working with simulated patients, students are assigned to various community locations where they see patients in 10-week rotations in the spring. From March through August of their first year, students will participate in inpatient settings in internal medicine and surgery, outpatient settings, the emergency department, and in acute or long-term care facilities.

“Learning and practicing clinical skills is imperative to becoming the best physician you can be, and this spring when we’re seeing patients, we’re going to gain as much knowledge as we can,” says first-year student Alli Ritts.

When students enter their second year, they are exposed to different patient populations in both the clinic and hospital setting through required rotations in geriatrics, pediatrics, internal medicine, and family practice. Two open rotations allow them to explore their own areas of interest.

Learning on your own terms

Under the new curriculum, medical students have a more open schedule, which helps them learn in an environment — and manner — that works best for them.

The revised schedule allows for three unscheduled half-days each week. This time lets them catch up on reading, spend additional time in the lab, complete online courses, or work with patients at neighborhood clinics.

Like his classmates, Fraser values this extra time and takes advantage of it.

“It’s nice because it lets us study in our own way. If I want to meet one-on-one with a faculty member, I can do that during the day because I know that person will be around. Or, if I work better in study groups, I can gather a group of classmates and work through cases with them,” he says.

Another advantage of the open schedule — it frees up time at the end of the year.

Typically, second-year students were done with school by the second week of May. Now they’re done in the middle of April. The additional time off allows students to absorb and reflect on what they’ve learned, participate in more extracurricular learning opportunities, or simply enjoy time with their families, Perkowski says.

Weekly small-group meetings with faculty members—this one led by Mark Yeazel, M.D., M.P.H.— promote a sense of community for students. (Photo: Richard Anderson)

Bringing it all together

Integrating the basic and clinical sciences is a major aim of the new curriculum. Traditionally, the first two years of medical school focused heavily on the basic sciences and years three and four on clinical sciences.

But over time, it became apparent to Perkowski and other educators, like Wesley Miller, M.D., chair of the Department of Medicine, that this method wasn’t totally effective.

“If we isolate the basic sciences from patient care, it’s hard for our students to apply what they’re learning in class to the clinical setting,” Miller says. “Instead, we must teach the science of medicine in the clinical context.”

Now, students are getting a more holistic view of medicine. For example, instead of taking cardiopathology, cardiopharmacology, and cardiopathophysiology as separate courses, they take a cardiology block that combines all of these topics.

In addition, patients are being integrated into the curriculum. A course about the science of a disease, including the related genetics and biochemistry, may also feature a presentation by a patient who has experienced the disease firsthand.

Alli Ritts, a first-year medical student, says the cirriculum changes motivate her and her peers to become

“That’s been very illuminating; the patient experience makes what we’re learning come alive,” says Ritts. “It motivates everyone to learn more and aspire to become the best doctors we can be.”

An emphasis on small-group work has also enriched student learning, says Perkowski. For the second-year students, this means forming groups of six to eight students and a faculty member and working through clinical vignettes of real-life cases.

Perkowski and Miller say such curriculum changes have enhanced student learning, but they plan to continue to refine the curriculum as they discover what works best.

If Fraser’s reaction is a good indicator, the new approach is on the right track: “It trains us how to think like doctors,” he says.

Emily Jensen is a communications associate in the University of Minnesota’s Academic Health Center.

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