By Julie R. Gross, EdM, MBA, IECA (NY)
As healthcare systems evolve and our knowledge of how adults learn deepens, medical education has undergone a process of reinvention and innovation. Although each medical school continues to offer its own unique curriculum, several overriding trends are sweeping the field. Many medical schools are beginning clinical work much earlier, integrating the social sciences and health care policy into the curriculum, and allowing students to customize their education through electives. Such changes are intended to strengthen the academic experience of students while creating more versatile and well-rounded physicians.
There is no question that these changes will affect medical education. The real questions are, How will these developments affect our clients? and How can we help?
Starting Clinical Work Earlier
Many schools have begun to phase out the traditional structure of medical education: two years of preclinical, basic science work followed by two years of clinical work. Schools such as Duke University School of Medicine, Harvard Medical School, and Vanderbilt University Medical Center have moved to an extremely accelerated curriculum with only one year of the core basic sciences followed by core clinical clerkships beginning in year two.
Harvard began implementing its Pathways curriculum in August 2015 when it condensed basic sciences to the first year and moved clinical training to year two. To help plan the next stage, it held an all-day session so that its faculty members could brainstorm new ways to foster active learning, increase problem-solving skills, and strengthen patient care among students.
Going even further, Columbia University College of Physicians and Surgeons has eliminated the traditional designations of first, second, third, and fourth years altogether and replaced them with the functional curricular segments of Fundamentals, Major Clinical Year, and Differentiation & Integration. The 17-month fundamentals curriculum covers molecular medicine, anatomy, disease, psychiatric medicine, and foundations of clinical medicine; the 12-month major clinical year includes clerkships in all the major clinical areas; and the 14-month differentiation and integration curriculum includes electives in specialty areas of interest and a scholarly project.
Medical education is also increasingly incorporating problem-based learning (PBL) into the preclinical years. This technique utilizes clinical cases to stimulate discussion among a small group of students, thereby creating a real-life, collaborative, and active learning environment. For example, at Northwestern University Feinberg School of Medicine, each PBL group comprises six to nine students and a faculty facilitator. The overall PBL process “mimics the manner in which a practicing physician obtains data from a patient,” according to Northwestern’s website, and enables students to further develop clinical skills essential to becoming a successful physician, such as teamwork and communication. Most schools have established an effective mix of PBL and standard lecture-based teaching. The Integrated Pathways Curriculum at SUNY Downstate, for example, offers reduced lecture time in favor of a greater emphasis on small-group learning, such as PBL.
Effects on Medical Students
By starting clinical training earlier in their education, students can hone their clinical skills, apply classroom knowledge to relevant real-world situations, and increase their ability to handle a variety of medical cases. With the divergence of curricula offered at different medical schools, prospective students now have even more opportunity to find medical education approaches that are a good fit for their interests. As IECs, the more knowledgeable we are about the nuances of curricular differences, the better we can advise our clients.
Adding More Flexibility and Interdisciplinary Coursework
The medical profession made great strides when it acknowledged the importance of the social sciences in effective patient care. This is reflected in the addition of a social science section to the MCAT in the spring of 2015. Physicians must develop a diverse skill set to successfully navigate an increasingly complex healthcare environment. By finishing core clinical work earlier, students are granted greater flexibility in the third and fourth years that allows for increased research opportunities and an abundance of elective choices.
At Duke, for example, students dedicate their third year to what the school calls the “scholarly experience.” During that time, students pursue research in the biomedical field and may also complete a dual degree. As a result, an unusually high number of Duke students (40%) complete second degrees, including JDs, MBAs, MPHs, and MPPs, as well as MAs in areas such as clinical psychology.
Similarly, Weill Cornell Medical College students are required to identify an interdisciplinary area of concentration (AOC) midway through their third year. They can select from an array of options, including addiction medicine, human rights, neurogenetics, and patient safety. They also have the option to develop a customized topic. Students choose their AOC based on their personal interests and then pursue in-depth knowledge, skills, and a scholarly project within that particular area.
Albert Einstein College of Medicine incorporates thematic curricula across existing courses and clerkships throughout the four years. The Population Health and the Practice of Medicine (PHPM) theme integrates public health and clinical medicine to train students to think broadly and globally about such issues as patient safety, health disparities, healthcare economics, and legal issues in medicine.
Effects on Medical Students
The increased attention to broader medical issues—including population health, ethics, law, and healthcare economics—expands students’ perspectives and may even suggest areas of specialty. As IECs, we need to gain expertise in interdisciplinary education as well so that we can counsel clients on potential areas of specialization, research, residency, and dual degrees. Higher education has become less siloed, and to help our students take full advantage of current opportunities, we need to think creatively about combining their talents and interests.
Shortening the Duration of a Medical Education
Partly in response to the earlier clinical training, several med schools, such as New York University (NYU) School of Medicine, have begun to offer an accelerated three-year program. Students selected for NYU’s Three-Year MD Degree Pathway program (3YMD) start rotations in their chosen specialty six weeks earlier than four-year students and spend their first summer pursuing a research fellowship in that same department. Those students declare their specialty when they apply and are guaranteed residencies in an NYU-affiliated hospital. As a result, students don’t have to worry about matching into residency programs that may still be wary of the three-year medical degree.
There is ongoing debate about whether shortening the medical school education is beneficial. Goldfarb and Morrison (2013) stated that “given the growing complexity of medicine, it seems counterproductive to compress the curriculum into 3 years, reducing both preclinical and clinical experiences.” Yet, in another perspective, Abramson et al. (2013) claimed that a shorter medical school education could alleviate the physician shortage by producing physicians at a faster rate and substantially reduce student debt. Abramson, vice dean for education, faculty and academic affairs at NYU School of Medicine, (quoted in Hartocollis 2012) also said: “You’re going to see this kind of three-year pathway become very prominent across the country.”
Effects on Medical Students
A shorter medical education has clear benefits of saving time and expense, but the student sacrifices the opportunity to do more extensive research and electives. IECs can help individual students determine their personal trade-off between less investment and more medical exposure, depending on their age, life-style, financial circumstance, and career goals.
As IECs, we are always assessing the right fit for our students using a complex amalgamation of factors. And as the medical field continues to evolve, we must evolve with it; to serve our clients in the best way possible, we need to stay on top of a host of trends in medical education that go far beyond MCAT changes to include changing curricula, the role of clinical experience and research, and even the very notion of what it takes to be an exceptional physician.
Abramson, Steven B., Dianna Jacob, Melvin Rosenfeld, Lynn Buckvar-Keltz, Victoria Harnik, Fritz Francois, Rafael Rivera, Mary Ann Hopkins, Marc Triola, and Robert I. Grossman. 2013. “A 3-Year M.D.—Accelerating Careers, Diminishing Debt.” New England Journal of Medicine 369:1085–1087. doi:10.1056/NEJMp1304681.
Goldfarb, Stanley, and Gail Morrison. 2013. “The 3-Year Medical School—Change or Shortchange?” New England Journal of Medicine 369:108–1089. doi:10.1056/NEJMP1306457.
Hartocollis, Anemona. 2012. “N.Y.U. and Other Medical Schools Offer Shorter Course in Training, for Less Tuition.” New York Times, December 23. www.nytimes.com/2012/12/24/education/nyu-and-others-offer-shorter-courses-through-medical-school.html?_r=0
Julie Gross can be reached at [email protected]