EDUCATIONAL CONTENT

General Integration (3.0/9)

Student Concern: Students felt strongly that there should be more integration of subject material between courses, particularly for courses in the first two years of medical school. Specific suggestions for integration were in behavioral sciences; anatomy, physiology, and histology; neurology and psychiatry; and medical interviewing and physical diagnosis. The report also called for more collaboration between biochemistry and nutrition and microbiology and infectious diseases. Additionally, the report proposed an 8-year longitudinal patient visitation program.

Response: The Medical Curriculum Committee (MDCC) has as its primary goal the development of a well-integrated and comprehensive preclinical curriculum that is effectively taught and systematically evaluated. Since 1997, the MDCC has requested that first- and second-year course leaders meet with students annually to discuss curriculum coordination issues. Over the years, much unnecessary redundancy in topics addressed in preclinical courses has been eliminated and greater integration achieved. In addition, the MDCC preclinical subcommittee has recently undertaken substantive reviews of first-year courses to improve their overall quality, including recommending ways that first- or second-year courses may more closely coordinate with one another.

Effective coordination of our dynamic and evolving medical curriculum will necessarily be ongoing. Periodically, the Medical Curriculum Committee will need to consider more substantial ways of restructuring courses or sets of courses to promote better integration. As a part of this process, it will be necessary to keep in mind that excellence in education inevitably requires some redundancy. At curriculum coordination meetings this January, first- and second-year course leaders agreed to consider the following changes to achieve better course coordination:

• First-year, first-semester leaders agreed to study ways to integrate more closely Bio 117–Mammalian Physiology, Bio 184–Human Morphology, and Bio 189–Human Histology, including the possibility of developing an integrated cross-disciplinary course that encompasses the three basic science disciplines.
• At the end of the spring semester, first-year, second-semester course leaders will discuss more substantial ways to promote curriculum integration and coordination.
• Second-year leaders agreed to work toward better integration of Bio 279/280–Systemic Pathology, Bio 281/282–Pathophysiology, and Bio 273/274–Organ System Pharmacology. At the request of students, they will consider giving an examination in each course after each three weeks of instruction that coincides with the end of each pathophysiology section.
• Second-year course leaders have also agreed to share syllabi and to achieve better coordination. On a trial basis, during the spring semester in two sections of pathophysiology, two problem-based learning cases will deal with the pathological, the pathophysiological, and the pharmacological aspects of an illness. Also, patients with an illness currently being discussed in pathophysiology will be asked to come to a Bio 373/374–Introduction of Clinical Medicine (ICM) Thursday afternoon class to discuss the disease with his or her physician and to answer questions from students about the ongoing treatment.

Timeframe: By 2001–02, significant progress will be made at coordinating the preclinical curriculum as attested by its redesign. Specifically, a series of planning meetings will be held to develop a cross-disciplinary model in the first-year, first-semester courses. Planning meetings with second-year course leaders will also be held to explore designing a new examination schedule and to more closely coordinate course content as well as undertake interdisciplinary teaching when appropriate. If the interdisciplinary PBL cases and the patient classroom visit that are trial tested this academic year are rated as effective, new cases will be developed in each of the ten course sections of pathophysiology and more patients visits to ICM will be instituted.

The integration and coordination of courses in neurology and psychiatry suggested in the report will be discussed at course leaders meetings during the spring semester.

Timeframe: It is anticipated that better coordination of the medical curriculum will be achieved during academic year 2001–02. A review session will be held at the end of spring semester 2002 to determine the effectiveness of the coordination efforts of the course leaders.

The report recommended that patient interviewing, public health, and brain and behavior be consolidated into one course on epidemiology. The MDCC has a established a task force on professionalism in the medical curriculum that will consider, among other topics, how the clinically oriented courses in the first two years may be restructured to provide students with 1) more long-term patient contact and more long-term involvement with practicing physicians, and 2) more clinically relevant experiences in all four semesters of the first two years of medical education.

Timeframe: A faculty-development retreat will be held in June 2001 to consider professionalism across the continuum in medical school, in the residency and during full-time practice in the hospital or office setting. Moreover, the professionalism subcommittee of the MDCC will present a white paper at the annual September 2001 strategic planning retreat of the curriculum committee discussing its major findings and recommendations. These will include course restructuring to ensure more clinically relevant instruction and the effective mentoring of medical students by clinical faculty in the community.

USMLE Preparation in Courses (3.5/9)

Student Concern: Students felt strongly that courses should have as a specific objective coverage of material that will appear on the USMLE Step 1 examination. The report also recommended that USMLE question formats should be used on in-class examinations.

Response: According to the USMLE, the Step 1 examination is “designed to measure basic science knowledge. Some questions test the examinee’s fund of information per se, but the majority of questions require the examinee to interpret graphic and tabular material, to identify gross and microscopic pathologic and normal specimens, and to solve problems through application of basic science principles.” We held a workshop in 1998 for our faculty on the content and format of the Step 1 examination. A member of the National Board of Medical Examiners participated and urged our faculty to teach what they feel is best practice in their discipline and not “to test for the boards” directly.

Since that workshop the Step 1 testing format has changed from a variety of multiple choice and matching questions with one or more right answers to a single question format with only one best answer. Not all course leaders may be aware of the new question format. Thus, preclinical course leaders will be sent a memo describing students’ recommendations along with up-to-date Step 1 questions that they may use as model questions in their test construction. If course leaders express a need for more help in preparing such questions, we will hold a workshop with test construction as the focus.

In addition, a boards examination handbook is under development for students that will deal with the myths and realities of exam taking and include an annotated list of review books. It will also contain the names and telephone numbers of tutors at Brown who are available to help students prepare for the exam.

Clinical Faculty Interactions (3.8/9)

Student Concern: Students felt strongly that more clinical experiences and interactions with clinical faculty should be incorporated into the first and second years.

Response: We will ask first-year course leaders to recruit more clinical faculty to lecture in their courses. A change in this direction is already taking place in Bio 158–Medical Microbiology.

Timeframe: By academic year 2001–02, additional clinical faculty will be invited to participate in most preclinical basic science courses. An email survey of the course leaders will be taken at the end of each academic semester to determine the number of new clinical faculty asked to participate in preclinical basic science courses.

Elective Time (4.2/9)

Student Concern: Students felt that a continued commitment be made to maintaining elective time during the clinical years.

Response: The policy of the medical school on this matter states: “As an integral part of Brown University, the Medical School offers its students a wide variety of elective opportunities in clinical medicine, research, the liberal arts, and the basic sciences.”

In revising the academic calendar for the third- and fourth-years, the MDCC was informed by the medical school policy to maintain at least 25% of time for electives. With the new third- and fourth-year calendar changes, elective time will be 30%. There are 80 required weeks of study: 58 weeks of core requirements (or 9 clinical required courses) and 22 weeks of electives.

In comparison, Dartmouth Medical School has 68 weeks of core courses (or 15 required courses) and 12 weeks of electives (15%), totaling 80 weeks. Harvard Medical School has 60 weeks of core courses (or 10 courses) and 26 weeks of electives (30%), totaling 86 weeks.

In addition to the 22 weeks of elective time, there are also about 12 additional weeks during the third and fourth years for students to take electives or pursue independent study. This is exclusive of the 8 weeks of vacation time built into the third- and fourth-year academic calendar. In past years, this has been sufficient time for students to pursue a variety of away electives, independent research, and international health projects.

As recommended by students, the surgery clerkship was reduced from 12 to 8 weeks. On the other hand, a new 6-week community-health clerkship has been added to the core curriculum that results in two more weeks of required clerkship time. This change also had the support of students. Beginning in academic year 2001–02, the third year will start during the first week in July rather than in first week of August. This calendar change was instituted to provide students with additional time to undertake electives or for residency interviews.

Reducing the other clerkships, for example, the psychiatry or obstetrics and gynecology clerkships from 6 to 4 weeks or the medicine clerkship from 12 to 8 weeks will be discussed at a forthcoming meeting of the clerkship directors. Any formal change in elec-tive policy will have to be decided by the medical curriculum committee.

Timeframe: If the Medical Curriculum Committee (MDCC) were to vote to reduce clerkship time, it is unlikely that the change will take place until academic year 2002–03.

Pharmacology (4.8/9)

Student Concern: Students felt that the pharmacology course should include more clinical content and be more closely integrated with pathophysiology.

Response: The course leader for Bio 273/274–Organ System Pharmacology has been contacted about students’ concerns. We and second-year students will meet with him to discuss the students' recommendations. Pharmacology objectives are being included in the small-group, problem-based learning sessions in the endocrine and human reproduction sections of pathophysiology this spring on a trial basis.

Timeframe: Curriculum changes can be completed by the start of academic year 2001–02 for the fall semester of pharmacology and by the beginning of spring semester 2002 for the second half of the course.

Neuroscience (5.4/9)

Student Concern: Students were concerned that the faculty from Neuroanatomy, Brain and Behavior, Intro to Psych, and Neuropathology should communicate with one another and attempt to increase coordination between their courses.

Response: A meeting will be scheduled shortly with course leaders who teach neuroscience to discuss more effective curriculum coordination.

Timeframe: Close and effective coordination can be achieved by academic year 2001–02 among the four courses: Bio 260: Human Neurology, Bio 370: Brain and Behavior, Bio 278: Introduction to Clinical Psychology and Bio 262: Neurologic Pathophysiology.

Anatomy (5.9/9)

Student Concern: Students expressed a desire for more clinical applications in the anatomy course. One specific suggestion was to use clinical faculty to teach surface anatomy correlated to physical diagnosis.

Response: Anatomy faculty felt that a careful balance needed to be maintained between invited clinical faculty and the core basic science teaching staff for the course and that the current balance was about right. No changes are contemplated.

Web Resources (6.7/9)

Student Concern: Students believed that more of an effort should be made to integrate web resources into courses.

Response: The Office of Curriculum Affairs (OCA) will form a course leader subcommittee to discuss priorities in developing web-based educational resources. Stephen Smeaton, M.D., the medical school’s new web administrator, Dionne Gomez, the medical school course coordinator, and Tovah Reis, the medical library coordinator, have agreed to offer their services in setting up web pages for interested course leaders. In January 2001, the associate dean for curriculum at Tufts Medical School gave a workshop here on web education. The workshop provided course leaders with specific examples of how the web page may be used for instructional purposes, and it motivated several of the course leaders to begin to set up or to refine their own web pages.

Timeframe: By academic year 2003–04, all preclinical and core clerkships will have web pages.

Psychiatry (7.7/9)

Student Concern: The report recommended that students rotate through each of the psychiatry clerkship sites rather than spending all their time at one.

Response: The director of the psychiatry clerkship was contacted regarding student recommendations. We will follow up on the request that students be able to rotate from one clinical site to another during the 6-week rotation.

Timeframe: If student rotations are feasible, the change in the structure of the psychiatry clerkship can be in place by academic year 2001–02.