August 26, 2016
This week marks the beginning of the 2016-17 academic year, but the College of Human Medicine residents and Block III students have been hard at work since July 1 in our seven campuses including the first cohort for our new Southeast Michigan Campus. The Block II students went through orientation earlier this week, and this spring they were assigned to their clinical campuses. As they enter the PBL curriculum, the faculty have been improving each domain with new resources and more active learning.
This has been a highly successful summer for the college marked by the selection of CHM alum Norman J. Beauchamp, Jr., MD, MHS, as the new dean. This summer also brought new grants and awards to the college that will be announced in the coming days, weeks, and months. Sunday, August 28th is the College of Human Medicine’s White Coat Ceremony at the DeVos Performance Hall in Grand Rapids. At the White Coat Ceremony faculty will welcome the newest CHM students and usher in the Shared Discovery Curriculum.
This is a very different curriculum. The first two years of medical school have a grand total of five classes. The content follows patient symptoms and concerns rather than disciplines or organ systems; we focus on the patient first and molecules later. Beginning with the first semester the student’s schedule is determined by their clinical work rather than their tests; we use only progress testing. After the first six weeks, our content is sequenced by what students are likely to see in clinic rather than organ systems or basic science discipline, and our learning societies are the setting for content and not just clinical skills or professionalization. In short, we tried to take the best of medical education and push it to all four years of the curriculum.
The College of Human Medicine was founded as a child of the 1960s and one of the first accredited community-based medical schools. The college has been an early adopter of many educational innovations including founding the longest-standing medical education research unit, creating one of the first formal medical humanities programs, introducing patient spirituality into the formal curriculum, and developing small group problem-solving and problem-based learning. Today it is common for medical schools to have at least one community-based program, host a medical education research unit, and employ problem- or case-based learning. This year the College of Human Medicine is fully implementing the Shared Discovery Curriculum (SDC), a new curriculum that moves away from a century of tradition and re-organizes medical education structurally and intellectually.
Education always seems to be in revolt or threatening revolution; whether the challenge is technological or generational, something in education is always threatening to change the world forever. Our time is no different. Quality medical education content is freely available all over the world, and the era of the droning professor at an 8 am or 4 pm lecture is all but over. Our curriculum, while embracing the changes in technology, focuses on the fundamental core of education. There is still a place for faculty to prioritize and present content, but the main roles of faculty that cannot be outsourced to technology are the student-faculty relationship and certification of competence/excellence. The SDC focuses on these two sustaining roles of a medical school and frees faculty from timed content delivery that is more standardized and convenient on a computer.
As my colleagues and I considered creating a new curriculum, we thought back to our most rewarding educational experiences. All of those experiences involved either a faculty member or a practical experience or both. With that simple lesson from countless hours of medical school and graduate school classes, we set out to create as many rewarding educational experiences for our students as we possibly could:
- We made meaningful clinical experiences the focus of each year of the curriculum.
- We created post clinic groups where students and faculty integrate clinical experiences with necessary science and humanities as the core educational meetings of the students’ week.
- We focused our assessments on guiding students toward excellence and competence rather than hammering them with two tests every week.
- We tried to design some joy into medical school.
- We performed a pilot test.
In a summer pilot test the college picked an academically and socially diverse group of 21 students split between the entering class and the end-first year class and ran those students through the first weeks of our proposed Early Clinical Experience. It turns out that the people we admit to medical school are highly capable people who deserve better than the first two years of a traditional medical school curriculum. Based on the reviews from our clinics, the pilot students were fundamentally useful in clinic. I’ve never had a clinical affairs dean ask for more students, but after the pilot test the clinics wanted more students. Importantly, by the end of the pilot test the students, regardless of prematriculation or first-year status, did as well as our legacy students on standardized patient cases and on practice board questions for the covered topics.
None of this should have been a great surprise to me. I’ve spent the last few years reading and thinking about Jane Addams and John Dewey; they would have predicted that highly experiential education would be more effective than a traditional preclinical curriculum. At the turn of the previous century, Addams helped found the American Settlement House movement, the field of social work, and Hull House in South Chicago. Importantly for our project, she broke new ground on adult education particularly for immigrants. John Dewey visited Hull House and applied the work of Addams more generally to education. It is possible to apply the work of these two highly practical philosophers to much of medicine and medical school, but we focused on a few key concepts:
- It is very useful to tie theoretical learning to hands-on experiences. Addams taught English to immigrants through vocational training; we teach the language of medicine through clinical experiences rather than theory-based course work.
- Knowledge is not separable from our measurement of knowledge. We only measure knowledge in terms of performance like answering questions or using information to solve a problem. The SDC explicitly moved our assessments toward real world objectives like answering patient questions or passing board exams rather than focusing on remembering course content.
- Content and experiences should be oriented to the needs of the student not the thought process of faculty. Many traditional courses are organized using a retrospective fallacy. Faculty tend to organize and simplify content with the most molecular basic science first and then “build” an explanation for larger organismal function. No curious child or curious scientist learns (or discovers the world) that way. We discover by engaging in the world and then digging down into the subject. Our content is structured first by patient experience and then digging down into humanities or necessary science that underlies what we see in people. Our curriculum is organized by the patient’s Chief Complaint and Concern rather than by discipline or organ system. Our students will engage with the science underlying shortness of breath based on the patient experience rather than divide dyspnea into cardiac, pulmonary, hematologic, neurologic, and other causes that the student only later integrates on the wards, or doesn’t.
While we all hoped the pilot test would be a good experience for the students, we did not realize how much it would enrich the teaching experience for the faculty. In the pilot test, faculty saw the students work in the domains of clinical work, basic science, social science, and the humanities, which is a broader and deeper educational relationship than in traditional curricula. And, faculty worked together with students to improve their own knowledge in ways that do not happen within the traditional curriculum. It was joyful and rewarding. In short, we inadvertently discovered the value of learning societies focused on academic achievement. Curricula are always created with students in mind, but we hope our learning societies (the Academy) help provide faculty with an exciting and rewarding teaching experience.
This video describes the major features of the Shared Discovery Curriculum. Some are new to medical education like JustInTime Medicine and the structure of the Early, Middle and Late clinical experiences, while the Learning Societies and Chief Complaints and Concerns are older ideas used in unusual ways. We use progress testing to assess student competence and excellence as well as guide the student’s next learning goals. Our Shared Discovery Curriculum is focused on the experiences of students and faculty together. We learn from each other. We believe the Shared Discovery Curriculum will one day become part of the national medical education landscape. Our students will learn in ways many us of did in residency or in the laboratory. While development of this curriculum has been time consuming and challenging, we believe the Shared Discovery Curriculum will provide a better learning experience for students and faculty while training students to a higher level, faster than a traditional curriculum. I hope you find this overview video of the curriculum useful and informative.
Aron Sousa, MD