University of California, San Francisco faculty at the Center for Health and Community (CHC) have received two grants to assist the UCSF School of Medicine in a radical redesign of the medical school curriculum. The CHC is taking the lead to add emphasis on culture and behavior to the curriculum, a change that UCSF faculty hope will enhance students' educational experiences and better prepare them for the world of medicine, said Nancy Adler, PhD, director of the CHC and chair of the curriculum committee.
The curriculum is being redesigned in fundamental ways, said Adler, who explained that the School of Medicine wanted to create a curriculum which promotes integration of disciplines, allows for an early introduction of clinical concepts, and expedites students' entry into the patient care setting. The grants from The California Endowment and The California Wellness Foundation to Adler and Melanie Tervalon, MD, UCSF assistant clinical professor of anthropology, history and social medicine, will provide 18 months of funding to revamp the curriculum. The old curriculum came under review beginning in 1996, and the new one will be finalized by the fall of 2001.
Though there have been incremental enhancements in the UCSF School of Medicine curriculum in the last three decades (including reduction of class lecture hours in the first two years, increased use of small group learning, and creation of interdepartmental courses), this endeavor marks the first radical redesign of the curriculum since 1969.
To support curriculum reform, the UCSF School of Medicine has established the Academy of Medical Educators, the first medical school organization in the country to encourage interdisciplinary approaches, provide funding for innovative educational programs, sponsor faculty development, and facilitate mentoring of teachers, said David Irby, UCSF vice dean of education in the School of Medicine.
The UCSF School of Medicine is a national leader in the way it is designing its new curriculum, said Irby. The traditional structure, consisting of two years of basic sciences plus two years of clinical rotations, will be replaced by a new model divided into three stages: the essential core, the clinical core and advanced studies and will span four years.
The first two years of basic science classes will be replaced by courses taught in integrated blocks, each centered on clinical cases. Cases will illustrate not only clinical manifestations of disease, but also basic science, as well as cultural and behavioral concerns, he explained.
"The redesign is an opportunity to introduce culture, community and behavioral issues into all levels of medical student education," Adler said. "From the start students will conceptualize and integrate cultural, social and behavioral factors into their understanding of biomedical and clinical issues." In the new curriculum, students will spend less time in the classroom (about 24 hours per week) and lectures will be de-emphasized so students can experience more independent internet-based and small group learning. Similarly, exams will incorporate problem sets, presentations and projects, all designed to provide more opportunities for active learning.
Students will begin their first year with a prologue, a case study of a motorcycle accident patient who will gradually regain consciousness. This paper-based case study (enhanced by live-action and videotaped scenarios) will provide students with brief overviews of anatomy, histology, pathology, biochemistry and pharmacology to give a general understanding of the human skeleton and the circulatory, respiratory and digestive systems. By the end of the prologue, Adler explained, students will have a foundation in the anatomy of the entire body, preliminary physical examination skills, and an understanding of cultural/behavioral factors such as prevention and stress and wound healing. She added that more detailed information about anatomy and other topics will be taught in future blocks wherever relevant.
Susan Masters, PhD, UCSF professor, department of cellular and molecular pharmacology and chair of the core essentials planning committee, explained that this new model allows for more integrated learning.
"In the current curriculum, faculty tend to teach from their own perspective in their own disciplines. In the new curriculum there are established channels for bringing people from diverse disciplines together to develop and implement curriculum." She adds that this interdisciplinary approach, combined with more emphasis on clinical cases, makes the first two years of medical school more relevant and exciting.
The third year curriculum will encompass 44 weeks of clinical clerkships and four weeks of inter-sessions, an important innovation in the new curriculum. The inter-sessions will provide time for students to leave clinical rotations and come back as a class to explore connections between the basic and behavioral sciences in the context of their clinical experience, explained Irby.
The general plan in year four, the advanced studies portion, is to give students a wide selection of elective choices. These include the opportunity to return to basic science, more time for independent scholarly and creative pursuits, the opportunity to gain teaching skills, and opportunities for sub-specialty rotations.
The UCSF School of Medicine is also among the first to provide stronger support services for medical students. The new model includes a plan to divide students into societies or smaller groups to enhance advising and guidance throughout medical school, said Irby.
Student response to all these changes has been positive, according to Masters, who explained that more than 30 first and second year students have volunteered to work on committees to shape the new curriculum. Some dedicated students are working through the summer and/or taking a year off from their medical studies to help with the redesign, she added.
The California Endowment and The California Wellness Foundation grants (in the amounts of $487, 331 and $25,000 respectively) will fund the salaries of those CHC-affiliated faculty working on the curriculum redesign with expertise in multicultural health and behavioral factors.
"The grants were given in recognition of the importance of preparing students to treat an increasingly diverse population," said Adler. "Social, cultural and behavior factors are key contributors to health and illness and have been given relatively little attention in traditional curricula."
"The California Endowment is delighted to be one of the funders of the development of this new curriculum," stated Lynn Alvarez, program officer for The Endowment. "An increased understanding of cultural differences by medical staff will lead to improved clinical outcomes for those communities."
The California Endowment was established in 1996 and is the largest private health foundation in the state. The Endowment maintains offices in Los Angeles, Sacramento, San Francisco, Fresno and San Diego, and has staff working throughout California.
The mission of The California Endowment is to expand access to affordable, quality health care for underserved individuals and communities, and to promote fundamental improvements in the health status of all Californians. The Endowment makes grants to organizations and institutions that directly benefit the health and well-being of the people of California. For more information on The California Endowment, visit their web site at http://www.calendow.org.
The California Wellness Foundation (TCWF) is an independent, private foundation established in 1992. The Foundation's mission is to improve the health of the people of California by making grants for health promotion, wellness education and disease prevention.