Reimagining the Medical Curriculum

BLOG / By Dr. Nitin Puri

Marshall University Joan C. Edwards School of Medicine is on the cusp of implementing a new curriculum that changes the way we think about pre-clinical and clinical education and merges them into an active-learning format. The planned rollout of this redesigned MD curriculum is July 2020.

Why change?—“don’t fix what isn’t broke.”

That’s probably the most destructive phrase in the English language. It is natural law that whatever does not evolve is rendered obsolete by its environment. However, the will to change should not emanate from a desire to survive but from a desire to evolve into something more effective and efficient.

Medical education is evolving all around us and we are ready, finally, to reexamine the utility of Flexner’s 2x2 model. It has been more than 100 years since Flexner proposed that medical curricula be divided into preclinical and clinical phases—one for learning the theory of medicine and the other for practicing its art. It has taken us a better part of 100 years to realize the fundamental flaw in this thinking—we learn best by experiences and theory of medicine removed from practice of medicine is just that, theory.

In essence, the medical curriculum is broken and needs to evolve. It is has the comfort of familiarity for the educators (they themselves learned it this way) but is not the most effective pedagogy for the educated. It’s for them that we need to change.

At Marshall, we have realized this need for change and are taking steps to bridge the gap from theory to practice. We are not alone. This change is sweeping the entire medical education community with support and guidance from our communities, our leaders and most of all, our students.

We are reimaging our pillars of medical education and shifting emphasis from teaching to learning (yes, there is a difference!). In our redesigned, vertically integrated curriculum, students will learn the theories of human health and disease as they are exploring the skills and attitudes of an effective physician. We are refocusing our attention to transference of skills, including life-long learning, problem-solving, data analysis and critical thinking, communications and team-building. Our goal is to nurture the development of a “master learner” with proficiency in skills and attitudes of a physician for our community—much like the apprenticeship model used in the past.

We will achieve these goals by employing active-learning pedagogies while moving away from a lecture-driven format. Programmatic assessment and constant feedback to the students are also key to this developmental process. Programmatic assessment is driven by frequent, low-stakes assessments for student learning followed by national, standardized examinations for evaluation of their performance on institutional standards. This approach takes a developmental outlook to medical education and provides students with effective and timely feedback for their growth and learning.

Finally, early clinical exposure and greater opportunities for clinical electives are a few of the principal drivers for this change. Vertical integration of the pre-clerkship content will reduce unplanned redundancies and provide more time in the clinics for our students—allowing increasing opportunities for career electives, including research, rural medicine and specialized care.

The overarching goal of this redesign is to provide clinically relevant, application-oriented, skill-based medical education in the larger context of physician as a professional and an agent of change in the community.

Nitin Puri, MD, PhD, is associate dean of medical education at the Marshall University Joan C. Edwards School of Medicine.

Date Posted: Monday, August 12, 2019