Faculty at the School of Medicine & Health Sciences take a hard look at the medical curriculum in an effort to give students more clinical experience sooner.
To hear Dr. Rick Van Eck tell it, there is very little downside to the revision underway for the medical curriculum at the UND School of Medicine & Health Sciences (SMHS).
“The initial, classroom-based phase of the curriculum, which previously took 24 months to complete, has been refined to 18 months,” explains the SMHS associate dean for Teaching and Learning and Monson Endowed Chair for Medical Education (right), “meaning students get into the clinic sooner. This should increase our students’ learning overall, help improve their Step 1 [national exam] scores, and reduce their debt load.”
In other words, it’s a win-win.
After more than two years of research and planning, “curriculum 2.0,” as the School’s senior associate dean for Medicine and Research Dr. Marc Basson calls it, is being rolled out in stages at the SMHS.
So why a revised medical curriculum now, starting with the medical student class of 2024? Quite simply, it was time, says Basson, not only because the practice of medicine has changed, but licensure requirements and even students have changed.
“Our current students maybe don’t want to be in a classroom listening to lectures all day, like I did,” he tells North Dakota Medicine over Zoom. “They’re more self-directed and know what they want to do and often can study topics themselves.”
Student preferences notwithstanding, several other factors precipitated a review of the School’s medical curriculum, continues Basson (right), including the fact that there’s just more medical knowledge to learn today.
“When I went to med school, we didn’t even have a class in cell biology, let alone molecular biology—so things are just different now. This is really designed to give students more and better exposure in a way that’s relevant to what they think they need while also preparing them for what we think they need to pass the licensure exams and boards and become really good doctors.”
Add the fact that the School is preparing for a reaccreditation visit from the Liaison Committee on Medical Education (LCME) in 2022, which the School must pass in order to continue providing the state with much-needed health workers, and the timing just felt right, says Basson.
Forward-looking, faculty led
Plus, adds Van Eck, the science of teaching has changed a lot in two decades.
“We do so much more active learning [in the pre-clinical months],” he says, referencing also the new SMHS building, the very design of which influences student learning in productive ways. “This allows for better competency-based outcomes at the same time as it addresses critical needs like telehealth that don’t appear directly in program goals, but which are important for us to teach, as COVID-19 has shown.”
Leading the discussion on curriculum revision has been a small cohort of faculty and administrators. In fact, much of the heavy lifting for the project was accomplished by faculty themselves, says Basson, who admitted that he will never be able to thank the faculty enough for their efforts.
One of these faculty leaders is Dr. Mark Koponen, associate professor in the School’s Department of Pathology.
“This gets the students into the hospitals and clinics sooner,” Koponen tells North Dakota Medicine, “and capitalizes on efficiencies in teaching the basic sciences, better integrating basic science and clinical practice. We’re more clearly defining outcomes and milestones, the final product of which will be more competent physicians entering their residencies.”
For Dr. Patrick Carr (right), assistant dean for Medical Education at the School and another key figure in the revision, the curriculum will help keep the SMHS among the more forward-looking medical colleges in the country.
In other words, while some schools are relatively new to things like patient-centered and problem-based learning, community medicine, and advanced simulation, UND has been doing these for decades. And these latest curricular changes will help keep UND at the forefront of medical education in the U.S.
“There are schools that were very progressive and backtracked a bit, and some that are very traditional still,” Carr (explains, referencing a school where students take in lectures from eight to five every day for two years and see no elective courses until their fourth year. “But with these changes, we’re aligning ourselves with the most progressive schools. One of the hallmarks of these changes is that we have much more flexibility built into the curriculum, which is good.”
“Fitness for purpose”
“We go to these [Association of American Medical Colleges] meetings and presenters get up and say ‘we did this great thing this year and here’s our data on this from last year,’ and I’m sitting in the audience thinking—we’ve been doing that for 15 years!” muses Basson in response to Carr’s example. “We try to be modest, so we don’t talk about it very much, but I think what we do is better. Our students can learn better and we can make better doctors because of it.”
The data supports Basson’s claim.
As the School’s latest Vital Signs annual report suggests, UND medical students pass the “Step 3” exam—the last test before students are awarded a medical degree—at a rate above the national average, and are on par with the national average for the Step 1 and Step 2 exams.
All of which is to say that even before the recent curricular revision the UND School of Medicine & Health Sciences had positioned itself to do best what it is most capable of doing: training very good primary care providers.
“Our school has a fitness for purpose, but this is not always known to the outside world,” concludes Dr. Minnie Kalyanasundaram, an associate professor in the School’s Department of Family & Community Medicine, one of the faculty responsible for helping revise the medical curriculum. “We're on the right track and things are looking good for the future. All systems are in place to tackle the pre-clinical and clinical education for our students, and that is the real strength of this medical school.”
Med students tend to agree.
“I like the idea of getting into the clinic sooner as this will help to develop those clinical skills sooner that are necessary for flourishing as a physician,” says first-year student Kole Hermanson, admitting that it’s all about trade-offs. “However, this comes at a cost—we have more classes in a week and more material in a given unified session that can lead to some students to be challenged by burnout.”
Zach Miller, a second-year med student whose class too has already seen some of the curricular changes, adds that while the condensed pre-clinical timeline can be stressful, it should benefit students in the long run.
“The restructuring involved a shortening of both the first- and second-year testing periods from a test once every eight weeks to once every four weeks,” he says. “I, for one, am very appreciative of the four-week model, as it improves my comprehension of the material and better prepares me for the Step 1 exam.”
And this, says Basson, is the takeaway.
“I’m pleased to say that although our [applicant] MCAT scores are somewhat lower than the national average, our Step 1 scores are not,” he smiles. “So we must be doing something right.”