Traditionally, medical schools followed a “classic discipline-based” curriculum originally developed in the early 1900s by Johns Hopkins. According to this model, during the first two years, students studied the basic sciences, mostly in lecture format; for the second two years, they moved into clinical work.
Over the years, several alternative models have been introduced for the first one to two years of med school instruction. In the late 1950s, Case Western Reserve University developed a “systems-based” curriculum in which study was organized around organ systems in a more integrated way. Then, in the late 1960s, McMaster University, in Canada, developed the “problem-based learning” (PBL) model, in which students research clinical cases in small groups under the guidance of a physician tutor.
In recent years, medical schools have continued to develop and implement a variety of more patient-centered and collaborative approaches. According to a study published in 2020, the previous decade saw medical schools decrease their reliance on the lecture format and laboratory work while increasing their incorporation of collaborative instructional methods. And according to Baylor College of Medicine, 124 of the 147 medical schools that participated in the 2017-2018 LCME Annual Medical School Questionnaire Part II indicated that curriculum change had been planned or completed within the previous three years.
Since 2020, urgent political issues including the COVID pandemic, Black Lives Matter, and the ongoing climate crisis have ushered in more changes still. In this post, we’ll walk through some of the latest trends in med school curricula.
Earlier clinical experience
Many medical schools have begun implementing clinical training earlier in students’ education in an effort to help students develop and practice their doctoring skills, hands-on, right from the start. In addition, the earlier students start doing clinical work, the more quickly they are encouraged to apply the knowledge they’ve gained in the classroom to real-world situations.
For example, at Duke, medical students now take only one year of core basic sciences, and move on to their core clinical clerkships in their second year. Similarly, Vanderbilt’s “Curriculum 2.0,” implemented in 2013, entails a 13-month preclinical curriculum followed by clerkships in students’ second year.
Other schools have introduced clinical experience earlier in a more gradual fashion. At Weill Cornell, for example, students take courses in core basic sciences for a year and a half, move on to core clinical clerkships in January of year two, and transition to the post-clerkship curriculum in February of year three. Mount Sinai has stuck to the traditional model—two years of core basic sciences, followed by two years of clinical work and electives—but has integrated some clinical experience into the first two years nonetheless: the Longitudinal Clinical Experience Program allows pairs of students to care for chronically ill patients within weeks of starting med school.
More flexibility
By finishing core clinical work earlier, students are granted greater flexibility in the third and fourth years, allowing for research opportunities and an abundance of elective choices. At Duke, finishing the core curriculum and clinical clerkships by the end of the second year enables med students in their third and fourth years to devote between 10 and 12 months to scholarly investigation and elective rotations. Vanderbilt’s new curriculum leaves “plenty of time in Years 3 and 4 to choose clinical experiences and electives based on [students’] career interests.” Similarly, Weill Cornell’s Areas of Concentration Program requires students to complete an independent Scholarly Project, under the guidance of a faculty member, beginning in their third year.
Shortening the duration of a medical education
Partly as a result of the earlier clinical training, a number of med schools—including NYU, Texas Tech, and Penn State—have begun to offer accelerated three-year medical school programs. Three-year MD students usually start rotations in their chosen specialty earlier than four-year students and spend their first summer pursuing a research fellowship in that same department.
These programs are often paired with residencies. At NYU, for example, students on the accelerated track declare their specialty when they apply, and are guaranteed residencies in an NYU-affiliated hospital. Students in Penn State’s three-year program progress directly into a three-year Internal Medicine Residency at Penn State Health Milton S. Hershey Medical Center. This way, students don’t have to worry about matching into residency programs that may still be wary of the 3-year medical degree.
Emphasis on problem-based learning
Medical education is also increasingly incorporating problem-based learning (PBL) into the pre-clinical years. This technique utilizes clinical cases to stimulate discussion among a small group of students, thereby creating a real-life, collaborative and active learning environment. The PBL teaching method is driven by students rather than professors.
At the Cleveland Clinic, for example, PBL forms the core of the med school curriculum during the first and second years. PBL groups include eight medical students and one faculty facilitator. As stated on the website, “The result is that students learn how to work in a team to maximize knowledge acquisition and develop collaborative interpersonal skills. PBL allows students to take responsibility for their own learning and for that of their peers.”
At Feinberg School of Medicine, each PBL group is comprised of between six and nine students, plus a faculty facilitator. The overall PBL process “mimics the manner in which a practicing physician obtains data from a patient.” This enables students to further develop skills essential to becoming a successful physician, such as teamwork and communication.
More interdisciplinary coursework
Physicians must develop a diverse skill set to successfully navigate an increasingly complex healthcare environment. As a result, several schools have carefully crafted their curricula to include courses and themes that span beyond the basic and clinical sciences. This fosters a more interdisciplinary approach, with an emphasis on topics such as health policy, ethics, and population health. In fact, Albert Einstein College of Medicine has a longitudinal theme program, Population Health and the Practice of Medicine, which “incorporates into all its courses and clerkships training on how to practice medicine in an ever changing and complex 21st century health care system.”
To cater to students with more interdisciplinary interests, many schools offer dual degrees, including an MD-PhD, MD-MPH, and MD-MBA. Certain schools also offer dual degrees in areas such as health policy, clinical investigation and bioethics.
Response to topical issues
In the past few years, medical schools have continued to revise and revitalize their curricula, spurred by urgent issues including the COVID pandemic, the Black Lives Matter movement, and climate change.
For example, in addition to compressing the clinical curriculum and exposing students to patient care earlier in their medical education—as have many med schools over the past decade, as discussed above—Einstein recently introduced a mandatory service-learning component as well as a new 50-hour course in health systems science and health equity that medical students take across all four years.
In January of this year, Harvard Medical School’s Educational Policy and Curriculum Committee voted to embed the theme of climate change and health into all four years of the curriculum. The new curriculum “will examine the impact of climate change on health and health inequality, applications of these impacts to clinical care, and the role of physicians and health institutions in arriving at climate solutions,” according to The Harvard Crimson.
And Mount Sinai is leading a three-year Anti-Racist Transformation in Medical Education project to replicate their change-management strategy at 11 partner medical schools across the US and Canada, with the aim of aiding med schools in dismantling systemic racism and bias in their work and learning environments.
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