As our healthcare systems continuously evolve, medical education must follow accordingly. Although each medical school continues to offer its own unique curriculum, curricula as a whole are following several overriding trends. These changes, outlined below, are intended to strengthen the academic experience of students, while creating more versatile and well-rounded physicians.
Starting clinical work earlier
Many schools have begun to phase out the traditional structure of medical education: two years of pre-clinical, basic science work followed by two years of clinical work. By starting clinical training earlier on in their education, students are able to utilize and expand their hands-on doctoring skills right from the start. This helps students hone their clinical skills, and enables them to apply knowledge from the classroom to relevant real-world situations.
However, med schools are approaching this change in very different ways. On one end of the spectrum, schools such as Duke and Vanderbilt have moved to an extremely accelerated curriculum with only one year of the core basic sciences, followed by core clinical clerkships beginning in year two. Similarly, Harvard has announced that in August of 2015 they will launch a new curriculum, Pathways, that also condenses the basic sciences to the first year.
On the other hand, Mount Sinai has maintained the structure of starting formalized clinical clerkships in the third year, but during year one, med students are partnered with patients to begin a longitudinal clinical experience. Several other medical schools, including Weill and Perelman, have struck a middle ground: students learn the core basic sciences for one and half years, with core clinical clerkships beginning in January of year two.
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 School of Medicine, students dedicate a full year to a scholarly research experience. During this year, students may pursue research or a dual degree, while also completing electives, some standard coursework, and studying for the Step 1 Exam. Similarly, Weill Cornell students are required to select an Area of Concentration (AOC) midway through their third year; these range from global health to neuroinflammation. Students choose their AOC based on personal interest, and then work to obtain in-depth knowledge, skills, and a scholarly project within that particular area.
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 incorporates a theme of population health into already existing courses and clerkships.
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.
Shortening the duration of a medical education
Partly as a result of the earlier clinical training, several med schools, such as NYU, have begun to offer a pilot “three-year pathway” program. The 3-year program is very similar to the core 4-year MD program, except that 3-year MD students start rotations in their chosen specialty six weeks earlier and spend their first summer pursuing a research fellowship in that same department. These students declare their specialty when they apply, and are guaranteed residencies in an NYU-affiliated hospital. This way, students don’t have to worry about matching into residency programs that may still be wary of the 3-year medical degree.
There is ongoing debate as to whether or not shortening the medical school education is beneficial. In a New England Journal of Medicine perspective piece, Drs. Goldfarb and Morrison state “Given the growing complexity of medicine, it seems counterproductive to compress the curriculum into 3 years, reducing both preclinical and clinical experiences.” Yet, in another Perspective piece, the authors claimed that a shorter medical school education could alleviate the physician shortage by producing physicians at a faster rate, and substantially reduce student debt. Dr. Steven Abramson, vice dean for education, faculty and academic affairs at NYU School of Medicine, predicts: “You’re going to see this kind of three-year pathway become very prominent across the country.”
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. For example, at Feinberg School of Medicine, each PBL is comprised of 6 to 9 students and 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.
Most schools have established an effective mix of PBL and standard lecture-based teaching. The Integrated Pathways Curriculum at SUNY Downstate, for example, offers reduced lecture time in favor of a greater emphasis on small-group learning such as PBL.
For more information on medical education or any other part of the medical school application process, contact Collegiate Gateway – as always, we’re happy to help.