Medical Curriculum Redesign For a New Generation And a New Age

The Gross Clinic, 1875, Philadelphia Museum of Art and the Pennsylvania Academy of Fine Arts    Label from Philadelphia Museum of Art: Dr. Samuel D. Gross appears in the surgical amphitheater at Jefferson Medical College, lit by the skylight overhead. Five doctors (one of whom is obscured by Dr. Gross) attend to the young patient, whose cut left thigh, bony buttocks, and sock-clad feet are all that is visible to the viewer. Chief of Clinic Dr. James M. Barton bends over the patient, probing the incision, while junior assistant Dr. Charles S. Briggs grips the patient’s legs and Dr. Daniel M. Appel keeps the incision open with a retractor. The anesthetist (Dr. W. Joseph Hearn) holds a folded napkin soaked with chloroform over the patient’s face, while the clinic clerk (Dr. Franklin West) records the proceedings. A woman at the left, traditionally identified as the patient’s mother, cringes and shields her eyes, unable to look. Confident of the outcome of the operation, Dr. Gross calmly and majestically turns to address his students, including the intent figure of Thomas Eakins , who is seated at the right edge of the canvas.

After two decades without any major modifications, the University of Connecticut School of Medicine is plunging into a plan of widespread curriculum change. Among the expected reforms of the plan, such as
team-based learning, are humanistic ideals like developing student empathy.

“We haven’t really changed much in 20 years, so this is going to be a revolutionary change,” said Suzanne Rose, MD, MSEd, senior associate dean for education.

As the landscape of clinical practice evolves, the tools that physicians in training need to be successful are shifting as well.
Education models of the past that relied on rote memorization are being eclipsed by methods that incorporate interactive learning.

“Things are changing, the information is changing,” Rose said, “and it’s rapid, and it’s explosive and massive, and none of us can keep all that information.”

For Rose, the most important skills that modern-day physicians can cultivate are the humility to know when they have a gap in their understanding and the ability to retrieve information to fill that gap.

One needs to teach and develop critical thinking amongst students to produce Nobel Laureates and high achievers. Don’t be a Dupe. Be a Critical and Creative Thinker!

But these skills are not the only ones being emphasized in the new curriculum.

T.V. Rajan, MD, PhD, professor of pathology and laboratory medicine, has identified areas of importance that are more humanistic than scientific.
One of those is a widespread loss of empathy.
When students begin medical school they are typically very socially conscious, Rajan said, but after their third year they tend to lose their sense of empathy.

“They become calloused, and they become cynical,” he said.

Though Rajan is not sure why this occurs, he thinks it may be linked to the fractured interactions that students have with patients during treatment.

“There is literature in the medical education field that the idea of seeing a patient as a momentary kind of interaction is part of the reason why there is a loss of empathy among medical students,” he said.
“They see patients, but they don’t know what happens to the patients after they leave on that particular visit.”

UConn Health worked to address this issue during the school’s last major curriculum change in 1994 with a program known as Student Continuity Practice.
Instead of treating patients intermittently, students were paired with a cohort of patients, which they followed every week over a long period.
For the new curriculum, Rajan hopes to continue this practice and to make the physician-patient relationship even more intimate.

“They will have a cohort of patients that they follow from the first day they are in the medical school to the last day,” Rajan said.
“So they actually know them. Not only will they see them in the outpatient clinic and the inpatient clinic, but they will actually go with them to their homes.”
Rajan believes that such close physician-patient interaction will influence preventative care, help to clarify questions about prescribed medications and make hospitals less confusing to patients.

The crux of the project is geared toward bringing a more human element into the interaction.

“I think that medicine has made the mistake in thinking that it’s all a science, but it’s not a science, it’s actually an art,” he said.

“It is a profession that involves humanity more than just science and facts, and we would like to bring that back.”

Image: Year-1891 “The Doctor” by Luke Fildes(1843–1927) British painter and illustrator. File:The Doctor Luke Fildes crop.jpg   In 1949, Fildes’ painting The Doctor was used by the American Medical Association in a campaign against a proposal for nationalised medical care put forth by President Harry S. Truman. The image was used in posters and brochures along with the slogan, “Keep Politics Out of this Picture” implying that involvement of the government in medical care would negatively affect the quality of care. 65,000 Posters of The Doctor were displayed, which helped to raise public skepticism for the nationalized healthcare campaign.

Team-based learning is another model that UConn Health hopes to emphasize, with students both working and being assessed in teams. One program called VITALS,
Virtually Integrated Teams Aligned in Learning, will facilitate analytical thinking and allow students to engage in discussions about current events.
This curriculum “revolution” is partially supported by Bioscience Connecticut, an initiative from Gov. Dannel Malloy that aims to jumpstart the state’s economy by generating job growth in bioscience research, innovation, entrepreneurship and commercialization. Building construction and renovations funded by the incentive plan are working in tandem with the changes proposed for the new curriculum, Rose said.

While UConn Health is motivated to incorporate innovative changes into its curriculum, it is also sensitive to the changing characteristics of modern-day students.

“When we studied medicine, I was working 100 hours a week,” said Rose, who attended medical school more than two decades ago.
“I missed my son’s first haircut. This generation is not willing to do stuff like that, and they are right.”
Rose said many students have a desire to keep a sense of balance in their lives while in medical school. They also seem to value work differently from their baby-boomer forerunners.

“This is a generation that grew up in the Persian Gulf War, that now is facing terrorism,” Rose said.

“They grew up with very different experiences, and what they want in life is different from what a baby boomer wants. The baby boomers valued experience over expertise. This generation says it doesn’t matter how hard you work, it’s really what the product is.”

Because of this, Rose said, many colleges are moving toward an education that is driven more by measuring competency than experience.

“So it’s not how many procedures you have done that qualify you for doing the procedure, it’s whether you did the procedure well,” she said.

Rose hopes to incorporate new ways of measuring student success into the curriculum, namely a way to reward students who research questions they are unsure about and penalize those who are confident with an inaccurate understanding(?).
She believes the process of giving students feedback in this way could help foster lifelong learning skills.
“We still have to teach students to take multiple choice exams,” Rose said. “That’s just the way of the world.”

Image: Susruta is depicted performing an otoplastic operation. The patient, drugged with wine, is steadied by friends and relatives as the great surgeon sets about fashioning an artificial ear lobe. He will use a section of flesh to be cut from the patient’s cheek; it will be attached to the stump of the mutilated organ, treated with homeostatic powders, and bandaged. Page on
Image: A picture of Susruta examining a patient. Note the palpation of the radial pulse. Page on

With all of these changes in mind, the type of student UConn Health is looking for is shifting as well. Students will be expected to collaborate in teams and to work as critical thinkers who can admit when they’ve made a mistake.

“I think we are going to need a lot of self-directed learners, students that are motivated,” Rose said.
“Of course we will have a lot of support and the infrastructure, but the student who is an auditory learner who likes to come and sit and listen in a lecture is probably not going to do as well here.”

A student who can learn only through lectures, and depends solely upon regurgitated knowledge, would also not do well in the above mentioned teaching set-up.

Adapted from an article
By Hannah O. Brown
The Online Journal for Emerging Physician Leaders


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