Curriculum Integration: Embracing Change in Medical Education

By Hillary Johnston-Cox, an MD-PhD student, Boston University School of Medicine, Boston, Massachusetts.

Change is an important component of evolving medical curricula and provides the means for students to learn and develop their clinical mindset.  I am part of an ongoing team-led integrative curriculum initiative at Boston University School of Medicine (BUSM), described in this Innovation Report in Academic Medicine’s January issue.  This experience has provided me with a different thought process about medical education and reinforced the observation that medicine is a life-long learning process.

At BUSM I was in the first medical school class to go through an integrative second year curriculum.  In prior years, pathology, pharmacology, and microbiology were covered independently, and the organ systems discussed for each of those sub-sections.  The transition to a more system-based format had been developing for a few years with the Cadaver Biopsy Project, where biopsies were obtained from human cadavers donated to the Gross Anatomy Course and examined in the first year Histology course; these same gross pathology tissue samples and sections were then incorporated into the second year disease and therapy course for gross pathology and histology small group sessions.  The first set of modules were chaotic at times, with issues ranging from lecture content not being coordinated between different clinical departments and the content of exam questions being fair and representative of the required material.

Although the initiation of the integrative curriculum was met with challenges, over the course of the year it improved dramatically.  As a tutor for the new coursework during my graduate school years following the change, I saw the innovative idea really come together and start to form the mold of an integrated platform that continues to strengthen and incorporate evidence-based medicine.  From a student’s perspective, the development of the concept and its implementation over the course of a few years was encouraging of the prospect of change and the process of execution.

As an incoming student, being the “guinea pig” for such a huge curriculum change was worrisome.  However, through the effort and teamwork involved in evolving our education and the improvement with the implementation, the benefits became clear.  Change takes time and patience: having confidence in our education leaders is key.  We tend to not support changing a system that has had positive results in the past; it takes great leaders and educators to have the forethought to continue improving the system and challenging the established way of education.

This initial experience led me to want to be part of an additional work force to integrate the basic sciences into the clinical coursework of the 3rd and 4th year of medical school.   Having the opportunity to see first hand how changes in curriculum were implemented from an administrative level was an excellent learning experience. As a student we tend to underestimate the work that occurs behind the scenes to make our ever-evolving educational experience saturated with important evidence-based management.  We forget that medicine is a continuous learning process, with new observations and data constantly being published.

The integration of the basic science underlying pathophysiology of different disease processes allows us to rethink the focus of clinical management and pharmacotherapy, pushing our generation of physicians to always ask questions and challenge old paradigms.  We have the technology and scientific tools to reach a new level of understanding about mechanisms of disease and develop new treatments; changes in education help facilitate these processes.  We should continue to embrace change in aspects of medical education and continue to ask how we can improve the curriculum.

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One Comment

  1. Kemi Tomobi
    January 16, 2014 at 11:58 PM

    There are at least two changes I would like to see in medical education: 1) a mandatory (not elective) health disparities course, and 2) spirituality in medicine course.

    Health disparities drives up healthcare costs, so it is valuable to be culturally competent.  Findings such as in the NEJM VItamin D study further reveal that knowledge of health disparities and African history can save money and prevent pursuit of unnecessary tests and misdiagnoses (1).  But just as African-American history should be integrated throughout the curriculum in grade schools, possibly health disparities can be better integrated in the basic science and clinical curriculum.  University of Chicago has successfully implemented a mandatory health disparities curriculum; current and prospective students of all races see this as an advantage in their education (2).  Problem based learning sessions can deal with some issues with health disparities in the curriculum.

    Spirituality in medicine sounds very “soft,” unappealing, and less likely to be tested on licensing exams.  However, when we consider cases that do not obey an exact science or experience unexplained medical miracles, sometimes we have to delve into our spiritual roots.  Sometimes it is faith, humility, and gratitude that aids medical practice. At times it is persistence. The most powerful medicine is not what you put in your mouth – it is the words that come out your mouth.  There are several health studies that focus on how one’s words influenced his of her long term health.  There are several opportunities to discuss spirituality in medicine and medical education, and I could see this becoming a struggle to integrate into a curriculum at a medical school.

    While there are several things I would like to change, those are my top two priorities.

    1.  Vitamin D–Binding Protein and Vitamin D Status of Black Americans and White Americans.  Camille E. Powe, M.D., Michele K. Evans, M.D., Julia Wenger, M.P.H., Alan B. Zonderman, Ph.D., Anders H. Berg, M.D., Ph.D., Michael Nalls, Ph.D.,Hector Tamez, M.D., M.P.H., Dongsheng Zhang, Ph.D., Ishir Bhan, M.D., M.P.H., S. Ananth Karumanchi, M.D., Neil R. Powe, M.D., M.P.H., M.B.A., and Ravi Thadhani, M.D., M.P.H.  N Engl J Med 2013;369:1991-2000.

    2.  “The Minority Student Voice at One Medical School: Lessons for All?” Kirsten Dickins, AM, Dana Levinson, MPH, Sandy G. Smith, PhD, and Holly J. Humphrey, MD.  Acad Med. 2013;88:73–79.