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Recent Innovations in Medical Education

Might innovations in medical education inspire innovations in general higher education?

Photo of Bettina Fliegel
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In recent years some US medical schools have developed new and innovative ways to approach the study of medicine.  For generations medical students spent the first two years of their education in lectures and labs.  Year one was basic sciences which included courses such as gross anatomy, cell biology and biochemistry.  Year two clinical sciences - pathology, physiology, pharmacology and behavioral science etc.  Students were introduced to patients in the third year.  Years 3 and 4 were clinical rotations on hospital wards.  During the past several years this approach has started to change.

 ….. medical schools including those at N.Y.U. and Harvard University have been doing some soul-searching about whether this lock-step curriculum creates doctors who lack humanity, who see patients as diseases rather than as whole people and who have what the medical literature calls “ethical erosion” — a loss of idealism, empathy, morality.

The result has been an increasing focus on clinical studies and, in a curriculum introduced by N.Y.U. last week, on fostering from the beginning more personal relationships between medical students and patients.

... the N.Y.U. curriculum makes connections, professors say, between the relatively abstract science being taught in the classroom and the way it plays out in real life.

(quoted from: In Medical School Shift, Meeting Patients on Day 1; NYTimes 2010)

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             NYU has introduced The Curriculum for the 21st Century.                               Students now meet patients on day 1 of med school.  This curriculum is patient centered and disease focused.  Also, this new approach is structured to give students flexibility in their education.

One highlight of the new curriculum are the 'Pillars'.  Pillars are disease based topics woven throughout the curriculum functioning to integrate teaching of basic and clinical science.  They help to create real world relevance to what is being presented in the classroom.  They focus on population health and health disparities, emphasizing the diversity that students will see in patients throughout their career.  Pillars begin on the first day of school.               

An example of how 'Pillars' work: 

At N.Y.U. last week, new students were introduced to the “four pillars” of the new curriculum: diabetes, colon cancer, tuberculosis and heart disease, emblematic public health scourges of the 21st century.

Dr. Ann Danoff, an endocrinologist, told the students that the four-pillars concept updated the medical school adage “Know syphilis, know all of medicine.”

Dr. Danoff and her colleagues then proceeded to introduce the students to patients with diabetes, colon cancer and tuberculosis. As the term goes on, the students will visit clinics and hospitals once a week to meet more patients. The goal is for them to learn to listen and communicate, to use a stethoscope and to conduct a basic physical exam, as well as to connect the diseases they see in the patients to the science they are learning in class.

On Day 1, Courtney Butler, 28, a guest patient, said to the students that she had been told at 13 that she had diabetes, but that her symptoms had been missed at first because, as an athlete, losing weight and being thirsty seemed normal. She shared her embarrassment at being the only child who went to the nurse’s office to check her blood sugar….                                                                                                                                  

(quoted from: In Medical School Shift, Meeting Patients on Day 1; NYTimes 2010)

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Another innovation in NYU's new curriculum is a 3 year pathway to the MD degree, as an accelerated option for select students.  In this path students must decide on the field of medicine they want to train in from the time of admission to med school, They will be matched to a residency position at the NYU Medical Center in this field.

Students start school 6 weeks earlier, than students in the 4 year path, with a Special Topics in Medicine elective.  They will also have the benefit of a mentor in their residency field from day one.  Similarly, they will spend the summer between their first and second year doing a summer fellowship in their chosen department. 

One major benefit is that students will save one year's tuition and housing fees, reducing student debt burden.

 



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Tell us about your work experience:

I am a physician/pediatrician with clinical, administrative and teaching experience. My practice is currently focused on serving adolescents within the juvenile justice system in New York City.

What is a provocation or insight that might inspire others during this challenge?

What might we learn from recent medical school innovations that can be applied to innovations in general higher education? How might we partner with employers to create programs that integrate work experience and classroom studies from day 1, perhaps with the guarantee of a work position upon graduation? What industries might be good partners for this approach and why? How might we design programs to reduce the number of years to a degree, decreasing overall cost?

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Photo of Kate Rushton

Hi Bettina!

A great post as always!

I really like this because the patient is more than the disease and may have multiple conditions.

Is the NYU ‘3 year pathway to the MD degree’ more for mature students that have prior experience in the medical field e.g. a nurse wanting to become a doctor?

I can see this curriculum being applied to the sciences and engineering, psychology and sociology. Could it be applied to the Liberal Arts?