For the first time since 1966, the School of Medicine is on its way to major curriculum revisions, scheduled for implementation in fall 2003.
"We want our curriculum to remain unique," said Sandy Williams, who took over as dean of the medical school this summer. "We're trying to come up with new ideas, new technologies that may be better and may be more relevant."
In 1999, when Russel Kaufman became vice dean for education and academic affairs, he commissioned a group to review the curriculum, which has remained largely the same for 35 years. The review moved to phase two last year and culminated in a report last summer.
In July, Kaufman reorganized the office of the curriculum, appointing a new associate dean for curriculum development and associate dean for curriculum assessment. Kaufman also created a curriculum committee now engaged in a third phase--assessing what changes should be made to the curriculum and how best to go about making them.
"The curriculum used to be organized by course directors," Kaufman said. "We need a more integrated curriculum across all courses.... The committee is the effective arm of [curricular change]."
Kaufman listed several reasons for curriculum reform: changes in the practice of medicine, new educational technology, greater focus on professionalism, including ethics, medical history and communication skills and more education on new regulations and medical accreditation.
In addition, Kaufman has stressed greater educational technology as part of medical training and has appointed Jeff Taekman assistant dean for education technology.
"It will be a combination of simulation, web-enabled learning, probably eventually some virtual reality," said Taekman, an assistant professor of anesthesiology. "There's a lot of exciting new technology, but at this point, we're just forming the group throughout the Medical Center."
The first changes have already been implemented to the third-year research requirement, adding more vigor to the research component and mandating a thesis. Kaufman said the third year's academic focus brings brighter students to Duke who go on to become leaders in the academic and clinical worlds.
"The third year is very geared toward research," said third-year medical student Aerlyn Dawn. "A thesis requirement is currently in place, but they're trying to add more formality to the thesis and sort of make more specific requirements."
Many students take a year off during their third year for more research at professional schools at Duke, such as the Fuqua School of Business.
The first- and second- year curriculum is more complicated, and that is what the committee will likely turn to, in addition to incorporating professionalism, assessment and education technology into every level of study.
Currently, the four-year curriculum is split rigidly. The first year is comprised of five blocks: basic science, including genetics and cell biology, anatomy, neurobiology, microbiology and pathology and pharmacology. Duke's medical school is known for rapidly teaching students medical science basics in one year rather than two, to allow for more clinical and scholarly research.
"The reputation for the first year is it's very fast paced, very rigorous, a lot of material crammed into short periods of time, so students can get to patients sooner," Dawn said. "It's one of the major draws to Duke in general."
Vic Nadler, professor of pharmacology and cancer biology, said that the current first-year curriculum fails to apply basic science to clinical situations. A subcommittee Nadler headed found a lack of organized presentation of human embryology, little integration of anatomy in a clinically useful context and student difficulty in using science in clinical problem solving.
"[A more clinical approach has] emerged at a lot of other places," he said. "A big problem at Duke is that there was no interest in looking at the curriculum [for several years]."
Nadler's report recommended a three-pronged approach to the first-year experience. The first unit will focus on molecules and cells, the second on the human body and the third would concentrate on the body and human disease. Nadler said the third unit will likely include a number of blocks, including principles of medical science--pharmacology, microbiology and pathology--and a series of courses on organ systems and disease processes.
He said the third unit will be vital to apply basic science in a clinical setting, but that inevitably, other useful material might have to be discarded along the way.
"The issue is what really needs to be there, how much time do we get to do this and when that issue is settled--which is way down the road--what's the best way of organizing the information that will be most clinically useful," Nadler said.
Kaufman said the new curriculum will place a greater emphasis on public health, especially in light of growing bioterror concerns, as well as more education on reimbursement, documentation and procedures of managed care.
Petrusa said that in addition to changing the intellectual and technological aspects of the curriculum, administrators hope to improve how they monitor students as they progress through the school.
"We are developing a longitudinal student database that is intended to track each and every student and their progress toward meeting each of the goal's objectives," Petrusa said.
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