The School of Medicine is plowing forward with planning for the integration of basic science classes in the first year of its curriculum.
When the new curriculum fully debuts next fall, the first year will include innovations less ambitious than the substantial weaving together of courses with clinical applications planned last year. The traditional 12 lecture courses will still be combined into three blocks--Molecules and Cells, Normal Body and Body and Disease--that will cover roughly the same content as the classes they are replacing.
The revisions to the curriculum are a significant movement toward a more relevant training process that strives to instill in physicians a sense of the greater context of medicine.
"The first year of implementation will always be a learning experience for everyone," said Jo Rae Wright, vice dean of basic sciences and professor of cell biology. "We will learn some things that we will change, and we'll expand material and make them better courses."
Administrators and faculty expressed some hesitation to proceed with the curriculum last year when Molecules and Cells, which debuted in fall 2002, was met with frustration from students. Students said the block lacked congruency and structure. Administrators admitted that course planning had not been sufficiently thorough but called the problems "standard issues" for any newly-developed class.
When the course ran this past August, course directors and students said the class went smoothly, largely due to the incorporation of an additional instructor who sat in on all the lectures and advised professors about how to connect material.
"The idea of a course coordinator who is there to listen to every lecture and helps develop exams and lectures was crucial," said Dr. Christian Raetz, chair of biochemistry and one of the course directors for the class.
Raetz added that next year the course may include more non lecture-based sessions such as term papers or learning experiences related to clinical applications of the basic science material.
The goal of the large block courses is to free the content from the structure of a traditional curriculum to allow greater interaction of complementary concepts. For example, half of the content from traditional cell biology will be taught in Molecules and Cells and half will fall into Normal Body.
"Material that should be taught together shouldn't be separated because of artificial separation," said Dr. Edward Buckley, associate dean of curriculum development. Although details are not yet final, the material will likely be structured around organ systems within each block so that students will learn about an organ's anatomy, physiology and pathology together rather than learning about the subjects and continually revisiting the same organs.
The new curriculum will also allow for more case-based and problem-solving activities, Buckley said, because adults learn better through experience than lecture. Interactive learning will also give students practice applying science to specific situations in the ever-changing field of medicine.
"We don't know what material for sure is important for the physician of 2015," Buckley said, noting the emergence of new diseases and the evolving emphasis in health care. "We want to take the information and teach them how to apply it."
However, hands-on learning is more time-intensive than traditional lectures, and Duke is committed to teaching its basic science classes in one year even though most medical schools spread them out over two.
In order to fit the additional material into the curriculum, the school year will expand by three weeks--time found by beginning the year two weeks earlier and shortening winter break by one week. The additional time also will enable a new week-long unit on human behavior, taught by members of the psychiatry department and focusing on health-related behaviors such as sleep patterns and stress responses.
As officials in the School of Medicine continue to refine the new curriculum, they are attempting not to duplicate the mistakes made when implementing Molecules and Cells. The directors of all three blocks are meeting regularly with each other and with administration to tie together the three blocks better, said Colleen Grochowski, associate dean of curriculum development.
Normal Body will also have a coordinator to help ensure continuity of material, but course directors do not expect to depend on that position to the same extent that Molecules and Cells has. "We don't anticipate encountering any of the same sorts of problems because the changes in Normal Body are less drastic than the ones implemented in that course," said Matt Cartmill, professor of biological anthropology and anatomy and course director of Normal Body.
Associate Dean of Curriculum Assessment Emil Petrusa said the School of Medicine is also attempting to find a similar coordinator for Body and Disease. Several professors involved with the development of the Body and Disease block declined to comment on the class.
Grochowski said another focus of the inter-block discussions has been on unifying content and using examples that relate to the broader ideas in medicine. "For example, they can look at an obesity case in Molecules and Cells. Then in human behavior they can look at the same case but look at a different element of it," she said.
The scope of the planned revisions--although still extensive--is less than the Curriculum Committee initially recommended.
"In reality, everyone wants to do more, but since medical students aren't going to stay for 10 years, you just can't," Wright said.
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