New curriculum integrates clinical and science education

When planning for a new curriculum began in 2010, the impetus was not so much a sense that there were problems, but rather that medical education must keep pace with the explosion in scientific knowledge and the evolution in the way medicine is practiced. In fact, reform in medical education is occurring in medical schools across the country. “We thought it was our responsibility to pay attention to all the things that were changing around us and to be as creative, innovative and forward thinking as possible, recognizing that although we are good, we are not perfect,” Richard Belitsky, M.D., Harold W. Jockers Associate Professor of Medical Education, told alumni in June during the annual reunion.

As a first step, the Strategic Planning Committee for Medical Education drafted eight overarching goals to serve as the foundation of the new curriculum, and a set of guiding principles to guide the process of curricular reform and impart the core values of our school. Now, with implementation of the new curriculum set to begin in the fall of 2014, Belitsky described some of its key elements. One of the hallmarks of the proposed curriculum is integration of basic and clinical science. Another is early clinical experience, with all students participating in a longitudinal clinical experience that starts at the very beginning of medical school. In addition, students will begin their clinical clerkships in the middle of their second year. This will provide them with more freedom and flexibility after the required clerkships to pursue sub-internships, electives, and research.

A new approach to clinical clerkships departs from the current model, in which students spend two weeks in some specialties and up to eight weeks in others. Instead the clinical year will be divided into four 12-week blocks structured around clinical themes: The “Medical Approach to the Patient” block brings together training in internal medicine and neurology. The “Surgical Approach to the Patient” block includes surgery and emergency medicine. A “Women’s and Children’s Health” block, will focus on pediatrics and obstetrics and gynecology, and a “Primary Care and Mental Health” block includes psychiatry and primary care. “We are asking disciplines that have similar approaches to patients to plan together in ways that best take advantage of each 12-week block, for more continuity with patients, supervisors, and mentors,” Belitsky said.

To reinforce the integration of science and clinical care, clerkships will start with a “precede” that revisits basic and clinical science concepts relevant to that clerkship. During the clerkship there will be “bursts,” additional opportunities for teaching those and other important concepts and skills.

Students, Belitsky said, say that they love the learning environment and relaxed atmosphere of the Yale System, but during clerkships want more feedback about whether they are learning what they need to know. Assessments of students’ performance in the curriculum will be geared to providing this feedback, along with the mentorship and guidance needed to help students reach their learning and career goals. Assessment, Belitsky said, should be an ongoing process that lets students evaluate whether or not they’re progressing. “We don’t want this to become the kind of school where students are preoccupied with tests and numbers and grades and comparisons,” Belitsky said. “We want them to be inspired with learning and take responsibility for their education.”

In the end, Belitsky said, the curriculum rebuild “is not just about courses, clerkships or how we allocate time. It’s about who we are as an institution, and the unique educational environment that we have here. We are blessed to have stewardship over something that is enormously important to so many people. We will make sure that we retain the special qualities, the core values and the principles of the Yale System that are so important to this school and give it its unique reputation in the country. Everything we are doing is driven by the core values of our school.”