Faculty, students react to proposals for curriculum

Faculty and students have welcomed proposals to revise the medical school curriculum even as they raise questions about some of the specifics, according to Asghar Rastegar, M.D., professor of medicine and a member of the Dean’s Committee on Medical Education. The committee, formed two years ago by Dean David A. Kessler, M.D., to take a thorough look at medical education, has recommended integrating the teaching of basic and clinical sciences, strengthening clinical experiences in the first two years and revisiting basic science in the clinical years. (Yale Medicine, Spring 2000, “Deconstructing Education.”)

The committee plans to submit a draft report to Kessler by September 1. The report will include the committee’s recommendations as well as input from faculty and students, said Rastegar, deputy chair of internal medicine. Kessler may send the report back to the committee for revisions, or pass it on to the new deputy dean for education, Herbert S. Chase Jr., M.D., for implementation.

Led by Ralph I. Horwitz, M.D., chair of the Department of Internal Medicine, and Charles A. Janeway Jr., M.D., professor of immunobiology, the committee has met weekly for more than a year to discuss a restructuring of the four years of medical school. Under the committee’s proposals, basic science course work would end in December of the second year, students would take a month-long course in clinical skills, then move on to laboratories or the wards.

The committee has proposed a reduction in scheduled hours in the basic science years from 1,400 to 1,100. During their clinical years students would have 12 months on the wards and an opportunity to schedule an uninterrupted block of six months for thesis research. The committee is considering ways to integrate basic sciences in a meaningful way in both the third and fourth years.

Faculty members want to ensure that adequate supervision is built in to the six-month period proposed for thesis research, Rastegar said. At “town meetings” held to discuss the proposals some faculty expressed concerns that basic science departments would lose control of their courses. Others believe that meaningful support of faculty who have significant teaching roles is needed to improve the educational environment.

Students, meanwhile, are concerned about the integration of basic and clinical sciences. “They wanted to be assured that, by condensing the first two years into 15 months, what would be achieved would be an enhancement of the quality and not just loss of time and material,” said Nancy R. Angoff, M.D. ’90, HS ’93, M.P.H. ’81, associate dean for student affairs.

Issues for future discussion include governance of the curriculum, strengthening clerkships and the role of technology in medicine and teaching.