Author: Gowda Shilpa
Date: September 2007
It's a place that you've been probably more than a few times. The visit could be for yourself, or a loved one, but it always seems to bring out the same twinge of anxiousness at the pit of your stomach each time you enter, sometimes more strongly than others. You know how important it is for you to make it out, but you can't help but think about where else you could be and wish that you could be there instead. As you enter, a faint smell of bleach tickles your nose. The first thing you see is a tall rectangular desk, against the wall opposite the entrance, and then two young women dressed coolly and professionally behind it, their manicured fingers gripping the telephone as they talk into the receiver. They smile widely and nod in your direction, and you manage a smile back at them. You make your way up to the desk, shuffling through chairs pushed or seated together against the side walls. You hand your driver's license to one of the ladies behind the desk, who then glances at it, nods, and returns it to you along with a clipboard stuffed with several papers. Gripping the clipboard, you make your way to the far right wall and sit yourself down in one of the chairs propped against it. Pulling at the ballpoint pen attached to the clipboard by a string of silver beads, you begin to fill out the papers. After you return the clipboard back to the women behind the desk, you take your seat again, sit back, and close your eyes for a few seconds, mentally rehearsing the information that you will want to give and the questions that you will want to ask. It is not long before a door on the opposite side of the room opens, and a middle-aged women dressed in scrubs calls out your name, waits for you as you rise out of your seat once again, and leads you past the door, down the hallway hidden behind it, into a small room with a wooden door.
Visiting the doctor can be routine yet unpleasant for many people, particularly those who have been previously met with unfortunate news at the doctors' office. However, knowing that doctors are giving them the best care in a kind manner can certainly make the experience a lot more positive for these patients. And more positive experiences in the doctors' office in turn could encourage more patients to seek out help when they need it, play a great role in preventive medicine, lower health care costs, and improve efficiency, among other things. But what gives a doctor the qualifications and character to create positive experiences for patients? Training at a top-notch medical school can certainly help, particularly if that school trains their students to not only be academically qualified, but also socially responsible, compassionate, and creative leaders. Recognizing the need to produce such leaders, many medical schools across the nation are making sweeping changes in their curriculums, and Mayo and Warren Alpert are no exceptions.
Dr. Keith Lindor, M.D., Dean of Mayo Medical School. Image courtesy of: mayoresearch.mayo.edu/mayo/research/lindor_lab/
Dr. Keith Lindor, Dean of Mayo Medical School since 2005, has worked with colleagues of the medical school to create a more efficient and effective curriculum, producing happier, more satisfied, and less stressed student doctors. In fall 2005, just months after he entered his position as dean of the medical school, he discussed the new curriculum with committee members, and launched the new curriculum by 2006. The new curriculum is available online, on the website of the American Association of Medical Colleges: http://services.aamc.org/currdir/section2/courses.cfm. Classes during the second year, normally lasting several months each, were shortened to six-week blocks. Furthermore, the medical school has tried to emphasize the clinical relevance of material as it is taught, bringing clinical information back into the classroom and allowing students to apply what they have learned. These changes in the medical school have definitely left students feeling a lot less stressed. "One student went to Guatemala to work in a free clinic and felt like she was on vacation," said Keith Lindor, in an interview with JYI. The new curriculum allows students to create experiences in which they can learn a lot, but also enjoy themselves too and attend to personal needs.
Dr. Phil Gruppuso, M.D., Associate Dean of Warren Alpert Medical School. Image courtesy of: biomed.brown.edu/Faculty/G/Gruppuso.html
So reducing student stress and increasing satisfaction is great, but how exactly did the new curriculum affect the academic performance of students? Scores on national exams taken during medical school, such as the USMLE or United States Medical Licensing Exam, are often used to assess the academic qualifications of students and may provide some important insight. "Scores on national exams increased by 30 points," Keith Lindor reported. "Students scored 70 percent, now score 80 percent relative to the national average." These results from Mayo suggest that less student stress can coincide with greater academic results.
On the other hand, the Warren Alpert Medical School of Brown University has similar motivations for curriculum change, though its means of creating that change are slightly different from Mayo's. Its new curriculum is available online at ttp://med.brown.edu/students/curriculum/. Like Mayo, Brown seeks to introduce clinical relevance at the stage of learning. "We seek to get students out to a community clinical setting, about a month after they start, for half a day each week," said Phil Gruppuso, associate dean of the medical school, in an interview with JYI. Much like Mayo, Warren Alpert wants to allow students to apply what they have learned and hopes to give them a framework for learning new material by sending students to community medical centers.
Furthermore, Alpert Medical School has sought to increase student satisfaction with the introduction of the Scholarly Concentration Program, which allows students to study medicine in the context of a particular area. Possible options for concentrations include global health, advocacy, aging, medical education, technology, innovation, and management. Participation in the program is voluntary, but requires additional time on the part of the student; students will typically devote their summers to study under the program. Besides summers, students will have a full day on Wednesdays during the academic year as well as time during the third and fourth years of medical school to pursue studies under the program.
Additionally, Alpert Medical School has tried to integrate different classes in the curriculum, showing relationships between disciplines kept separate under the old curriculum. "Pharmacology and biochemistry used to be separate courses," explained Dr. Gruppuso. "Course directors had a fair degree of independent thought. Now, content is determined centrally by the clinical content working group. Subjects are no longer divided up; they are incorporated into the integrated medical sciences." With medical professors independently teaching according to their own syllabi and interests, it would sometimes be difficult for students to see the full relevance of one medical science subject to another. However, during the entire first year of medical school, under the new curriculum, students will take two parts of only one course, the Integrated Medical Sciences I and II. This course teaches several of the basic medical sciences in an interwoven, applicable manner.
As these changes to the Alpert Medical School are so recent, the long-term effects and overall success rate yet remain to be seen. The results will be known in a few years, as students under the new curriculum take national exams, and as funding and rankings for the medical school are correspondingly allowed to change. Naturally, most students and faculty are concerned about whether Brown is taking the right steps, but they can also understand the motivations for change. To help ease the concerns and increase thoughtful input, Dr. Phil Gruppuso has encouraged collaboration within the medical school community and sought out the opinions of medical school students.
The recent changes in medical school curriculums are part of a growing movement for improvement in health care. As the effects of current changes present themselves, medical schools will decide how to proceed and may very well create further change. It is everyone's wish for the end result of these changes to be a community where students can grown and learn; a community from which students can emerge to be the best doctors and to promote a better, healthier world.
- Written by Shilpa Gowda.