In South Dakota and across the country, the discipline-based structure of preclinical medical school curriculum has remained unchanged for more than a century. However, the modern-day physician needs to think in an integrative fashion, drawing simultaneously from multiple disciplines to effectively diagnose and treat patients’ illnesses. To meet these emerging challenges, medical education is undergoing a major overhaul at the University of South Dakota Sanford School of Medicine, through the introduction of an innovative “Three-Pillar” curriculum, which places the school at the forefront of revolutionary change.
The new curriculum will be implemented this July, beginning simultaneously with Pillars 1 and 2. Pillar 3 is scheduled for implementation in January 2016.
In the following question-and-answer session, Janet Lindemann, M.D., M.B.A., dean of medical student education and Matt Bien, M.D., associate director of medical education services (the primary architects of the new curriculum) lend their insights into the mechanics behind the Three-Pillar system and how it will better equip medical students for the changing demands of the medical profession.
Why change the curriculum?
J.L.: The medical school curriculum is changing in order to better prepare physicians for the current health care environment. The format and methods for medical education across the country had not changed significantly for a hundred years; however, in recent years there has been a significant call for curriculum reform. An important analysis published in 2010 by the Carnegie Foundation recommended that the traditional basic sciences should be integrated with clinical practice. This contrasted with the traditional two years of classroom learning followed by two years of clinical clerkships, and this is the new idea behind Pillar 1 in the new curriculum. The new course of integrated scientific foundations will also be shortened to 18 months.
A second recommendation was to move the primary location where students learn about diseases out of the hospital and into the outpatient environment. Patients now spend much shorter periods of time in the hospital, and while there, [they] are much sicker. For medical students starting their careers as physicians, it is important to learn how illnesses are diagnosed—now largely done outpatient and through interprofessional teams—and about illness from the patient’s perspective. This is the foundation for the new Pillar 2—the longitudinal integrated clerkship. Students will learn common diagnostic skills across multiple disciplines simultaneously, allowing learning to a deeper level, and they will have longer relationships with patients.
Third, new physicians need to understand the complex systems within health care. Finally, there needs to be more flexibility for medical students. Students do not learn at the same pace or in the same way, and currently there are so many directions one can go in medicine and many options to explore. These last two concepts underlie planning for Pillar 3 during which students will be able to make specialty choices earlier than before, and explore more prolonged options in research, global health and other scholarly pursuits.
The reason why we chose this particular time to reform the curriculum was because when we passed our accreditation review in 2009 we were granted eight years before our next review. Knowing how long it takes to undertake complete curriculum reform, Dean Rod Parry promptly began to lead the effort.
M.B.: Dr. Lindemann has nicely outlined the new Three-Pillar curriculum. Tradition in medicine runs deep, both in practice and in training. But recent changes in the entire health care system necessitate a change in how we practice medicine and consequently how we approach training. The new curriculum looks to maintain the best aspects of that traditional model while incorporating elements that better meet current and future needs.
What do you feel are the primary strengths of such an approach as contrasted with the more traditional methods of teaching and learning? In other words, what are the primary benefits to students, faculty—and ultimately, the patients?
J.L.: Students will learn the clinical application of science earlier in the process than before, and studies have shown they will retain their learning longer. With this, students will be able to take on more responsibility for patient care and become a more active part of the team. One new element in the clinical clerkship is that students will be expected to follow a small panel of patients throughout their health care experiences (e.g., following an expectant mother through pregnancy, delivery and newborn child care). Faculty physicians will see the benefits of this because students will be more actively involved in patient care. As students gain a greater understanding of the health care system and the importance of quality and safety, patients will benefit because students will have opportunities to advocate for their patients in new ways.
Can you tell us a about any adjustments that will have to be made in terms of personnel/resources to accommodate the Three-Pillar system?
M.B.: Faculty and staff are looking forward to the new curriculum with anticipation and expectation. But change is never simple. Almost everyone will find that life in the new curriculum is a little different. Yet many things remain the same. Students will still be eager to learn about disease and wellness and excited to care for their patients. Faculty will still share a wealth of experience and wisdom, albeit in a slightly modified schedule.
One significant change that started in the planning process will continue in the new curriculum. Clinical and basic science faculty have worked closely together to integrate more
clinical elements into the new Pillar 1 curriculum. These clinical faculty will continue to participate more actively in the team-based and case-based learning elements of the reformed basic sciences. Likewise, we hope to carry more of those building blocks of science into the clinical years.
Most of the change in personnel will come in the form of changing or shifting duties with little, if any, net loss or gain in numbers. At least initially, scheduling of students and coordination of curriculum in the clerkship year will pose some challenges. An additional education coordinator was added to the Sioux Falls campus. Each of the campuses will also have its own coordinating committee, with faculty representatives from each of the seven major disciplines.
What types of additional flexibility will students have in terms of shaping their medical education that they may not have enjoyed previously?
J.L.: Students will have some additional flexibility in their schedules which will allow them to pursue areas of interest and learn independently. It is now an expectation in medical education, as is true in life-long adult learning, that students identify gaps in their own learning and actively seeks ways to fill those gaps. This ability to learn from your experiences and continually improve your clinical skills is a necessary competence for all physicians.
What are your biggest hopes, in terms of outcomes, for this new system of teaching and learning?
J.L.: The University of South Dakota Sanford School of Medicine has a long legacy of outstanding graduates who are well-trained in medical science, excellent diagnosticians, act professionally and uphold high ethical standards. They are aggressively pursued by outstanding residency training programs across the country. We certainly expect that to continue but also expect to see this next generation of physicians leading the effort to address the complex issues awaiting them in health care.
M.B.: The University of South Dakota will continue to train students of the highest quality and professional standards. The new curriculum will allow earlier integration of clinical medicine, more meaningful patient experiences and a broader understanding of the entire system of care. Likewise, faculty will continue to experience the same rewarding opportunities to teach but with students who are even better prepared and more capable in that clinical role.
This story originally appeared in the Spring/Summer 2013 issue of South Dakotan M.D. magazine. Read the full issue.