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Curriculum Debriefing

Enhance first and second-year medical curriculum with organ-systems approach, clinical skills, interterm periods, and elective opportunities. Students' views on changes considered.

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Curriculum Debriefing

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  1. 6/9/03 Curriculum Debriefing

  2. Basic Structure

  3. Year 1- Basic Structure 1. Molecules and Cells • Biochemistry, Cell Biology, Genetics 2. Normal Body • How normal organs work and look 3. Body and Disease • How the normal body can go wrong • Possibly some diagnostics and therapeutics

  4. Year 1 Changes • Integrated: organ-system based • For “Normal Body” and “Body and Disease” • Addition of embryology and psychopathology • Addition of Normal Human Behavior Course • Eating, sleeping, sexual behavior, stress response, psych development • Schedule to incorporate one half day “off” per week for independent study • Need to extend year by 3 weeks • 2 weeks earlier start • 1 week out of Christmas break

  5. Year 1: Question 1 How would you feel about an organ systems based approach to learning in the first year? • I would support the organ systems approach • I’m neutral on the issue • I think it’s a bad idea

  6. Year 1: Question 2 Do you like the idea of having a half-day of independent study per week? • Yes • Undecided • No

  7. Year 1: Question 3 What effect do you think a half day per week for independent study would have on your overall retention of the material? • Increase retention • No impact • Decrease retention

  8. Year 1: Question 4 How would moving the start date two weeks earlier impact your decision to come to Duke? • I would have chosen another school • This would have negatively affected my decision, but I would have come to Duke for other reasons • This would have had no impact on my decision

  9. Year 2 Basic Structure • Begin with 2 wk “OCY” • Intro to wards, practice H&P’s • 5 blocks of 8 weeks • Medicine (8 wks) • Surgery (8 wks) • Peds (6 wks) + Elective (2 wks) • Reduced from 8 wks, new schedule not decided • Ob/Gyn (6wks) + Elective (2 wks) • Reduced from 8 wks, decreased outrider experience • Family Med (4 wks) + Psych (4 wks) • Psych reduced from 6 wks • MPHS moved to fourth year • Additional elective (4 wks)

  10. Neurology • Was a requirement that could be met in second year or in fourth year • New requirement: 2 week experience some time in medical school • 2-4 wk elective in 2nd year • 4 wk 4th year elective • NICU as a 4th year • Neurology clinic as ambulatory care experience • Can do neurosurgery selective as a part of surgery • The net result opens up elective time in the SECOND year

  11. Interterms • 1 week period that precedes every 8 wk block • Why Now? • A way to better prepare for clerkships • Meets LCME mandates not elsewhere in curriculum in an active way • Integrate the curriculum • Meet clinical reasoning goals • Get acquainted with issues about access to health care • Learn about cost issues and health care

  12. Interterm Goal: Prep For Clerkship • Review relevant basic science • Anatomy before Surgery • Introduce relevant basic science topics not already covered in first year • Clinical skills workshops

  13. Interterm Goal:Develop Clinical Reasoning • Cases based on “common” clinical situations • Cough, fever, chest pain, back pain, etc. • Cases incorporate “orphan” topics • Pain, nutrition, palliative care, delivering bad news, cultural issues, etc. • Health systems, cost, policy, ethics relevant to cases wil be reviewed • Example of a similar case presented to an expert attending • Small group work to work through case issues and final presentation at end of the week to attending

  14. Interterm Goal:The Health Care Team • Students will arrange to meet with other members of the health care team to better understand their roles • Chaplain • Pharmacist • Physical therapist • Hospice • Rehab • Etc.

  15. Year 2: Question 1 How useful do you think the interterms will be? • Very useful • Somewhat useful • Not at all useful

  16. Year 2: Question 2 What do you think should be the main emphasis of the interterms? • Basic science brush up for clerkship • Orphan topics • Ethics • Case-based learning of common diseases

  17. Year 2: Question 3a - 1st Years • Would you rather have neurology required in the 2nd year or have elective opportunities prior to 4th year? • Neurology in the 2nd year • Electives in the 2nd year

  18. Year 2: Question 3b - 2nd years • Would you rather have neurology required in the 2nd year or have elective opportunities prior to 4th year? • Neurology in the 2nd year • Electives in the 2nd year

  19. Year 2: Question 3c - 3rd Years • Would you rather have neurology required in the 2nd year or have elective opportunities prior to 4th year? • Neurology in the 2nd year • Electives in the 2nd year

  20. Year 2: Question 3d - 4th Years • Would you rather have neurology required in the 2nd year or have elective opportunities prior to 4th year? • Neurology in the 2nd year • Electives in the 2nd year

  21. Year 2: Question 4a - 1st Years • What do you think about reducing the time for Pediatrics in favor of a two week elective? • Support • Unsure • Opposed

  22. Year 2: Question 4b - 2nd years • What do you think about reducing the time for Pediatrics in favor of a two week elective? • Support • Unsure • Opposed

  23. Year 2: Question 4c – 3rd years • What do you think about reducing the time for Pediatrics in favor of a two week elective? • Support • Unsure • Opposed

  24. Year 2: Question 4d – 4th years • What do you think about reducing the time for Pediatrics in favor of a two week elective? • Support • Unsure • Opposed

  25. Year 2: Question 5a – 1st years • What do you think reducing the time for Ob/Gyn in favor of a two week elective? • Support • Unsure • Opposed

  26. Year 2: Question 5b - 2nd years • What do you think reducing the time for Ob/Gyn in favor of a two week elective? • Support • Unsure • Opposed

  27. Year 2: Question 5c – 3rd years • What do you think reducing the time for Ob/Gyn in favor of a two week elective? • Support • Unsure • Opposed

  28. Year 2: Question 5d – 4th years • What do you think reducing the time for Ob/Gyn in favor of a two week elective? • Support • Unsure • Opposed

  29. Year 2: Question 6a – 1st years • What do you think about reducing the time for Psychiatry? • Support • Unsure • Opposed

  30. Year 2: Question 6b - 2nd years • What do you think about reducing the time for Psychiatry? • Support • Unsure • Opposed

  31. Year 2: Question 6c – 3rd years • What do you think about reducing the time for Psychiatry? • Support • Unsure • Opposed

  32. Year 2: Question 6d – 4th years • What do you think about reducing the time for Psychiatry? • Support • Unsure • Opposed

  33. Year 2: Question 7 • What do you think of including a four week elective? • Support • Unsure • Opposed

  34. Year 3 • Choose 10 months or 12 months of research • Minimum was 8 months previously • Thesis requirement - due last day of research • Can be graded for honors at your request • Stats module, IRB/IACUC modules required • Can take course work if approved by study program director and if pertinent to project • PRACTICE: Continuity clinic • Up to a half day per week of clinic if approved with your mentor and study program director • Otherwise, a fourth year ambulatory care elective is required

  35. Year 3: Question 1 • What do you think about the third year being at minimum 10 months? • It’s a good idea – less than 10 months is not enough time to allow me to get a real project done • It does not make a difference to me • It’s a bad idea – 8 months should still be an option

  36. Year 3: Question 2 • What do you think about taking classes outside the medical school (i.e. clinical research design, genetics, cancer biology)? • I am looking forward to them • It does not really matter to me, but I like the option • They shouldn’t be allowed; classes take too much time away from research time

  37. Year 3: Question 3a • What do you think about the continuity clinic during the third year? • Great idea - allows me to keep clinic skills sharp • Unsure • Bad idea - experience takes too much time away from research

  38. Year 3: Question 3b - 4th Years • What do you think about the continuity clinic during the third year? • Great idea - allows me to keep clinic skills sharp • Unsure • Bad idea - experience takes too much time away from research

  39. Year 4 - New Requirements • Required sub-internship and a separate “intensive” (ICU/ER/Anesthesia) experience • 4 week capstone class • What you need to know to be an intern • Law and medicine • Financial realities, insurance, licensing and credentialing, etc. • Advanced basic science

  40. Year 4: Question 1 • What do you think about the sub-internship being a requirement? • It’s fine; I would have done it anyway • I would not have done it without the requirement, but it will be useful • A Sub-I should not be a requirement

  41. Year 4: Question 2 • What do you think about the “intensive” (ICU/ER/Anesthesia) experience being a requirement? • It’s fine; I would have done it anyway • I would not have done it without the requirement, but it will be useful • An “intensive” rotation should not be a requirement

  42. Year 4: Question 3a • What do you think about the capstone? • Support the idea; it addresses a lot of questions I may have • Unsure; it may be of benefit • Oppose; it is a waste of time and these topics should have been taught earlier

  43. Year 4: Question 3b – 4th Years • What do you think about the capstone? • Support the idea; it addresses a lot of questions I may have • Unsure; it may be of benefit • Oppose; it is a waste of time and these topics should have been taught earlier

  44. Year 4: Question 4a • Which part of the capstone do you think will be most useful? • What you need to know to be an intern • Law and medicine • Financial realities, insurance, licensing and credentialing, etc. • Advanced basic science

  45. Year 4: Question 4b – 4th years • Which part of the capstone do you think will be most useful? • What you need to know to be an intern • Law and medicine • Financial realities, insurance, licensing and credentialing, etc. • Advanced basic science

  46. Community Partner • Meets goals not currently met • Goals • Understand chronic illness and the impact on the individual and his/her family over time • Understand reality of cost and access to care problems • A longitudinal patient experience • Each student assigned to a family for two years and meets with them periodically • Would debrief PRACTICE group about patient progress

  47. Community Partner - Question 1 • What do you think about the community partner? • Beneficial - it will address issues that are lacking in the current curriculum • Unsure - may be of benefit, but could be too time consuming • Bad idea - these issues are addressed elsewhere in the curriculum and this may not address these issues anyway

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