Curriculum: What's the difference?

[extremelyrealname]

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Potentially dumb question, but I always see people highlight that they like the curriculum at a school or it has a "great curriculum", but when I read about each school online they all seem pretty similar unless they accelerated in the pre-clinical years or integrated vs not. I know I'm missing something, anyone have any advice on how to identify good and bad things about a curriculum?

 

[Goro]

Potentially dumb question, but I always see people highlight that they like the curriculum at a school or it has a "great curriculum", but when I read about each school online they all seem pretty similar unless they accelerated in the pre-clinical years or integrated vs not. I know I'm missing something, anyone have any advice on how to identify good and bad things about a curriculum?

This is almost worthy of a review article in Medical Education.

I'll try to give my feedback based upon my own experience at three different medical schools.
Classic Flexner (non-integrated): The individual disciplines are given as separate courses (Anatomy, Physiology, etc).
+: Subjects are categorized
-: no connection to the Big Picture of, say, how the GI system works

Systems-based (Integrated or Vertical): The individual disciplines are given as components of a larger course that is organ systems based (ie, Respiratory, Endocrine)
+: easier to absorbed both basics and clinicals
- : larger amount of diverse material in a shorter block of time

Flipped curriculum: Material is given as self study, and then assessed in some fashion, either by working through a clinical problem, or by short quizzes, assignments, or team exercises.

Offhand, others include Problem Based Learning: (from Wiki): Problem-based learning (PBL) is a student-centered pedagogy in which students learn about a subject through the experience of solving an open-ended problem found in trigger material. ... The PBL process was developed for medical education and has since been broadened in applications for other programs of learning.

 

[aldol16]

Many schools have transitioned now to systems-based learning and we learn medicine in blocks (e.g. renal block, neuro block, etc.) that take a few weeks each (some longer than others). So there isn't that much to distinguish schools but you can also look at length if that's important for you. Some schools have condensed their pre-clinical programs to 1.5 or even 1 year (Harvard, Duke). This could give you more unstructured time and flexibility to pursue your interests.

 

[jk441]

We’re on a 1.5 year systems-based/integrated pre-clinical curriculum; I like it and think it’s helpful to also learn about path/disease processes within the same time span as the basic physiology. Pros: mentioned above, helps solidify your understanding of normal + abnormal
Cons: condensed amount of time (yet here I am on SDN..)

 

[operaman]

Goro again hits the nail on the head above. This is a very important aspect of medical education and unfortunately doesn't get a lot of discussion other than medical students complaining that they hate whatever curriculum they have.

I'll add a few of my thoughts:

1) regardless of the pre-clinical curriculum, actually learning the material will come down to individual effort. Different institutional approaches may help or hinder various students, but medical students overall are bright and gifted people who will push through and succeed regardless.

2) if I had to do it all over again, I would ask a lot of questions regarding how many pre-clinical activities are mandatory with tracked attendance and penalties for not showing. I would probably ask these questions AFTER getting accepted lest I come off as lazy, but I think this would be a helpful way to compare similar programs. Students tend to come to things that help them and are smart enough to avoid wasting time on activities that are not helpful in the short term. They are also terrible at knowing which activities will be truly helpful in the long term. Even so, I would be wary of any curriculum where the school felt they had to compel attendance for most activities.

3) In line with #2, a good curriculum is far more about the execution than the concept. I am amazed at medical education's ability to ruin good ideas with poor execution. It's why my eyes roll every time I read an article saying "medical students need to learn more about _____" because I can already picture the mandatory lecture/activity and list of objectives handed out by the uninterested faculty member who got tasked with doing it.

4) Know yourself. People vary too widely to say that any one approach is better than the others. I've sat through too many lectures or activities that I thought were completely useless only to look at my friend and have them say it was the best thing they'd ever seen.

5) Ask about how faculty are selected for teaching preclinical courses. Are these dedicated instructors? Are these primarily researchers for whom giving 1 or 2 lectures is part of their academic duties? What is the ratio of PhD to MD/DO instructors? Whatever the system, I would argue that having a sizable cadre of dedicated teaching faculty across the disciplines is ideal with a small portion of topics presented by researchers and clinicians with specialized knowledge in that area. Teaching is an art unto itself and being a good clinician or a good researcher has zero bearing on how good a teacher someone is; yes, I know this goes against what a lot of schools may try to say to justify their practice.

6) A school's board scores don't tell you didly squat about their curriculum. It tells you how competitive their admissions were. Basta.

7) The preclinical curriculum is arguably the most consistent between schools and the least important aspect of your medical education. No school climbs the US News rankings on the strength of their pre-clinical years. The name and opportunities you will find at a Top tier school over a bottom tier one do not manifest themselves in a lecture on biochemistry. There is no secret preclinical material being taught anywhere. If I were doing it over again, I would focus most of my questions and decision making off of the clinical experiences, research opportunities, and quality and connections of clinical faculty. I would use differences in preclinical curriculum as a possible way to decide between otherwise similar schools.

8) The clinical years seem far away but are where you really get your money's worth. I would ask a lot of questions, especially of clinical students during interviews. How are clerkships set up, how long, what options for electives, etc. What are the medical students' roles on the various services? How are didactics set up across the clerkships? Do you get to spend full days with your team or are you pulled out every day for lectures? What hospitals do students rotate through? How much autonomy are students given -- you will obviously be supervised, but some hospitals have essentially banned students from doing anything at all while others may have a student first-assisting with the attending in the OR or doing lots of bedside procedures themselves. Typically students get to do more at VA and county/public hospitals and much less at university hospitals. I think an ideal setup would give you exposure to both the teaching and unique cases of a referral university hospital as well as some time at VA/county/public hospitals where you get a lot more autonomy and opportunity to actually do things.