Data on integrated curriculum vs traditional curriculum.

Discussion in 'Allopathic' started by coffeesnob, 05.18.14.

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  1. coffeesnob

    coffeesnob 2+ Year Member

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    My school has a fully integrated curriculum that has been in effect since two years ago. Our average Step 1 score dropped dramatically because a lot more people (compared to previous years) failed after the implementation of the new curriculum.

    Rumors I have heard are:

    1. Integrated curricula sound good theoretically but have not proven to work (in terms of board scores). Thus, many schools who once had a fling with the integrated curriculum resorted back to the traditional one. I have heard Harvard is such a case but I cannot back up this claim.

    2. Integrated curricula start working after about 3 years after initiation.

    3. Integrated curricula allow students to pass classes more easily than the traditional one. So their lack of knowledge will be evident only on standardized tests like Step 1.

    I haven't been able to find any articles on these topics.
     
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  3. Psai

    Psai ヽ(´ー`)ノ Account on Hold 2+ Year Member

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    I heard that my school's step one score dropped after they changed the curriculum a while ago and it took about 2-3 years for the average step 1 scores to get back to baseline. No data though, sorry.
     
  4. dyspareunia

    dyspareunia

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    Define integrated and traditional curricula for me.

    Also, I'd bet that a change in curriculum (in any direction) would result in lower board scores initially especially if you use the same professors. The professors are used to teaching one way and it will take them time to teach the new way plus ensure the "correct" material is being taught and emphasized.
     
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  5. Porfirio

    Porfirio 2+ Year Member

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    I am glad that I had an integrated curriculum. Step 1 was so much of an individual experience - it did not matter what/how the professors were teaching. What mattered was how much "free time" the school gave me to study for Step 1. It is like every other exam we have taken - you study for taking that exam, cram material in, vomit material out in A, B, C format, then get out of the exam feeling like you failed.

    My integrated curriculum made the first two years of medical school short (we took Step 1 back in Feb/early March). They gave us 4 weeks of "free time" to study for Step 1 (it should have been longer), but who the hell cares now. I passed/did well on Step 1, and now I am in 3rd year and 4 weeks left on my 2nd rotation. The first two years of medical school are terrible, but it does get better.
     
  6. DermViser

    DermViser 5+ Year Member

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    Integrated = Organ system based
    Traditional = By basic science subject
     
  7. CherryRedDracul

    CherryRedDracul 2 Chainz Muscular Dystrophy 2+ Year Member

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    Sounds typical. When a curriculum is radically changed, it begins its life like an infant: can't walk, can't talk, positive Babinski. Through learning (mostly by trial and error) the curriculum improves its weak points over time. But it's at the sacrifice of the first crop of medical students who have to go through this new curriculum as they serve as lab animals. At my school, Step 1 scores and grades dropped after the latest curriculum change.

    Here, we have a quasi-traditional curriculum in block scheduling format. Ultimately, at the middle of our 2nd year, we have a course that is largely path, but serves to integrate everything we learned prior into a cohesive unit. What I like about the current set-up is that you ultimately get a few passes through the same material over the first two years, and that helps with getting material sticking to your brain.

    I just wish we had more quality instructors. Sometimes it was better to just not follow the lectures.
     
    Last edited: 05.18.14
  8. Kahreek

    Kahreek 2+ Year Member

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    i have traditional curriculum, never had integrated. cant comment.
    You do go over and over again on the same subject from different prespectives. Cant really say if it is better or worse.
    Maybe it can be easier to pass a test if you half nail anatomy, physiology and histology on the same test, instead of doing separate subjects on the same stuff. But again it completely depends on the test difficulty and evaluation method rather than the contents.
     
  9. Psai

    Psai ヽ(´ー`)ノ Account on Hold 2+ Year Member

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    Story of my life lol
    I like the ones who can keep your attention and can tell you everything without even looking at the powerpoint slides as opposed to the people who stare at the screen and slowly read to you at 0.7 speed.
     
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  10. atomi

    atomi Member 10+ Year Member

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    No ****. That's because these new curricula are spearheaded by administrators hellbent on making a name through themselves by mixing things up. Change for the sake of change. The reforms are predicated on the idea that group learning is the best way to learn for everybody and they force students to come to class and play their silly TBL games, and even more disturbingly, they design assessments so that you will only do well if you participate in the group activities. The focus is for them to use you as guinea pigs to get data to publish research. USMLE step 1 is not used as a metric for evaluating the success of the curriculum. These people (Education M.Eds and Ph.Ds) don't care about your future success as a doctor after you leave the preclinical curriculum. They just care about establishing names for themselves in the world of education. Not surprisingly, students who rely on the curriculum to teach them the medical knowledge they need for the USMLE will be left holding the bag.
     
  11. dyspareunia

    dyspareunia

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    The plight of medical students everywhere. Let me pay you $50k so that I can self-teach 99.9% of the material.
     
  12. DermViser

    DermViser 5+ Year Member

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    BINGO. The first 2 years has no accountability to med students and their Step scores and "improvements" are made long after that class has gone past that part of the curriculum. Medical students are their guinea pigs, esp. those of the M.Ed and PhD variety.
     
    Last edited: 05.18.14
  13. atomi

    atomi Member 10+ Year Member

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    I just spit out my coffee watching that video. Holy hell. What med school class had the balls to make that? If that video were made at the med school I went to, everyone involved would have, appropriately enough, gotten called into the "principal's office," an official email would have been sent out by the administration condemning it and reminding the student body of the standards they are expected to uphold, and formal reprimands in the form of comments citing unprofessional behavior would have been put in the students' permanent records and included in the MSPE. Exactly that happened for far less. In fact, one student actually got a reprimand in his file simply for not submitting critical feedback on his TBL peer evaluations. He said he had nothing bad to say about any of his teammates, and he was told that in order to pass he would have to submit critical feedback (effectively they told him to make something up), he refused and was labeled as "unprofessional." It upsets me to think how much of our tuition and time was squandered on this TBL pseudoscience peddled by "education doctors."

    I want to send each of those student actors a personal thank you letter.
     
    Last edited: 05.18.14
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  14. atomi

    atomi Member 10+ Year Member

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    It's worse than that. It's "let me pay you $50k so I can be taught by my self-aggrandizing peers who think they know everything as an MS-1."
     
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  15. CherryRedDracul

    CherryRedDracul 2 Chainz Muscular Dystrophy 2+ Year Member

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    LOL sounds like a school I would never go to. But the unwritten rule is to never criticize anything at your school because there is a strong chance that the administration will make you rue the day you decided to refuse to blow them.

    At my school, things seem to be a little more lenient. We have an annual show for the 4th years as a sort of a good-bye to them before they embark, and there's plenty of criticism labeled at how the school is run ... along with some good old twisted medical school humor and other live performances. TBL is always the brunt of the jokes every year. I'm glad our administration at least lets our voices be heard for that show.

    Disclosure: I found TBLs kind of fun because it was just socializing time for me. Was it time well spent for learning? No, not really. It was more of an excuse for me not to do work.
     
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  16. Prodromo

    Prodromo 7+ Year Member

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    After watching that video and reading the comments I am very happy I had a traditional curriculum. It boggles my mind that they are forcing specific teaching styles on adult learners who have obviously figured out how to teach themselves by the time they were accepted into medical school. 99.9% of my studying was done independently and I was extremely successful and efficient as a result.
     
  17. CherryRedDracul

    CherryRedDracul 2 Chainz Muscular Dystrophy 2+ Year Member

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    You hit the nail right on the head. I can understand if the inculcate the concepts of TBL in earlier learning years like in high school or even undergrad. Babying medical students is a waste of time for them. Besides, I see plenty of TBL (AKA study groups) outside of classes, but it's self-governed. It's like we're the square pegs and the school's TBL curriculum is the round hole and they're trimming our edges off and jamming us into the hole so that they can data-mine us and p-hack their studies so that they win. They can never lose.
     
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  18. DermViser

    DermViser 5+ Year Member

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    Apparently, it's from UNC. Their class show was in 2013, and they're the class of 2015, so my guess is they were finished with their basic science coursework by that time and were about to enter clinicals. At my school we definitely would have had the unprofessionalism hammer thrown at us, if we had done something like that. Yup, we also got a threat of "unprofessionalism" if we didn't submit evaluations on time.
     
  19. atomi

    atomi Member 10+ Year Member

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    This comment brings up a very important point. "Researchers" use quotes like this from people like you to support their argument that "See, TBL really works, students really like it and have fun." They cut out the rest of what you said and ignore negative feedback that they can't spin.

    Interestingly, at the same time, they are publishing papers expressing frustrations that students are spending TBL time "disengaged" and surfing facebook, chatting with friends, and texting on their phones, and they are tyring to design strategies to eliminate this and make sure that you will only get good grades if you are engaged during TBL. In other words, they are attacking the one source of positive comments they get from the whole thing: that it's a fun social hour for some people.
     
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  20. dyspareunia

    dyspareunia

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    Is TBL in most US MD schools now? I think it's a huge waste of time, but as others have said it's a nice break from the books.
     
  21. DermViser

    DermViser 5+ Year Member

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    If you look at the "research" papers on PBL - they're more self-promoting opinion pieces rather than actual research on the effectiveness of PBL. The papers that promote PBL learning are exalted http://www.ncbi.nlm.nih.gov/pmc/articles/PMC225793/, thus resulting in a domino effect to where medical schools start adopting it to where eventually the LCME requires some level of PBL-type groupwork incorporated or threaten the med school with probation: http://www.mysanantonio.com/news/lo...nio-s-medical-school-on-probation-2222609.php

    Meanwhile papers that point out the very real problems of PBL:

    The Problem with Problem-based Medical Education
    http://onlinelibrary.wiley.com/doi/10.1002/bmb.2003.494031010158/pdf
    • "Around 1990 the craze for student-centered, problem-based learning began sweeping through United States medical schools like wild fire through a parched Colorado forest. Its promoters and advocates thought they had reinvented medical education. Like most plans, on paper it looked great. But, in my judgment, twixt the cup and the lip, between the design and the implementation, there have been many a slip."
    Dysfunctional problem-based learning curricula: resolving the problem
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3532094/?report=classic

    Influence of curriculum type on student performance in the United States Medical Licensing Examination Step 1 and Step 2 exams: problem-based learning vs. lecture-based curriculum.
    http://www.educus.com/Journals/11703641?AspxAutoDetectCookieSupport=1
    • "United States Medical Licensing Examination Step 1 scores over the seven-year period were 214 for Traditional Curriculum students and 208 for Parallel Curriculum students" (2001)

    are widely ignored bc they go against academic, ivory tower groupthink.
     
    Last edited: 05.18.14
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  22. DermViser

    DermViser 5+ Year Member

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    Which they can then publish and be first author in academic medical education journals in their quest for tenure to show just how great their ideas are. Funny how their PBL sessions never actually work like this:

     
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  23. WaylonS

    WaylonS 2+ Year Member

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    QFT

    BTW, I love your Leigh Bowery avatar
     
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  24. DermViser

    DermViser 5+ Year Member

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    Keywords: "for the 4th years" --- a.k.a. after they've already matched and are relatively invincible.
     
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  25. Rirruto

    Rirruto 5+ Year Member

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    I was always frustrated by classmates who used this argument to defend [insert gimmick]-based-learning: "I really like X-based-learning, therefore it should be mandatory for all students."
     
  26. DermViser

    DermViser 5+ Year Member

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    If you look at one study: http://journals.lww.com/academicmed..._primary_care_career_choice__a_complex.6.aspx, those from PBL-type schools had a higher percentage of their students choose primary care

    (Will leave out my snide, not politically correct commentary on why this is)
     
  27. DermViser

    DermViser 5+ Year Member

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    These are the same classmates who:
    • are mad when those who don't go to class make higher exam scores than those who do go to class.
    • believe that bc THEY attend class every day bc that's how they learn, so should you, and if you don't then it's a moral failing and disrespect on your part.
     
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  28. TKE340

    TKE340 2+ Year Member

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    Is TBL really that bad? (I don't start school for a few months) My school has a full TBL integrated problem-based curriculum with no lectures. We go to school Mon, Wed, Fri from 9-noon, the rest is self study. Sounds pretty good to me.
     
  29. CherryRedDracul

    CherryRedDracul 2 Chainz Muscular Dystrophy 2+ Year Member

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    It will depend on the person, what group you're in, how your school handles TBLs, etc. For the most part, it's a mandatory period of stuff that's just there for the sake of being mandatory (and for the sake of the higher-ups to jerk themselves over). For me, it was a time to socialize and not do much work.
     
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  30. TKE340

    TKE340 2+ Year Member

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    Our groups are randomized every phase
     
  31. DermViser

    DermViser 5+ Year Member

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    https://www.aamc.org/download/266350/data/aps2003-01antolineproblem-basedlearning.pdf

    Yes, your school is well-known for PBL. I thought this line was very interesting regarding your school, "It is thought that board exams don't test all of the knowledge and skills gained in problem based-learning..." Yes, why use a numeric objective metric to hold your curriculum accountable to your students. :barf:
     
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  32. TKE340

    TKE340 2+ Year Member

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    From the information I've been able to gather, the average Step 1 scores are in the 220s. I believe what they are trying to say with that statement is that the scores can't quantify the teamwork and other attributes that they say PBL is supposed to instill.
     
  33. Wordead

    Wordead 7+ Year Member

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    That's funny....my takeaway on teamwork from TBL is that everyone else is incompetent and I can only trust myself and wikipedia/ the internet.
     
  34. DermViser

    DermViser 5+ Year Member

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    The problem is the average USMLE Step 1 score is about a 227. No school is going to admit their preclinical curriculum sucks. That's kept behind closed doors. I think in the article they give a lot more credence to their non-standardized oral exam as testing "problem-solving and analytical skills" than it probably actually does in reality. It's the Dunning-Kruger effect in action: http://en.wikipedia.org/wiki/Dunning–Kruger_effect
     
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  35. DermViser

    DermViser 5+ Year Member

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    You mean like this?
     
  36. Psai

    Psai ヽ(´ー`)ノ Account on Hold 2+ Year Member

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    wikipedia has given me approximate knowledge of many things
     
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  37. Anastomoses

    Anastomoses secretly an end artery Banned Account on Hold 2+ Year Member

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    This might sound crazy but...I wouldn't be surprised to learn that certain students might learn better from one versus the other. Maybe learning should be student-tailored? I don't think that has to cost them a fortune if done in an organized manner.
     
  38. DermViser

    DermViser 5+ Year Member

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    There are schools that have 2 independent learning tracks - Ohio State, Drexel, LECOM (DO). The problem is for the rest, you don't have the option, it's only 1 track. Sometimes asking a school to be organized is asking a lot.
     
    Last edited: 05.18.14
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  39. coffeesnob

    coffeesnob 2+ Year Member

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    whoa. that sounds pretty bad to me. but maybe your school knows what it's doing. When you say no lectures, do you mean not even recorded ones? Are you going to be "taught" anything in any form?
     
  40. DermViser

    DermViser 5+ Year Member

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    Here is how it goes there at his medical school. There are NO taught lectures.


    I think it's funny the comment on the Youtube video and it got more thumbs down than thumbs up.

     
    Last edited: 05.18.14
  41. chronicidal

    chronicidal Scrub 5+ Year Member

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    First, board scores at Harvard are what is expected/predicted by their incoming MCAT scores. Second, Harvard's current iteration of curriculum reform aims for more integration, not less. The reform in 2006, called the New Integrated Curriculum, primarily functioned to integrate clerkships within 3rd year, now called the Principal Clinical Experience. The preclinicals are already organs-based instead of normal vs. abnormal. Example: you learn microbio in one block, rather than splitting it between a 'basic micro' course first year and a more clinically-oriented 'infectious diseases' course second year. "The resulting curriculum [from the current reform initiative], which leads to the Principal Clinical experience (PCE), will more fully integrate basic science and clinical medicine in an innovative program more developmentally appropriate for student learning." http://issuu.com/harvardmed/docs/dr_fall2013-14pdr22_issuu

    Third, I'd comment that the folks driving these reforms are rarely PhDs or EdDs. At any medical school, the curriculum is primarily in the hands of MDs. Sure they might be trying to publish to establish a name for themselves in medical education scholarship/leadership and get tenure, but I think that's vastly preferable to having the curriculum led by folks who are primarily interested in clinical or basic science research and only secondarily interested in improving education. Many schools when considering promotions and tenure decisions greatly devalue educational leadership and teaching. I for one would be glad to be a guinea pig at a school that was trying to make forward-looking innovations in education.
     
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  42. @JackShephard

    @JackShephard

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    This.

    Free time and great resources (with repetition + intelligence) make a great Step 1 score.

    To get those high scores, clinical knowledge helps - which some school's add into the first 2 years.

    All this curriculum talk is overblown and made complicated (like EMR or medical documentation).

    Here's my simple curriculum:
    • Get the best resources and teachers (Pathoma stands out as an excellent resource and teacher)
    • Let the students do what they want - don't force attendance to anything (group work is fine, but let students decide if they want to do groups - i.e. opt out)
    • Keep it high yield (stay away from PhD B.S. and research topics - that can be done individually)
    • Use NMBE subject exams and buy students practice NBMEs
    My school made everything too complicated and half of the students suffered because of it. You don't need research and studies to back each component of the curriculum. I prefer integrated - but focusing on integrated vs traditional isn't the most important factor - the 4 points above are much more important. For example, my school kept it low yield many times, used terrible resources half the time, forced students to learn in ways they didn't want to and occasionally made their own low yield exams.

    The reality is - 2 years is a LONG time to learn the fundamentals of medicine. I'm sure if the best resources and teachers were used, it could be done in 1 year. Because we have 2 years, each school can throw in lots of time wasting gimmicks and low yield hazing material.

    Students with desire and learning how they want to learn without nonsense required activities will succeed. That's a common sense approach.
     
    Last edited: 05.18.14
  43. DermViser

    DermViser 5+ Year Member

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    To be fair, usually clinicians (MDs) aren't the ones driving curriculum changes in the MS-1/MS-2 years unless they are a specific academic figurehead - Assistant Dean of Curriculum or Student Affairs, etc. in which that's part of their job description or they're part of a med school Curriculum committee of some sort.
    The faculty PhDs who actually teach the course carry out the "vision" that curriculum committee sets as to how the curriculum is structured and implemented.

    Both PBL style and MMI interviewing for med school admissions came from Canada from that darn McMaster University.

    In a lecture oriented curriculum, the student can learn the material based on how he/she learns best. In a PBL based curriculum, you don't have a choice bc everyone has to participate, or if you like it, you drag everyone else who doesn't want to learn that way with you. I don't think any class wants to be the "guinea pig" test year when a new curriculum hasn't been fully test-driven. People are much more comfortable when the kinks have been worked out. It would be different if say the school said, ok, we're switching to this curriculum so bc they'll be some kinks, we'll give you x many weeks more than we usually do at the end of MS-2 to consolidate the info - but that never happens.

    Nearly everyone in med school is promoted with the # of journal contributions as one aspect, whether it's Nature or whether it's Academic Medicine.

    I think Drexel has it best with respect to tailoring to a student by allowing them to choose either pathway: http://www.drexelmed.edu/Home/Acade...exelsInnovativeCurriculum/YearsOneandTwo.aspx
     
  44. TKE340

    TKE340 2+ Year Member

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    No required lectures. Students can request lectures on any of the material. Those are done on Thursdays, are recorded, and aren't mandatory. We are given notebooks at the beginning of each phase outlining the learning objectives and what to know in what textbook. The idea is that instead of giving you what you need to know in lecture, they give it in writing to kill time. Gives us way more time to study and less time in lecture copying down notes that I can copy from a book twice as fast.
     
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  45. DermViser

    DermViser 5+ Year Member

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    Also your med school is one of the few that had a complete PBL style curriculum from the very beginning since when the school opened back in 1982. They're not a recent switchover in the past decade or couple of years, for example. So obviously any kinks are fully ironed out. http://www.ncbi.nlm.nih.gov/pubmed/2394433

    If the faculty facilitators are as good and as invested in their students as those promotional Youtube videos for their school, then you're actually pretty lucky.
     
    TKE340 likes this.
  46. Rirruto

    Rirruto 5+ Year Member

    Joined:
    07.13.11
    Messages:
    76
    Status:
    MD/PhD Student
    Spot on. This perfectly describes [at least] 3 classmates from my entering class. I don't understand these students' mentality of needing to please/validate/gratify the teaching faculty by drinking the kool-aid and buying blindly into the curriculum as the sole path to the promised land. As adults in our 20s and 30s, we probably have figured out how we learn best.

    I recall many a sesh where I actively tried to not listen to other students/faculty avoid being confused.

    This is very reasonable.

    My more radical approach would be to have medical school be only MSIII+MSIV. Much like some of the specialty residencies (derm, rads), you apply to start the program 1 year after being accepted, with conditional acceptance for passing Step 1. The interim year, which would be entirely independent study and therefore tuition-free, would be to learn basic science and pass USMLE Step 1. Then you would start MSIII with a week of PEx instruction. Obviously this would never happen given the LCME's requirements for hours of instruction, but it's food for thought.
     
  47. @JackShephard

    @JackShephard

    Joined:
    02.06.14
    Messages:
    693
    I support your plan also.

    Our current system isn't very good - and it's also profitable for schools. There's no incentive to change.

    Monopolies don't lead to innovation.
     
    DermViser, Anastomoses and Rirruto like this.
  48. coffeesnob

    coffeesnob 2+ Year Member

    Joined:
    08.02.11
    Messages:
    332
    Status:
    Medical Student
    Ah. Our school got rid of the written syllabi along with the traditional curriculum. Your school sounds pretty cool and organized. My school isn't.
     
  49. CodeRedDew

    CodeRedDew Thirst Quencher 5+ Year Member

    Joined:
    11.13.11
    Messages:
    475
    Status:
    Medical Student
    You pretty much hit the nail on the head with this one. These are my EXACTLY my thoughts.
     
  50. GrabSlamBoot

    GrabSlamBoot 5+ Year Member

    Joined:
    11.28.10
    Messages:
    854
    Status:
    Pre-Medical
    I'm almost done with my M1 year at a one year basic science institution and having been through it I feel like it can easily be done at most schools. I do think that the pace is rather neck breaking but the pressure is alleviated by having a true P/F curriculum. And having a P/F curriculum allowed me to focus on board materials alongside my coursework to a much greater extent than I would have been able to at a non P/F school. I'd be interested to see how a 1.5 year curriculum felt on terms of workload and pace as compared to a one year school. Maybe it's the perfect middle
     
  51. dyspareunia

    dyspareunia

    Joined:
    03.06.14
    Messages:
    1,019
    Status:
    Medical Student
    The fact that your school teaches all basic sciences in 1 year and still somehow manages to devote time to non-board relevant material is beyond insane.
     

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