Questions for those with systems based curriculum

[lildave2586]

I'm serving on a task force at my school examining our pre-clinical curriculum. We currently have a block system, but it's not systems based. For those of you who do have a systems based curriculum, I have a few questions.

When does your systems based learning start? Is it the entire length of the first two years?
How is anatomy incorporated into the curriculum and do you have cadeveric dissection or prosection?
How/when does your school teach physical exam techniques?

If I think of more I'll add to this list, but thanks in advance.

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[VanBrown]

We have 8 organ modules and 2 fundamental modules at Alabama.

The first fall is all fundamentals and has a lot of gross lab. Subjects are biochem, immunology, micro, histology, physiology (basic), pharmacology, anatomy, ethics, etc... We also have an intro to clinical medicine course and in the first fall it is completely history taking (HPI, CC, etc)

The next 15 months is all organ systems. CV, pulm, GI, renal, MS, neuro, heme/onc, repro. Modules are usually 5 weeks long and we do the PE and history for each specific section during the module that the PE/history will pertain to.

Each module is basically the same in that the beginning is all of the histo, anatomy, and phys followed by pathology, pharm, and treatment. Most of our modules have an associated gross lab requirement.

 

[ruralmd]

When does your systems based learning start? Is it the entire length of the first two years?
How is anatomy incorporated into the curriculum and do you have cadeveric dissection or prosection?
How/when does your school teach physical exam techniques?

I'll help out.

We are systems based for the first two years. The first unit is Biochemistry and molecular biology and then we go into the systems. Its broken up into units with the first being musculoskeletal, next is head and neck and so on and so forth. Anatomy starts with musculoskeletal and continues until the end of the year, the last unit being reproductive. And during the anatomy section we do histology, physiology, etc for normal function.

Second year we continue with a similar model but the first unit is general principles and we cover micro, neoplasia, pharm, etc like they are arranged in First Aid. So for our exam we would study each section in First Aid for our final (Pathology, Pharmacology, Microbiology). Then following that we go by system covering all the pathology, micro, pharm, physiology (again). So we will cover the entire GI system with a quick review of 1st year during the first day and then micro, pathology, and pharmacology.

Hope that helps, if its not clear let me know.

 

[MilkmanAl]

When does your systems based learning start? Is it the entire length of the first two years?

We have 8 weeks of biochem and cell bio, and the rest of the first year is systems-based with phys, anatomy, histo/microanatomy, and ICM running concurrently. Phys and histo end before head and neck starts, and the anatomy transitions into neuro (only anatomy and neuro for about 3 weeks, and then only neuro for another month). Second year is all systems, all the time.

How is anatomy incorporated into the curriculum and do you have cadeveric dissection or prosection?

See above and dissection. Anatomy lasts a little less than 6 months.

How/when does your school teach physical exam techniques?

As the systems come.

 

[lildave2586]

We have 8 organ modules and 2 fundamental modules at Alabama.

The first fall is all fundamentals and has a lot of gross lab. Subjects are biochem, immunology, micro, histology, physiology (basic), pharmacology, anatomy, ethics, etc... We also have an intro to clinical medicine course and in the first fall it is completely history taking (HPI, CC, etc)

The next 15 months is all organ systems. CV, pulm, GI, renal, MS, neuro, heme/onc, repro. Modules are usually 5 weeks long and we do the PE and history for each specific section during the module that the PE/history will pertain to.

Each module is basically the same in that the beginning is all of the histo, anatomy, and phys followed by pathology, pharm, and treatment. Most of our modules have an associated gross lab requirement.

Let me see if I got this correct. In your fundamentals block, you have gross and then again with the systems? How long do your systems modules usually last?
Thanks for the response

 

[lildave2586]

I'll help out.

We are systems based for the first two years. The first unit is Biochemistry and molecular biology and then we go into the systems. Its broken up into units with the first being musculoskeletal, next is head and neck and so on and so forth. Anatomy starts with musculoskeletal and continues until the end of the year, the last unit being reproductive. And during the anatomy section we do histology, physiology, etc for normal function.

Second year we continue with a similar model but the first unit is general principles and we cover micro, neoplasia, pharm, etc like they are arranged in First Aid. So for our exam we would study each section in First Aid for our final (Pathology, Pharmacology, Microbiology). Then following that we go by system covering all the pathology, micro, pharm, physiology (again). So we will cover the entire GI system with a quick review of 1st year during the first day and then micro, pathology, and pharmacology.

Hope that helps, if its not clear let me know.

Sounds good. How many weeks does your first unit last? When do you do physical exam skills/ethics stuff and when do you do immunology (maybe it's in micro general principles?)

 

[ruralmd]

Sounds good. How many weeks does your first unit last? When do you do physical exam skills/ethics stuff and when do you do immunology (maybe it's in micro general principles?)

The first unit was about 5 weeks.

Physical exams are taught in a class called icm. The physical exams are coordinated with the units so we learn the cardio exam with the cardio unit etc.

Ethics is contained within our medicine and society block, which lasted about a month. Basically the behavioral science section of first aid with alternative medicine sprinkled in.

Immunology was taught in the hematology unit.

 

[OPPforlife]

We have a total of 7 blocks in first year with the shortest being 2 weeks and the largest 6.5.
First block:
Fundamentals blocK: Has a ton of fundamental biochemistry and genetics. no anatomy, no histology. little bit of embryology...uptill gastrulation I think or maybe even neural tube formation.
Second block:
Musculoskeletal block: Includes anatomy of upper and lower limb and back. Histology also included in this block namely bone, muscle, and skin histo. This block also includes peripheral neuro including spinothalamic tracts for sensory and pain perception. Contains some physiology i.e. motor neurons, actions potentials and stuff like that. Biochemistry included glycolysis, electron transport chain, oxidative phosphorylation and gluconeogenesis.
Cardiovascular and Pulmonary block: Includes CV/pulmo physiology, anatomy, histology and embryology. Biochem was comprised of FA oxidation, Triglyceride synthesis and cholestrol synthesis. A few lectures on vitamins were also given.
GI/Renal block: Very similiar to CV block except with GI/Renal. Biochem included Folate metabolism, nucleotide metabolism, oxidative stress, pentose phosphate pathway, glycogen metabolism, porphyrin metabolism, ethanol metabolism, and few very basic lectures on nutrition.
Reproductive block: Anatomy, histology, an embryology like other blocks. Physiology was mostly endocrine stuff. Biochemistry included lactation and Vit D.
Cognition and Control: neuroanatomy and neuroscience. really long and seemingly very challenging block.
Synthesis Block: Is supposed to be mostly case based but the final word is not yet out. This block will only be 2 weeks long.

I think over all our curriculum is pretty amazing. Lectures seem to go well together and it makes learning kind of organized. Supposedly second year is all systems based as well...with a similar order but I am not sure.

Oh and we also have a fundamentals to patient care class. It is systems based as well, so depending on what system we are in we learn physical exams, interview taking, and other aspects of patient care.

 

[VanBrown]

We have anatomy as a part of almost every one of our modules. We are currently in GI and had 6 lab sessions (2 hrs each, of which you are responsible for attending 3 but the material for all 6). This way you see the gross anatomy as you are going through the specific modules.

 

[Rollo]

We're on a trimester basis at PCOM. First trimester is anatomy, histology, embryology, and little bit of radiology. Second trimester is the mother of all trimesters because in about 12 weeks, we cover the fundamentals of biochemistry, pharmacology, genetics, micro, immuno, oncology, hematology, basic pathology, and molecular bio. Third trimester is cardio, renal, and pulm which covers physio, path, micro, pharm, and internal medicine aspects of the specific system.

Second year is GI, reproductive, neuro, and couple of other things (i'm only M1 so don't know the specifics about M2 yet).

We dissected in first trimester, and we don't get anatomy again formally. Of course, we have to know the anatomy of the heart to understand physio but we aren't taught anatomy in systems.

 

[lildave2586]

We have anatomy as a part of almost every one of our modules. We are currently in GI and had 6 lab sessions (2 hrs each, of which you are responsible for attending 3 but the material for all 6). This way you see the gross anatomy as you are going through the specific modules.

Do you do the dissection in the anatomy lab? The dean at our school is not willing to give up cadaveric dissection. I know a lot of schools are going to prosection models and labs where the faculty dissects and the students watch just to speed things up. The dean at my school refuses to give up student-dissection, and this may be an obstacle to systems based curriculum. I would love to hear how your schools deal with this!

 

[p30doc]

When does your systems based learning start? Is it the entire length of the first two years?
How is anatomy incorporated into the curriculum and do you have cadeveric dissection or prosection?
How/when does your school teach physical exam techniques?

If I think of more I'll add to this list, but thanks in advance.

Systems based starts 2nd year. Anatomy is runs the length of the fall semester of M1, it is full dissection. Physical exam techniques start 1st semester of M1 as well and runs through the end of M2.

 

[mednsports]

Do you do the dissection in the anatomy lab? The dean at our school is not willing to give up cadaveric dissection. I know a lot of schools are going to prosection models and labs where the faculty dissects and the students watch just to speed things up. The dean at my school refuses to give up student-dissection, and this may be an obstacle to systems based curriculum. I would love to hear how your schools deal with this!

I'm at UAB with vanbrown and yes we do all the dissections. There are no prosections. Module based is the way to go IMO but you need to keep the dissections. You just don't learn the material as well if it is already dissected out for you.

 

[lildave2586]

I'm at UAB with vanbrown and yes we do all the dissections. There are no prosections. Module based is the way to go IMO but you need to keep the dissections. You just don't learn the material as well if it is already dissected out for you.

I agree, and I'm glad our dean wants to keep student dissection. Do you dissect on the same body for each system? You don't use the same body for a year and a half do you?

 

[VanBrown]

Yeah we do a lot of dissections and they are pretty good. I learn my anatomy so much better when it is tangible and I can touch it... plus it helps with surgical anatomy so that you get all the spatial relationships. Our curriculum has kind of evolved over the last few years (started organ based 3 years ago) and has been accumulating more gross time.

 

[MilkmanAl]

I disagree about dissecting leading to better learning. You definitely need to be able to handle the structures, but actually finding and cleaning them was just a waste of time, in my opinion.

 

[URHere]

I guess I'll chime in for OHSU.

Our MS2 year is systems-based. Our blocks are: Cardiovascular, Metabolism, Neuroscience, Human Growth and Development (including reproduction and aging), and Blood.

MS1 year is more general - we start with 2-3 months of anatomy (we have dissections, 4 students/cadaver), then we move into basic biochem and cell biology, then on to "normal physiology" where we go through a mini-systems based curriculum (cell phys, cardio, renal, pulmonary), and we end with our "biological basis of disease" class where we cover basic immunology, microbiology, etc.

We also have a clinical medicine course that runs the full length of the first two years. This course lasts one afternoon/week. The first two hours are devoted to the "social issues" of medicine (healthcare reform, epi, special patient populations, etc), and the second two are devoted to clinical skills.

 

[mednsports]

I disagree about dissecting leading to better learning. You definitely need to be able to handle the structures, but actually finding and cleaning them was just a waste of time, in my opinion.

Well I disagree with that.

 

[VanBrown]

Well I disagree with that.

Agree, just having it set out in front of you doesn't give you an appreciation of what surrounds it, in which body plane it lies, etc. Looking at a gross book you would think the body is laid out in a clear manner and that would be reinforced by a set-dissection for you to examine. Cleaning and getting into the anatomy is the only way to LEARN where it is... not just recognize it once someone else has done the work for you.

 

[EmersonAnne]

We're systems based for the first two years. We start out first year with Foundations of Medicine for four weeks. It's just basic histo, immuno, genetics, biochem, etc. It's to get everyone up to speed so we all start at the same place.

Next four weeks is the Musculoskeletal system. We begin Gross Anatomy (full dissection) doing all the muscles, nerves, arteries, veins, and bones in the back, the arms, hands, feet, legs, and just a bit of head and neck. We also do everything related to the system -- all the physio of muscles, biochem, immuno, genetics, internal med of musculoskeletal injuries, pathology of diseases of the MS system, etc. We also have a class called Osteopathic Clinical Skills (I'm at a DO school) where we learn clinical skills (not just OMM) related to the MS system -- back pain, injured shoulder, sports-related stuff.

We have finals week, which includes our clinical skills practical, pathology practical, Anatomy practical, and written final, then we get a week of electives.

Then we start Cardiopulm I. We do all the subjects, same as musculoskeletal, though we have a lot more physio for this section. Anatomy lab isn't as intense as it was in MS, but we dissect the heart and lungs and all things associated. In clinical skills, it's about heart sounds, breath sounds, taking blood pressure, taking blood, etc. Finals week is like it was for Muscuoloskeletal -- Anatomy practical, path practical, clinical skills practical and written, and written final.

Christmas break.

Cardiopulm II. No Anatomy for this section since it was all done in Cardiopulm I, but we continue with the same sorts of subjects. This time more on pathology versus the normal. EKG heavy.

Electives for a week.

GI. Anatomy of the abdomen, etc. The bodies aren't as fresh as they were in the beginning of the year, but they're OK. We already had our Anatomy practical for this section a couple of weeks ago. Finals week is this week for everything else (and I should go study!). Clinical skills is about bowel sounds, etc.

Renal. Last section of the year. We dissect all the things that have to do with the renal system in anatomy and learn the rest in lecture and clinical skills lab.

Second year, we begin with neuro. While the first years do Foundations of Medicine, we have the anatomy lab to ourselves to dissect the head and neck. All subjects pertain to neuro. Clinical skills is about neurologic exams, etc.

That's it for Anatomy. So all of first year we have anatomy and for the first four weeks of second year.

After that, we have neuro II; skin, blood, and lymph; endocrine; and reproductive. None of those include anatomy, but they do include everything else -- path, histo, biochem, immuno, genetics, clinical skills, etc.

Since it's a DO school, in clinical skills lab, we also learn OMM, but since you're posting in the allo forum, I assume you're at an allo school so your clinical skills lab could be devoted to all the things I mentioned without the OMM.

 

[MilkmanAl]

Agree, just having it set out in front of you doesn't give you an appreciation of what surrounds it, in which body plane it lies, etc. Looking at a gross book you would think the body is laid out in a clear manner and that would be reinforced by a set-dissection for you to examine. Cleaning and getting into the anatomy is the only way to LEARN where it is... not just recognize it once someone else has done the work for you.

I wasn't talking about just looking in a book. Like I said, I think you need to be able to handle to prosections. Cleaning a nerve (or whatever) is about as close to totally useless as you can get, though. What's the point of spending 2 hours on a dissection that you can go through thoroughly in 20 minutes after it's done? Are you telling me you actually learned from skinning your cadaver and scooping out fat and fascia?

The time squandered in lab was what made me hate the class so passionately. If they'd provided us prosected bodies and let us have at it, anatomy wouldn't have been half as bad. I'm not seeing why having a body pre-dissected would enhance the contribute to thinking every body was laid out perfectly. Any med student who thinks that in the first place is ridiculous, and it's not like they're going to do full-body dissections and throw them out until they find a few with no aberrant properties.

Right...anyway, despite hating the class more than I ever thought possible, I actually thought the systems-based anatomy idea was quite sensible and worked very well. It sucked to have to drag myself into anatomy through most of the year, but I can't even imagine how badly that class would have blown had I not had the phys to contextualize what I was learning. It at least made the anatomy memorizefest somewhat more bearable. More than anything, though, handling the anatomy made the phys make more sense.

 

[Redgar]

First 14 weeks: biochemistry, metabolism, molecular biology, genetics, immunology, hematology, and extremities anatomy

Second Unit: nervous system, head and neck. included relevant gross anatomy, physiology, biochemistry, histology, genetics, embryology, and strokes/lesions.

Third Unit: cardiovascular, respiratory, and renal systems. includes relevant gross anatomy, physiology, biochemistry, genetics, embryology, histology, and *basic* pathology. Also included a reinforcement of immunology and hematology.

Fourth Unit: endocrine, gastrointenstinal, and reproductive systems. again, with all the relevant disciplines and basic coverage of diseases affecting these systems.

For what it's worth, I almost feel that gross anatomy should have been done at the beginning for the entire body to give us a picture of the whole body that we're dealing with. Going from anatomy lab to dissect the limbic system and then learning about NMDA spikes in lecture 2 hours later just seemed a little disorganized. Integrating all the other disciplines, though, has made sense to me; as well as having metabolism and genetics at the beginning of the year before getting into systems.

 

[Jolie South]

Do you do the dissection in the anatomy lab? The dean at our school is not willing to give up cadaveric dissection. I know a lot of schools are going to prosection models and labs where the faculty dissects and the students watch just to speed things up. The dean at my school refuses to give up student-dissection, and this may be an obstacle to systems based curriculum. I would love to hear how your schools deal with this!

why do you think that you have to give up dissection in a systems based curriculum?

My school stretches out dissection over the first four blocks so that lectures and dissections correspond.

 

[Premed Worrier]

We're on a trimester basis at PCOM. First trimester is anatomy, histology, embryology, and little bit of radiology. Second trimester is the mother of all trimesters because in about 12 weeks, we cover the fundamentals of biochemistry, pharmacology, genetics, micro, immuno, oncology, hematology, basic pathology, and molecular bio. Third trimester is cardio, renal, and pulm which covers physio, path, micro, pharm, and internal medicine aspects of the specific system.

Second year is GI, reproductive, neuro, and couple of other things (i'm only M1 so don't know the specifics about M2 yet).

We dissected in first trimester, and we don't get anatomy again formally. Of course, we have to know the anatomy of the heart to understand physio but we aren't taught anatomy in systems.

This sounds like ours. Especially the first block. The second block I think we only had one or two Pharmacology lectures and no heme onc but the rest was spot on. Our third block is neuro and derm.
We only have actual lab anatomy during the first block but quick reviews and self-refresher during the rest of the 2 years (I assume).
We learned how to ask the basic questions of a full History in the first block while also learning many of the physical skills. We continued practicing the history in the second block and finished learning the motions of the physical exam. Now that we are in neuro we are learning more in depth information about the neuro H&P skills and maneuvers so hopefully we will understand what we are getting, how to test more specifically, and know why we are doing it in the first place. I would assume this is continued through second year. We have 3 weeks in the first year were we have preceptors in the community to help practice our H&P and one week in our 2nd year. Our second year we also facilitate the 1st year's learning Physical exam.
We also learn our pharmacology as we go for the systems.
We have our 'what would you do if....' classes every couple weeks in large group settings and the in between weeks with a small group.
As far as each individual system goes it is like mentioned we get our specific histology, microbiology, oncology (if warranted), pharmacology, embryo review, slight biochem review that is relevant.
We also have a group centered self taught case each week.
Yeah, sounds like a lot I guess, but it seems to flow pretty nice with few hiccups.

 

[lildave2586]

why do you think that you have to give up dissection in a systems based curriculum?

My school stretches out dissection over the first four blocks so that lectures and dissections correspond.

I'm not really sure that you need to give up dissection, but that's the argument our anatomy department gives for opposing a switch to an organ based curriculum. Their claim is that the logistics of maintaining a lab stretched out over a long period of time (1+ years) is too difficult.

I'm wondering, who has a stand-alone embryology course? We've got one, and I think I'd like to get rid of it. IMO it should be incorporated into anatomy, but again the department argues that students will neglect learning the embryo that is sprinkled throughout the anatomy and just get the points from the anatomy topics.

 

[MilkmanAl]

Their claim is that the logistics of maintaining a lab stretched out over a long period of time (1+ years) is too difficult.

I can sort of see that. Then again, I can also see a lot of reasons why a year-long anatomy program would actually be quite a lot easier, logistically.

the department argues that students will neglect learning the embryo that is sprinkled throughout the anatomy and just get the points from the anatomy topics.

That is absolutely what I did. If embryo was a stand-alone course here, I can pretty much guarantee that I would have failed it. Embryo was far and away my least favorite subject, and that's saying a lot considering how much I hated anatomy. I know it's not a useful argument, but I'm not sure they should be pissed about you ditching the subject that's almost totally irrelevant to your career in favor of the slightly more relevant one.

 

[Jolie South]

I'm not really sure that you need to give up dissection, but that's the argument our anatomy department gives for opposing a switch to an organ based curriculum. Their claim is that the logistics of maintaining a lab stretched out over a long period of time (1+ years) is too difficult.

I'm wondering, who has a stand-alone embryology course? We've got one, and I think I'd like to get rid of it. IMO it should be incorporated into anatomy, but again the department argues that students will neglect learning the embryo that is sprinkled throughout the anatomy and just get the points from the anatomy topics.

Why would you need 1+ years? We do it in 6 months. That's how long it takes to cover the basic systems.

 

[MilkmanAl]

True, and the 6 months includes basically every break you get during the year, too. (It did for us, at least.)

 

[illixir]

Ours looks like this for preclinical years, systems but grouped thematically, pretty much being tested 5 times overall, anatomy dissections in blocks 3,4,5. Prosections for 1,2,6 though for the class below us dissected in block 2 as well. The first parts separated by commas are covered half through lecture and half smallgroup. Histo/histopath is all lecture. Our schedule is MWF lecture/smallgroup and T is anat or histo. R off.

Block 1(july-aug) - 5 weeks - population health, biostats, epi, community health, preventative medicine. Introduction to anatomy with stuff like what artery/nerve/vein is. Introduction to histo/hpath with types of epithelia, etc. and inflammatory cells. Pretty much an extended orientation.
Block 2(aug-oct) - 11 weeks "Human blueprint" - genetics, molecular bio, endocrine physio/path, reproductive physio/path, cancer biology. Anatomy of the pelvis and perineum. Histo/hpath of endocrine/reprod.
Block 3(nov-feb) - 11 weeks "food to fuel" - biochemistry, nutrition, GI phys/path. Anatomy of the abdomen. Histo/hpath of GI.
Block 4(feb-may) - 14 weeks "homeostasis" - cell biology, pharmacology, cardio phys/path, renal phys/path, pulmonary phys/path. Anatomy of the thorax. Histo/hpath of cardio/renal/phys.
-- Summer--
Block 5(aug-nov) - 14 weeks "host defense and host response" - immunology, microbiology, heme/onc. Musculoskeletal anatomy(extremities/back). Histo/hpath for heme/onc, infection.
Block 6(nov-march) - 14 weeks "cognition/sensation/movement" - neuroscience, neurology, psychiatry, orthopedics. Anatomy of the head and neck; Neuroanatomy. Histo/hpath of CNS/PNS/bone, connective tissue.

I actually enjoyed this curriculum(finished a month ago). It's hard to ask for as much memorization of stuff with things this scattered but since dealing with everything in same system, our tests were more clinical vignettes but responses in essay.(like 20 short answer) Much more focus on basic understanding.

We also re-went over the physical exam stuff as it came up by curriculum and even practiced some of them in a SIM center. But we also learned how to do a full H&P for every system on standardized patients in block 1-2 over the course of 8-10 weeks or so.(2-3 hours a session). We also had a 1 week clinical immersion that is included in that number for each block which was rotation-like stuff, clinical exercises, or shadowing/pimping related to those specialties. (No immersion in block 1)

 

[Rollo]

Ours looks like this for preclinical years, systems but grouped thematically, pretty much being tested 5 times overall, anatomy dissections in blocks 3,4,5. Prosections for 1,2,6 though for the class below us dissected in block 2 as well. The first parts separated by commas are covered half through lecture and half smallgroup. Histo/histopath is all lecture. Our schedule is MWF lecture/smallgroup and T is anat or histo. R off.

Block 1(july-aug) - 5 weeks - population health, biostats, epi, community health, preventative medicine. Introduction to anatomy with stuff like what artery/nerve/vein is. Introduction to histo/hpath with types of epithelia, etc. and inflammatory cells. Pretty much an extended orientation.
Block 2(aug-oct) - 11 weeks "Human blueprint" - genetics, molecular bio, endocrine physio/path, reproductive physio/path, cancer biology. Anatomy of the pelvis and perineum. Histo/hpath of endocrine/reprod.
Block 3(nov-feb) - 11 weeks "food to fuel" - biochemistry, nutrition, GI phys/path. Anatomy of the abdomen. Histo/hpath of GI.
Block 4(feb-may) - 14 weeks "homeostasis" - cell biology, pharmacology, cardio phys/path, renal phys/path, pulmonary phys/path. Anatomy of the thorax. Histo/hpath of cardio/renal/phys.
-- Summer--
Block 5(aug-nov) - 14 weeks "host defense and host response" - immunology, microbiology, heme/onc. Musculoskeletal anatomy(extremities/back). Histo/hpath for heme/onc, infection.
Block 6(nov-march) - 14 weeks "cognition/sensation/movement" - neuroscience, neurology, psychiatry, orthopedics. Anatomy of the head and neck; Neuroanatomy. Histo/hpath of CNS/PNS/bone, connective tissue.

Isn't this a traditional curriculum and NOT systems-based?

 

[illixir]

Isn't this a traditional curriculum and NOT systems-based?

Not sure how you're seeing that. A traditional curriculum is one where you do anatomy, histology, physiology, pathology, pharmacology as their own separate courses going through all the systems separately in each of those courses(e.g. anatomy/histo beginning of first year, physio first year, path/pharm second year). A systems-based curriculum has you studying all 5 of those things at once(plus any other system relevant stuff) for a given system at the same time and then doing that again for each of the other systems, which is what we do.

 

[MilkmanAl]

It's certainly not a traditional curriculum, but I don't think it's really systems-based either. I've never heard of anything like that before.

 

[ButImLETired]

Ok, so this is how we do it...

we start with a 2 week (I think) course called "Foundations of the profession" with some basic history of medicine, teamwork-building exercises, lots of small group discussions of ethics and healthcare economics etc. Basically an elongated version of orientation.

Then we got into "Molecular Foundations of Medicine", which went from August to mid-October. This was biochem, cell bio, molecular bio, all that good stuff.

In between blocks here we have things called "Intersessions", which last a week. Each is a multidisciplinary introduction to a disease or group of diseases. So we had a cancer intersession with lectures on different types of cancers, patient panels, small groups, etc. We also just had an intersession on diabetes, in which we were told to "pretend to have diabetes", give ourselves shots, check our glucose, count carbs and stuff.

Anyway, mid-Oct to mid-March we had "Structure, function and development". This consisted of system-based anatomy, physiology, histology, and embryology. We did full dissections although there was the occasional prosection for the complex stuff that we could look at just in case. We started with the back, then did thorax and mediastinum (which obviously went with cardiopulmonary physiology, histo, and embryo), then abdomen and pelvis, then head and neck, and we finished with limbs.

Then we had spring break.

Now we're finishing up with micro and immuno, so we're doing immunology, virology, bacteriology, and parasitology, with a week to focus on global health and epidemics.

We're not doing physical diagnosis stuff until next year.

My understanding is that next year, it'll be systems-based again, starting with the musculoskeletal system and ending with the reproductive one, and doing the path and pharm of each system. At the same time, they're taking physical diagnosis and history taking and all that. They do path and pharm from August until mid-March, and then after spring break have a couple of months of neuro and psych. And they finish with a general review of key basic science points to prep for step 1.

 

[thepoopologist]

Bump. Did you find that systems helps with memorization

 

[LordATPSynthase]

I disagree about dissecting leading to better learning. You definitely need to be able to handle the structures, but actually finding and cleaning them was just a waste of time, in my opinion.

I believe that there is better learning in dissecting but MOST of the time it is worthless because you are cleaning.

Finding structures and IDing is definitely important use of time and forces you to run through relationships/names over and over (passively, much of the time) which is good for learning, but so most of the time (for my groups) just went into cleaning.

But if I had the choice of going back and either just using prosections instead of dissecting, I would still stick to dissecting.

 

[justdoit31]

We are mainly systems based in blocks

We start with an Anatomy block and actually do that by region I believe the block is 12 weeks long
Then we have a Cell and Tissues block- histo, genetics, biochem, cell bio

Then we start systems: we do physiology the first year and also a block with all the micro/immuno stuff

2nd year we have a neuro block, a multisystems/cancer block, and then 2 blocks that go through the path/pharm of each system.

 

[Isoprop]

first year: blocks by subject.
second year: blocks by system.

it's great.

 

[Isoprop]

crap i just realized this was a necrobump.

 

[mdeast]

We start systems blocks in March of Year-1 and they continue through March of Year 2. I think the order is Pulmonary, Cardio, Renal, GI, Endocrine/Women's Health, Derm, Hematology, Neuro. Each block integrates path, phys, and pharm of that respective organ system. Before that we have 2 blocks of anatomy. Second one is Head/Neck and runs concurrent with Neuroanatomy/Intro Neuro. First quarter is Molecular Biology, Histology, Dev Bio, Quant Med, Genetics, Immunology, Biochem, Anatomy below Head/Neck. There's also a early "preview" of the block system in the form of "Infectious Disease" block where we learn bugs and the early fundamentals of pharm....but this is taken concurrently with other classes. Organ system blocks also include PBL sessions within our Practice of Medicine course where we learn advanced physical exam skills and do case-based discussions on relevant topics to that organ. We also have bi-weekly practicum to test new PE skills in the clinic with a community physician.

 

[Lbgem]

crap i just realized this was a necrobump.

You little troublemaker you.

 

[ucbsmd]

I'm serving on a task force at my school examining our pre-clinical curriculum. We currently have a block system, but it's not systems based. For those of you who do have a systems based curriculum, I have a few questions.

When does your systems based learning start? Is it the entire length of the first two years?
How is anatomy incorporated into the curriculum and do you have cadeveric dissection or prosection?
How/when does your school teach physical exam techniques?

If I think of more I'll add to this list, but thanks in advance.

My school just made the switch this year to a systems based schedule.

The systems begin in December, so its about 1 1/2 years to go through all the systems.

We start with surface anatomy and radiology in October and do full cadaveric dissection with 2 groups of 3 alternating weeks of direction on our cadavers(the group dissecting is responsible for teaching the other group that weeks dissection)

For the physical exams, we start with a rapid EMT-B training for the first two weeks followed by about a month of medical ethic, healthcare 101, and History and Physical taking.

 

[mrwesticles]

We sort of had systems based learning, but the real problem was pharmacology. Drugs weren't taught as one group but gradually over the two years. Still not sure if that was the best way.