The Michigan State University College of Human Medicine wants to get medical students into the real world much sooner with the launch next month of an entirely new curriculum.
Rather than spend their time in classroom instruction and lectures to learn basic sciences, first-year MSU medical school students will start receiving early clinical instruction in settings such as physician offices within weeks of arriving on campus. Second-year students would spend time learning at hospitals, outpatient clinics and emergency rooms to complement their classroom training.
Having medical students in contact with patients much earlier in their education essentially moves forward some of the methods of third- and fourth-year clinical rotations and post-graduation medical residencies. Working alongside physicians allows them to better and more quickly connect what they learn in the classroom with the practical lessons offered in a clinical setting.
“We think we can train students to a higher level faster than a traditional curriculum,” said Dr. Aron Sousa, interim dean of the MSU College of Human Medicine.
“A lot of clinicians will say that the part of their education where they learned the most was the first year of residency,” Sousa said. “As we were thinking about what a new model of medical school curriculum should look like, a lot of us sort of turned to those most intensive educational experiences that we had and realized that those were all related to patients. Our curriculum starts with patients and puts students with patients as soon as we can make it safe for both the patient and the student.”
Under the changes, students at the College of Human Medicine in Grand Rapids and East Lansing will begin learning in a clinical setting within six weeks of starting their medical education.
Early classroom instruction is organized not by basic sciences or medical disciplines but by issues that students will come across in a clinical setting, such as abdominal pain, blood pressure, body temperature and body weight, Sousa said.
“Our students are going to go see problems that patients have, like ‘I’m short of breath,’ and that’s a completely different approach,” said Dr. Diane Wagner, associate dean for undergraduate medical education at the College of Human Medicine. “Patients do not come with labels on their forehead: ‘I have a biochemistry problem.’ They just say their stomach hurts.”
The College of Human Medicine launches the new curriculum at its campuses in Grand Rapids and East Lansing after five years of planning. The change essentially differs from the traditional model of medical education by putting patients at the center of a student’s learning early on in their education, rather than first drilling into the basic sciences.
“When you take the patient and realize that is the most basic understanding that students should have, that turns the traditional medical school education — where you think of the sciences as basic — on its head,” Sousa said. “Now the patient is the most basic understanding the student has and the science is the advanced learning that they would do.
“So they learn about the patient, and then they use that patient as the impetus to learn more advanced parts of sciences that form the basis of management and treatment of patients and their families.”
The traditional medical education model in which students first learn basic sciences such as anatomy and physiology and then work with patients in their third and fourth years has been in place for a century, Sousa said. The model has evolved over many decades.
In the 1970s, for instance, case-based and problem-based learning came into practice where students learned about and studied patient cases. MSU later began community-based medical education and sent students “to learn the nuts and bolts of taking care of patients in the community where patients lived” around the state, from rural to urban settings, Sousa said.
CONNECTING THE DOTS
The move to embed first-year medical students with patients early in their education has been emerging for years, said Michele Serbenski, the associate dean for planning and performance excellence at the Homer Stryker M.D. School of Medicine at Western Michigan University in Kalamazoo.
“Students used to be in a classroom setting for the first two years, reading and studying all about stuff, but you didn’t see, touch or even interact with patients until your third year,” Serbenski said. “That’s really been evolving and changing with medical schools recognizing the need to connect the dots between what’s learned in class today with a real-world experience.
“It’s the idea of connecting what they’re learning in the curriculum to the real world. They can start to apply skills and their knowledge immediately.”
The Stryker School of Medicine, which enrolled its first class in 2014, begins to get first-year medical students in contact with patients as early as five weeks into their education. That puts them at locations such as the Family Health Center in Kalamazoo; CentraCare, a provider of services to the elderly; and outpatient clinics and physician practices.
One noticeable benefit is that third-year medical students are better prepared when they complete their classroom work and start spending all of their time learning in a clinical setting, Serbenski said. Students generally are not as “incredibly nervous” when they begin their clinical rotations.
“The students aren’t in a classroom for two years and then all of a sudden they’re going to be thrown out into a clinical world that they didn’t know how to navigate or had never been to,” Serbenski said. “It just makes them more prepared. It gets them into the clinical world where they’re going to live someday so much sooner so it’s not a mystery to them.”
The experience makes students better prepared as well when they take what they see and learn in a clinical setting into the classroom.
“They can bring back questions and information from the clinical experience that they had to the classroom and say, ‘Yesterday, this happened and I have a question about it related to what we’re studying.’ It gives them relevance,” Serbenski said.
‘MORE THAN THE MOLECULES’
MSU’s College of Human Medicine embarked on rewriting its curriculum as care providers place greater focus on team function, medical quality, clinical processes and “the quality patient experience,” Sousa said.
All of those issues are driving forces behind changes occurring today in health care. Those changes required MSU to take a deep look at how it educates and prepares medical students to work in today’s health care setting.
Care providers today “are looking for a different kind of graduate than they have before,” Sousa said. “That means a curriculum needs to focus on more than the molecules.”
To test the coming change, the College of Human Medicine conducted a pilot with 21 medical students who were at different points in their education and “ran them through a shorter version of our early clinical experience,” Sousa said. The net result anecdotally was a “better experience” for students, faculty and partnering care providers.
“There was a very palpable, different feeling among the participants of how that educational experience was,” Wagner said.
Pre- and post-pilot knowledge and skills exams given to the 21 participating students found they “not only did well over the course of it, but they did well at a level we didn’t expect,” Sousa said.
The pilot showed that incoming first-year medical students are able to handle the new curriculum that has them learning in the classroom and clinical setting simultaneously.
“We have good data that they will tolerate it, that they will tolerate it better, and they will also learn and develop skills,” Sousa said.
The new curriculum also seeks to “focus more on competencies and assessment that’s meaningful” for the medical students, “rather than just hammering them over the head over and over again with exams,” Sousa said.
That can help address the burnout rate among medical students, about 25 percent of whom nationally experience depression at some point in their educational careers, Sousa and Wagner said.
“What you don’t want at the end of medical school is a bunch of burned out people who don’t remember why they started,” Wagner said. “We wanted to make sure we are providing something that is worthy of their skills and their abilities. To take someone who’s so bright and so capable and sit them in a classroom for two years doesn’t really feel like what they deserve.”