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Why Change the Undergraduate Medical Curriculum?
Since the last major revision of the KUMC medical curriculum in 2006, content audits, consultant reports, AAMC graduation questionnaires, internal surveys and the LCME self-study and re-accreditation site visit have identified the need to critically and comprehensively review and update the entire undergraduate medical curriculum. Although the overall quality of our educational program was validated by the LCME, the thoughtful suggestions for improvement offered by the site visitors convinced the faculty leaders and school of medicine deans that a top to bottom review of the curriculum was critical. Consequently, the need and desire for curricular transformation became the focal point of faculty discussions, starting with the faculty retreat in the summer of 2013, the combined module and clerkship directors' retreat, and the medical education retreat in the spring of 2014.
Physician Changes Needed to Adapt to Health Care in the Future (Adapted from AMA)
Aside from the internal drivers for curriculum transformation, forward-looking trends in medical education in a 21st-century health care systems context requires an evaluation of the education process to bring greater focus on "next level" learner preparation. For example, the ACGME and the AAMC have suggested that graduates of medical schools must demonstrate core competencies and Entrustable Professional Activities (EPAs) vital to the first year of residency. In addition, our educational programs must:
- Train patient-focused, teamwork-oriented, population-minded physicians to provide expert, professional and compassionate care for individuals, groups and diverse communities and adequately handle chronic diseases.
- Train physicians with a broad understanding of the health care system as a whole.
- Prepare independent and reflective lifelong learners who can succeed in the next stage of medical education and are ultimately equipped for lifelong commitment to self-improvement in practice.
- Develop physician trainees who are confident and comfortable with the use of healthcare technology, and who can critically evaluate the appropriate and effective use of new technologies.
- Create a training program that can evolve in the context of new partnerships that support systems for longitudinal clinical training and provide integrated experiences within teams of care.
- Create a medical education program that seamlessly integrates broader healthcare systems goals of the improvement of healthcare outcomes and patient safety as well as increasing the efficiency of care delivery to large populations.
- Create a training program that promotes demonstrable competency and encourages exemplary skills in patient safety, performance improvement, and patient centered team care.
A recent NPR podcast describes these national trends in medical education.
Since the LCME visit, our faculty have identified a number of areas for enhancement, and other initiatives that will require changes to significantly transform our approach to medical education. The faculty have expressed a general consensus that the following features are key to a transformed curriculum:
- Vertical and horizontal integration, with blurring or elimination of the preclinical/clinical dichotomy
- Promotion of active, independent or self-directed learning with demonstration of competence and academic excellence
- Early engagement in substantial clinical experiences, supplemented by a robust clinical skills and simulation infrastructure
- Revised and standardized assessment, enrichment and remediation procedures that align with national standards
- Inclusion of updated and enhanced content areas, that may promote managerial, population health and research skills
- A stimulating environment that enables faculty to develop, implement and improve educational programs and develop a comprehensive array of skills as educators
Our curriculum must evolve to prepare the physician of the future, and must be adaptable, flexible and responsive to the needs of our community. With revamped medical education spaces, clinical skills and simulation facilities, we will provide new opportunities for excellence and an upward trajectory of progress that will propel our school into the top tier of medical schools in the country. Our curriculum cannot be static, but must continuously evolve, so that change and improvement become the norm.