Medical School Curriculum Redesign a Community Effort

School leaders are reaching out to the community at large as it begins a three-year process that will include a series of retreats, focus groups and town hall meetings.

“We want to make sure we include the many people that will be affected by a new curriculum — that includes the community and the people who will be patients, our students and faculty, and our hospital systems, which are a training ground for our students and a workplace for our students after their training,” says Lisa Jane Jacobsen, MD, associate dean for medical curriculum.

“There are a lot of different stakeholders who will be weighing in on our plans for a new curriculum, and it takes time to gather people’s thoughts and ideas and then organize that into working groups,” she adds.

The effort kicked off Sept. 28 with a retreat held at the Jacobs School that featured about 150 people — consisting of Jacobs School faculty, clinicians, basic scientists, students and residents, along with community leaders and partners, hospital and health systems leaders and administrators and leaders from across UB programs and schools outside of the medical school.

Attendees were asked to fill out a survey that, among other things, inquired about what needs they envisioned for better health care in Western New York.

“Participants overwhelmingly said the most positive part of the experience for them was the opportunity to be involved in the dialogue,” says Jennifer A. Meka, PhD, assistant dean for medical education, who co-directed the retreat with Jacobsen.

Meka says including people from the broader university — such as the Graduate School of Education, School of Dental Medicine, School of Pharmacy and Pharmaceutical Sciences, School of Public Health and Health Professions and School of Nursing — was to make sure different perspectives were obtained.

“Many of them are going through or have gone through similar revisions to either their entire curricula or to some of their programs, so they have a lot of insight they can share about things they would have been thinking about earlier or that they would have done differently,” Meka says. “That is really critical for us, especially at this stage.”

Meka says it is also helpful to talk about some of the key trends in medicine.

“People in community organizations have great roles that they play within our education program, but they often do not see how it fits in the greater context of the educational experience for our students,” she says. “Oftentimes, depending on where someone is situated, they might only have one small picture of what we do.”

While input from outside entities will be an important part of the process, there are other factors to consider as well.

“Along with bringing in the stakeholders, we also need to look at the evidence,” Meka says. “There is a wealth of research from the science of learning and educational psychology that we want to draw upon.”

Some of the major ideas being discussed have to do with methods of instruction, Jacobsen says.

“We want to make sure we move away from lectures, which is a passive way to transmit knowledge,” she says. “We want to implement more active learning experiences, where students participate more actively in the classroom and apply their knowledge.”

That can involve working in teams, allowing students to get comfortable communicating with peers and solving problems together, Jacobsen notes.

Early experiential learning allows students to start off early in their training applying their knowledge to actually taking care of people.

“Having interactions with patients at an early stage not only improves their interest and makes it more applicable and relevant to them, it also improves the way they learn,” Jacobsen says.

“It gives them context. As opposed to trying to learn facts that are isolated, they actually have something they can connect it to and build off of,” Meka adds.

Jacobsen says using more case-based, team-based and problem-based learning as well as small group discussions and simulations are all different ways of promoting active learning.

The new Jacobs School building — with its flexible learning spaces — figures heavily in the process of revising the curriculum.

“We have the space and technology to not be constrained, and it allows us to be really thoughtful and deliberate about helping to support our faculty in implementing different designs and practices,” Meka says.

Jacobsen points out that all of the Jacobs School’s classrooms, lecture halls and auditoriums are designed to encourage group interactive learning.

She notes facilities such as the Sol Messinger, MD ’57 Active Learning Center, Margaret L. Wendt Foundation Clinical Competency Center and Behling Human Simulation Center all serve as valuable resources in this regard.

Meka says that people often think about curriculum as a written document and what is being taught, but in reality there are different aspects to it.

“There is the intended curriculum, which is what we identify as what we want to teach and how we might assess and provide instruction; the enacted curriculum, which is what is put into place; and then there is an experienced curriculum, which is what our students are experiencing based on their own perspectives,” she says.

“There are different ways that students can learn clinical reasoning and critical thinking skills that don’t just have to be in our traditional methods of thinking about how we teach them, and so setting up different types of learning experiences is a critical thing for us to do,” Meka adds.

She notes the importance of meeting with individual faculty members and other stakeholders to learn more about some of these specific skills as well as the different attributes that are important to them.

“We then need to take that information and figure out what are some of the best ways to approach teaching that and how we actually set up a system to assess that and ensure we are developing and producing the students that we want,” Meka says.

Jacobsen also points out that the nation’s health care system and the way care is provided have greatly changed during the last few decades.

“We need to teach our students more about how our health system works, and they need to learn their roles within the system,” she says.

Jacobsen notes a lot more emphasis is being put on the triple aim of providing value-based care that is high quality but that takes costs into consideration as well and also focuses on patient safety.

“Humanism is another key. We have a lot of competencies we expect our students to reach by the time they graduate,” she says. “We expect them to be compassionate, caring and ethical, patient-centered clinicians.”

“Beyond working with role-model physicians on the wards, there may be more deliberate ways to teach these qualities,” Jacobsen adds. ”We’re planning and thinking about how to provide experiences — whether it be clinical scenarios or students going out into the community to actually work with patients, seeing how people live and understanding their perspective.”

There also needs to be an emphasis on lifelong self-directed learning and teaching skills to be able to support lifelong learning, Meka notes.

“There is so much new information that comes out on a daily basis,” she says. “We want to be making sure we are equipping our students to be able to review that information, synthesize it with what they already know and use it to make informed decisions in the next steps of patient care or management.”

“And we want them to also be able to apply that to new research and discovery,” Meka adds. “Not to just be able to critically appraise the literature that is out there in terms of using it in clinical practice but also designing and thinking about their own possible investigations or opportunities for exploring different topics.”

Jacobsen says the idea of lifelong learning is crucial.

“I’ve seen the changes from the time where people used to think that in medical school you could learn everything you needed to know,” she says. “It is absolutely impossible to do nowadays because there is so much new information.”

“This really is a continuous process where on a daily basis physicians need to be looking things up to learn and educate themselves to make sure they are practicing the most up-to-date medicine they can,” Jacobsen says.

Alison Whelan, MD, chief medical education officer of the Association of American Medical Colleges, was the keynote speaker at the September retreat and reminded everyone to remember the importance of keeping things in context.

“Dr. Whelan encouraged us not to think just universally about the different skills and knowledge but to be looking inwards and outwards at the local community where our students will be practicing,” Meka says.

“She said we should be co-producing and learning with our community partners, which I think is very exciting,” she says. “We should be thinking about ways this endeavor can be beneficial for both the institution and the community.”

“Ultimately, we would like to have the people in the Buffalo community feel like this is their medical school,” Jacobsen says.