Evolution and Revolution: 5 Takeaways From the New Shared Discovery Curriculum

Much like our beginnings, the Michigan State University College of Human Medicine (CHM) is again rethinking and reshaping the medical school experience.  Change, in the best interest of our students and communities, has been a challenge CHM proudly embraces time and again.

In the early 1960s, reports had demonstrated the need for a medical school in Michigan focused specifically on serving the state's population through direct involvement in community health care.

That was the foundation for the College of Human Medicine to become the nation's pioneer community-based medical school in 1964. A formal philosophy of enabling clinical training within community hospitals materialized.

CHM also went on to develop "focal problems," a precursor of Problem-Based Learning (PBL). The college is the first to have a medical ethics unit as well as the first to offer a bio-psycho-social model of curriculum.

Since its creation, in fact, the college's curriculum has continued to evolve. The college has become nationally and internationally known as a leader in university-based, community-integrated medical education.

For some time now, CHM administrators focused on offering, once again, a different take on medical school curriculum. An innovative and more student-centered approach to medical training, the new curriculum is a response to advances in medical knowledge and new understandings about competency-based assessment.

Yet it isn't just why our curriculum is changing. Just as important is how the new curriculum will be implemented. Whether it's evolution or revolution, the Shared Discovery Curriculum (SDC) aims to change what is considered modern medical education.

The evolution can be the "why." The revolution can be the "how."

Over the last several years, we've spent a good deal of posts (like this one, this one, and this one) on this blog discussing some of the ways medicine is changing and thus, how the modern physician is evolving.

Continued advances in medical knowledge means an ever-changing landscape. Since new knowledge and skills are now required of students and residents, medical schools must also change and evolve.

It is with this focus on the future of medicine as well as the care of our students, patients, and communities that we introduce the Shared Discovery Curriculum.

This new model represents a radical departure from present educational models, emphasizing usefulness and experience as a framework for adult education.

Here are five of the main takeaways from this modern model of medical training:

EARLIER CLINICAL EXPERIENCES MEANS LEARNING BY DOING
For decades, medical schools across the country used a basic 2 + 2 model for medical education, wherein the study of medical sciences was separated from and followed by hands-on clinical clerkships.

Medical schools have come to realize that, while that model has worked in the past, the modern physician can be trained in more efficient and supportive ways.

The SDC is an integrated curriculum that unifies the necessary basic and disease sciences along with clinical experience throughout all four years of the educational program—progressively building upon previously learned material.

In the traditional model, it was possible for students to come first-hand in the clinic with topics that hadn't been discussed since the lecture they attended a year or two prior. Now, students will have the ability to see in the clinic what they are concurrently learning in the classroom. 

Introducing clinical exposure much sooner, the model now used in the SDC is broken up into three separate parts: Preparation for Early Clinical Experience/Early Clinical Experience (PECE/ECE), Middle Clinical Experience (MCE), and Late Clinical Experience (LCE).

The ECE places students in ambulatory settings with medical assistants, nurses, and physicians while the MCE also places students in inpatient environments. At this point, MCE students are with an Interprofessional team that includes residents and attending physicians as well as social workers, nutritionists, different therapists, and pharmacists among other health care members.

Better equipped for the last phase of education, the LCE places students in ambulatory and inpatient settings on disciplinary services where they are able to realistically prepare for the first day of residency training.

Between each clinical experience phase, there are what we call, Intersessions.

INTERSESSIONS OFFER TIME FOR PERSONALIZED SUPPORT, FLEXIBLE PROGRAMMING
Intersessions are a series of focused topic study courses that provide students opportunities to focus on a number of areas outside the given topics of study up to that point.

While some portions of intersessions will be required by the curriculum, other portions allow students to refocus on areas of relative weakness, offer time to explore other areas of health (research, public health, etc.), and provide dedicated preparation time for USMLE exams.

There are three types of intersessions:

• Core intersessions are those required by every student

• Foundation intersessions help students enhance understanding and performance

• Advanced intersessions focus on personal interests and individual strengths

Students work with their Learning Society Fellows to create a learning plan for specific intersessions, considering performance on the Progress Suite of Assessments (we'll get to that further down this post).

Collaboration is critical, which emphasizes the important role Learning Societies play in the new curriculum.

LEARNING SOCIETIES: SMALL GROUP LEARNING DRIVEN BY COLLABORATION
Students and educators are organized in the curriculum through the creation of four learning societies, which houses small scholar groups and are hub of coordination for our new academy model.

Beyond students, the learning societies are also made up of clinical faculty as well as basic and social scientists, which all play a part in delivering the curriculum's components.

These components include post-clinic debriefing, problem-based learning, student portfolio review, individual learning plan formulation/tracking, and other small group experiences.

Learning societies span the geographic campuses and medical student years in the curriculum, building on personal relationships between small groups of students and faculty, or Faculty Fellows.

This model promotes coaching as much as teaching and enables students to interact with educators in a variety of settings over multiple years.

On a regular basis, students will review their progress with educators via educational portfolios. Students and educators will be guided by these reviews, as they then can develop each student's individualized learning plans.

When forming the SDC, administrators identified ways in which the educator-student relationship can be revised for the benefit of successful outcomes. The learning societies, as a piece of the larger SDC puzzle, help modify the dynamics between "student" and "teacher" that have traditionally been the norm.

This longitudinal approach will help foster trusting relationships for students with each other and with faculty, providing a rich climate that promotes academic partnerships and ongoing mentoring.

PROGRESS SUITE OF ASSESSMENTS TRACKS INDIVIDUAL COMPETENCY
Progress assessments, given at regular intervals, help track each student's achievement and fluency. Students take the Progress Suite of Assessments and move through the curriculum as they demonstrate competency.

The components of the Progress Assessment are aligned with our SCRIPT competencies, testing medical knowledge, skills, and real world behaviors. Yes, students have the opportunity to demonstrate their ability to integrate knowledge and skills during actual performance with standardized patients.

Student portfolios contain essays, reflections, scholarly products, different projects, and even videos. These are all reviewed by Learning Society Fellows at intervals to ensure students are progressing and excelling.

This ongoing review through multiple types of assessments assures that students and educators are on the same page. Awareness of each individual's strengths and weaknesses allows each collaboration to be guided towards areas of challenge and opportunity.

But students are not the only ones being reviewed. Students are given the ability to rate their educators, peers, health care team, and actual patients. This constant stream of data assures everyone knows how to improve.

Improvement, in an overall effort to achieve full potential, is a constant goal for students. A combination of progress testing and experience-based education fuels each individual's learning plan.

JUSTINTIME MEDICINE LEVERAGES CLOUD-BASED TECHNOLOGY
Such a collaborative model of education requires that participants have access to numerous schedules, content, and assessments. The Shared Discovery model of education needs data to be rapid, reliable, and responsive to each person's needs.

JustInTime Medicine (JIT) is a self-service online interface that carries out those functions by leveraging cloud-based technology, so that students and educators can have access on all internet enabled devices.

Modern times call for modern measures.

The user-friendly interface provides easy access to tools and data. JIT logs records and notes learner progress for thorough evaluation.

It may not be a surprise that much about Shared Discovery is customizing the experience for each student. JIT follows suit in that there is a customizable course for calculating the contribution that each assessment makes toward goals and overall progress.

Additionally, student performance can be reported through a number of different paradigms, including SCRIPT competencies, EPA's, milestones and other specific competency frameworks—a noteworthy feature of the system.

Each individual student may be at a different point in terms of ingesting the curriculum. JIT offers a visual as to where that point is and, just as important, where the student needs to go. Color-coded tables show a student's progress to date.

The system registry also allows "drill-down" functionality to view the details of each assessment. Referring back to the progress suite of assessments, this allows students and educators to know exactly what portions of the curriculum a student is obtaining well and those a student may look at for more support.

Again, this all falls in line with how the collaboration works. With students and educators self-aware of where each other is in terms of progress, they can work together to tackle those portions of the curriculum in which a student needs more guidance.

In summary, all of these five takeaways are naturally interconnected. The intent is to get the best out of blending learning with action.

Clinical experiences at the center of the curricular design mean immersing students in real clinical environments and providing an authentic trajectory of training.

The Shared Discovery Curriculum is the College of Human Medicine's response to advances in the medical landscape. New knowledge and skills are now required for students, residents and practicing physicians to enable them to contribute to those advances. At CHM, contributing is a responsibility we all happily share.

For more detailed information on the Shared Discovery Curriculum, please visit curriculum.chm.msu.edu. 

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