School of Medicine has been working diligently to address the rapidly
changing trends in medical education. For the past four years, the Division
of Medical Education has taken dramatic steps to reform the medical
curriculum. This fall, incoming freshmen will be the first to experience
these curriculum changes. This new approach to learning will integrate
the teaching of basic and clinical sciences, introduce new knowledge
and skills required for the practice of medicine, and promote lifelong
learning behaviors in students. Mark OConnell, M.D., senior associate
dean for medical education, outlines some of the highlights of the new
curriculum with Jerry Lewis, assistant vice president for communication
for the School of Medicine.
Why is the University of Miami changing its medical curriculum now?
Perhaps the question should be Why didnt we do this a long
time ago? There is an amazing revolution going on in American
medical education right now, and its not quite clear why it suddenly
caught fire. Currently, more than 80 percent of the 125 medical schools
in this country have revised or are in the process of revising their
curriculum. So what we are doing here is pretty much in concert with
where most of the nation is going. But we are not alone in the United
States. These methodologies have been readily adopted in Europe, especially
England and Scotland, and there are a number of new schools in Southeast
Asia that also are incorporating an integrated, adult-learning style
of teaching. Its very exciting.
Historically, what events led up to this complete change in the way
medicine is taught in this country?
There have been various studies and reports through the years that called
for changes in medical education. One report in 1984 recommended that
medical students be taught reasoning and self-directed learning skills,
or what is called adult learning styles, instead of having them memorize
tons of facts. Another report in 1992 called for moving medical education
into the community and an ambulatory setting. According to that study,
if we truly want to prepare students to take care of patients, we should
steer away from the tertiary academic medical centers and into the real
world of health care in the community.
How will the curriculum change at the University of Miami? Are you incorporating
new areas of study into the curriculum, such as womens health
or geriatrics, to keep up with the changes in health care, cultural
differences, and overall demographics?
What we are trying to do is to integrate the teaching of the basic and
clinical sciences so that they run in parallel. We also want to introduce
new knowledge and skills required for the practice of medicine in the
21st century. Much of the new content and experience will occur in various
longitudinal themes that continue throughout the four years. In order
to organize that content, we have created themes that include professionalism,
humanism, community service, behavioral medicine, cultural diversity,
and womens health, to name a few. A large part of the change in teaching
methodology moves away from passive learning, and instead, is founded
on active adult learning theorylearners can assimilate complicated
concepts quicker if they are presented within a certain context, or
if they have an obvious relevance to connect to them. A significant
part of the skills set we are trying to develop in the students includes
how to effectively identify knowledge gaps, how to find and access information,
as well as how to critically appraise information. Geriatrics also is
a big theme in our new curriculum. There is a national effort, organized
by the Association of American Medical Colleges, to develop standardized
medical school objectives and define what should be in the curriculum.
However, since each medical school is unique, a standardized curriculum
would work only up to a certain point, because each school has a mission,
a unique identity, and specific areas of strengths and interests. Here
at the University of Miami we have a special opportunity with the large
and growing elderly population in South Florida. We also are focusing
on our multicultural and multiethnic population and how cultural issues
affect illness behavior and the success or failure of the health care
delivery system. Also, international health opportunities, where we
send students abroad to care for people and learn about medicine, have
a much more powerful potential than we had appreciated before.
How will the new curriculum be implemented?
We are going to initiate it in a rolling fashion. The incoming freshmen
class will be immersed in the new curriculum. The current sophomores,
third-year, and fourth-year students will stay in the traditional curriculum.
In other words, we will not need to have the entire curriculum up and
running on August 13, 2001, when the next round of freshmen start. We
have a year to fine-tune the second year of the curriculum. It will
be an evolving process.
How will this new curriculum eventually enhance the doctor-patient relationship
and ties to the community?
We always have been a school that prides itself on our linkages to the
community and our focus on community service, not to mention the community-based
clinical opportunities that we provide to students beginning as early
as the first semester. We really try to put them with role models in
the community early on. Weve spent a fair amount of time in our existing
curriculum on teaching interpersonal and interviewing skills, how to
interpret nonverbal communication and patient education. But the new
curriculum gives us the opportunity to do even more of this.
Are there any other areas of medicine covered in the new curriculum
that might not have been addressed before?
There is the need to put the new and sexy stuff in, not just because
it is politically correct, but because it needs to be there. Complementary
and alternative medicine, for example, are part of the new curriculum,
because you cannot send physicians into the world in the 21st century
without being aware of these treatments. Studies show that more than
50 percent of patients are on some type of alternative treatment and
that fewer than half of the patients will admit it to their doctors,
even after direct questioning. So we have to make future physicians
aware of these modalities in an evidence-based way.
Will the classroom structure change?
Many of our methodologies will be conducted in small groups. A faculty
member will meet with six to eight students at a time, work through
problems within the context of a case, and then discuss the case, using
X-rays, EKGs, etc. To do this, we have built small group teaching facilities
that are equipped with all of the latest high-tech capabilities. Some
of these rooms are set up as mock clinical examination rooms, equipped
with examination tables, sinks, blood pressure equipment, one-way glass,
audio, video cameras, etc. Here, in these clinical skills learning labs,
students will be taught basic exam skills, such as how to perform a
physical examination on a patient, and will be evaluated on their interaction
with the patient. This will allow us to teach clinical skills in a much
more standardized way.
What kind of an impact could our curriculum changes have on a patient
in Miami-Dade County?
Since we are introducing so much new content in the areas of communication
skills, in understanding patients on a humanistic level, and in understanding
the needs of the community, ethnic cultural groups, and women, this
new way of teaching will help doctors be more caring, effective, and
communicative with their patients.