Tuesday, June 19, 2012

PM: Advancing from Elective to Core Curriculum

Upstate Medical University is currently revising its undergraduate medical curriculum to keep pace with the rapid changes that have occurred in healthcare over the past couple decades.  Like many U.S. medical schools, our present curriculum is a modest variation of that proposed by Abraham Flexner two years before the sinking of the Titanic in 1912.  Needless to say, the way doctors practice medicine 100 years later is beginning to emphasize a substantially unique set of tools (e.g. EHRs), principles (e.g. genomics), and behaviors (e.g. e-Patients and social media).  

The new medical curriculum will undoubtedly implement more clinical exposure in the first two years, with better integration of basic science and clinical topics throughout the entire, standard 4 year program. Delivery is expected to incorporate increased active learning (e.g. live patients) and critical thinking, and decreased passive learning (e.g. lectures).  These are not novel concepts; many if not most medical schools across the country have made or intend to make similar changes.

The relevance of this change to me is that all material presently taught in my elective "Personalized Medicine 101: Digitizing Diagnosis for Doctors" would be absorbed into the core curriculum where all students become equally immersed in the topic areas.  PM101 topics include, but are not limited to: Genomics in Health & Disease, Molecular Diagnostics/Prognostics, Prenatal Diagnosis/Carrier Detection/Newborn Screening, Direct to Consumer Genetic Testing, Genetic Counseling, GINA/ELSI, Pharmacogenomics in Drug Metabolism, Epigenetics & GxE, Proteomics, EHRs/PHRs, Clinical Decision Support systems (e.g. IBM Watson), e-Patients & Participatory Medicine, Healthcare Social Media, mHealth, and Telemedicine. 

Should all of these topics represent core material for all budding docs setting up a clinical practice in the 21st century?  That is certainly my belief, assuming we stick with tradition and continue to train all budding docs for a once-size-fits-all M.D. degree.  Bear in mind that students entering medical school in 2012 will begin independent practice, on average, around 2020.  

This does not mean we stop teaching empathy, professionalism, differential diagnosis, systems medicine, gross anatomy, etc.  Indeed, all of those topics will be part of the new curriculum.  So, how does one teach exponentially increased clinical knowledge and skills without simultaneously increasing the curricular timeline?  Therein lies the $64M question for the task force assigned to sinking the Flexner model in 2012.  

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