School of Medicine Test Drives Curriculum Redesign

With today’s dynamic health care environment and rapidly advancing biomedical sciences, medical education must change so that students will be ready for the world that awaits them eight or 10 years from now.

The way students are trained currently ensures that they are going to be good at solving individual diseases and addressing individual organs, said Anna Chang, MD, an associate professor of medicine at UC San Francisco. But, she added, we haven’t been as successful in teaching students how to work within teams and systems and improve the health of entire populations, in addition to individual patients.

“For medicine to advance, we must find a way to give our students this expanded set of skills,” Chang said.

The UCSF Bridges Curriculum Redesign is aiming to address the ever-widening gap between what medical students are being taught and what they need to learn to function as modern physicians.

For more than two years, committees captured the vision of what the new Bridges curriculum should include and hammered out the framework that reflects that vision. It was then distilled into a blueprint that was approved by the Faculty Council in June.

“Over the past year, the vision of Bridges has moved from a big idea to an exciting reality,” said Catherine Lucey, MD, vice dean for education at UCSF School of Medicine. “That reality is the direct result of the creative energy and collaborative efforts of literally hundreds of UCSF faculty, staff and students who have come together to create strategies to improve the curriculum.”

The new Bridges Curriculum will be rolled out in two stages, beginning with the academic year 2015-2016.

“This is a pioneering effort,” said Chang, director of the Bridges Curriculum. “I think that Bridges is the most meaningful thing to happen in medical education in 100 years.”

Flipping the Traditional Structure

The traditional structure of medical school involves years of basic science education, followed by two years of clinical science – a format that Lucey noted was launched in 1910.

The Bridges blueprint moves away from that. In the 2015 version, the teaching of clinical skills and basic sciences are fully integrated throughout the four-year curriculum.

First-year students will be experience on-the-job training in the clinics from the first days of medical school. Third-year students, who traditionally rotate through various clinical sites, will revisit foundational concepts to fully integrate the scientific basis of medicine with the clinical application of medicine.

Through a Career Launch phase, fourth-year students will not only participate in advanced clinical experiences to hone their patient care skills but also will have dedicated time to conduct an in-depth exploration of a problem of their choosing that is relevant to advancing biomedical sciences or improving the health care system.

Culture of Inquiry

One of the innovations in the new curriculum is creating a culture of inquiry, in which students will rely less on memorization and more on learning to think critically and grapple with medical problems for which there are no answers.

“UCSF is not in the business of graduating doctors who just follow a flow chart,” said Mark Anderson, MD, PhD, professor of medicine and director of the Medical Scientist Training Program. “Our overall goal is to teach and develop the future leaders of medicine, and the way to get to that destination is by giving our students the ability to integrate information by including this idea of inquiry as part of educational experience.”

With Bridges, students will have “inquiry units” built into their foundational classes, and every student will take a deep-dive into a project that will span their entire four-year training.

Learning in the Workplace

A big change outlined in the blueprint is that first- and second-year students will spend 20 percent of their time in the workplace, said Susan Masters, PhD, associate dean for curriculum in the School of Medicine and chair of the blueprint steering committee. Students will not only learn the traditional clinical skills, but they will learn how health care systems operate, with a focus on collaboration with teams of health care professionals to improve the patient experience and the quality and safety of health care.

To accommodate these workplace learning experiences, the Bridges designers had to build in some flexibility into the student’s schedules. “We can’t send 180 students out in one afternoon,” said Masters.

The Technology Enhanced Learning group has been collaborating with UCSF educators to convert some previously in-person lectures to high-quality online videos that will engage students online and be supplemented by in-person class activities. The availability of this large library of online videos will reduce the need for having all students be in a classroom at one time.

Proof of Concept

One way to test out some of the ideas developed during the planning phases of Bridges is to have students immerse themselves into mini-versions of the new curriculum to see what works and what doesn’t.

Over the summer, eight medical and two pharmacy students served as “Curriculum Ambassadors” and took the program out for a test drive.

“We have developed a vision and a design for Bridges, but not until this moment have we tested it out on the students,” Chang said.

The Curriculum Ambassadors were embedded within a clinical team, and tasked with making recommendations for realistically implementing the curriculum. They had to figure out how to logistically plan the best times to interact with their team, and what is a realistic scope for projects for students at early stages of their training.

“I felt like we were authentic members of the team,” said Arielle White, a first-year medical student who pursued a health literacy project at San Francisco General Hospital and Trauma Center. “Sometimes in a preceptorship, it can feel like students are a burden … but I felt like the team I was working with was so excited to have students working with them and that we were contributing something.”

She and her partner, pharmacy student Omar Diarra, discovered through their research that the best place for patient literacy screening was during intake with the nurses, a finding that could mean a hospital-wide adjustment. “What we thought would be a really small change might turn into a permanent lasting change,” said White.

Another aspect of the workplace learning initiatives are learning how to collaborate effectively as members of health care teams.

Curriculum Ambassador Julie Wu, a first-year medical student, was paired up with third-year pharmacy student Matt Cummings to help SFGH with various quality improvement projects.

“Something I gained from the experience is looking at the hospital and seeing how everything flows from department to department and realizing that everything is connected,” said Wu. “We can’t just focus on one improvement project because the problem might be upstream or downstream of that.”

The value of collaboration also resonated with first-year medical student Onur Yenigun, whose project was focusing on the care of the most vulnerable patients in an orthopaedic surgery medicine/surgery service at the San Francisco VA Medical Center.

“It really showed me that one physician can’t do it all, it does take a team,” said Yenigun, who is no stranger to teamwork as a military veteran.

“I didn’t get too much of a sense of teamwork when I got to medical school, as we don’t often have that in the simulation practice,” he says. “This experience showed me how crucial it is to the health care of our patients that we are able to work together.”

There are more planned pilots ahead, as UCSF continues to refine the curriculum. It’s building on many past educational innovations at UCSF, including longitudinal clerkships, the Medical Scientist Training Program and the Pathways to Discovery program, which provides students with the opportunity to pursue a scholarly project of their choosing.

Lucey noted that the work is not only shaping medical education at UCSF, but also on a larger scale. “As we’ve embarked on this work and talked with our colleagues around the country, it is exciting to see how many other medical schools are following our lead and are pursuing similar strategies to essentially advance a new model of physician learning and practice for the 21st century.”

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