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For Release: February 20, 2013
Contact: Derik Hertel, 603-650-1211 or

Preparing medical students for a changing profession

Curricular redesign responds to new model, accelerates transformational learning

Dr. Tim Lahey

A critical component of the Dartmouth Geisel School of Medicine 2020 Strategic Plan for Excellence is the development of an innovative, world-class medical school curriculum. As a result, Geisel is rethinking how to prepare its students for the new clinical frontiers of the 21st Century. While this is a daunting and many-year task that requires the full involvement of the full Geisel community, Dr. Tim Lahey, project leader of the curriculum redesign, believes this effort will give Geisel the opportunity to be a world leader in medical education. He spoke with Dartmouth Medicine magazine about the effort.

Why does the medical school need to redesign its medical curriculum?

Lahey: It's a combination of changes in medical practice and changes in medical education. Medical practice has changed substantially since 1910 when Abraham Flexner proposed the traditional 2+2 structure of medical education. Nowadays, students practice in a longitudinal, technologically intensive and information-heavy context in which they function as members of multidisciplinary teams. Traditional medical education models that focus on the passive acquisition of tons and tons of facts and then plunge students into episodic and largely inpatient clinical practices are inadequate preparation for modern medical practice. Medical education, therefore, needs to give students training in strong pathophysiology, in inter-professional collaboration, in cross-culture communications, in teamwork, and in lifelong learning.

In addition, we have ample new evidence regarding effective means of educating our students. It is now clear that active, experiential learning in small groups and with student-led learning approaches encourage improved learning compared to large group, passive lectures. Therefore, modern medical education needs to emphasize these newer evidence-based techniques.

These changes have not escaped the notice of national regulatory bodies like the Liaison Committee for Medical Education (LCME), which is conducting an institutional assessment and site visit as part of the accreditation process of the medical school this spring. New national recommendations require less lecture time, more interactive teaching approaches, and more clinical time from the get-go, as well as individualized training in inter-professional, team-based, longitudinal clinical settings.

To make these changes a reality, we need more than incremental change: we need total curriculum redesign.

Where does the effort stand now?

Lahey: It's really early. The first draft of the four-year framework for the redesigned curriculum will be presented to the faculty for feedback and discussion in March 2013. This will give the faculty the ability to get a sense of the direction of the redesign, knowing that approval of the four-year framework will be followed by course and session design in 2013-2014. The four-year framework though will give a sense of what courses will occur when, and thus how they can get involved in the design and delivery of this new curriculum. The Medical Education Committee at the medical school will vote on the framework in May 2013, after which the framework will be brought to the full faculty for approval in June 2013. It is really important to us that beyond the greater than 100 participants in the curriculum redesign working groups that we hear from students and faculty to make sure the curriculum we design is outstanding and appropriate to Geisel.

How can others get involved in the curriculum redesign?

Lahey: I have been really impressed with the number of faculty and students who have come forward despite their busy days to get involved in the curriculum redesign. As a result, the several working groups of the curriculum redesign effort have involved more than 100 faculty and students. This process of deep community involvement will widen upon approval of the framework of a new curriculum, which will hopefully occur in 2013. Upon transition to the phase of curriculum redesign involving course and session design, newly appointed directors of courses and clerkships will begin the process of creating new course content using the principles and guidelines developed by the curriculum redesign process. These course directors - many comprised of teams of clinicians and scientists - will themselves work with multidisciplinary teams, meaning that there will be ample opportunity for a wide array of faculty to get involved.

This multidisciplinary team structure will ensure that the curriculum is centrally coordinated, but still a grassroots and thus representative effort. In so doing we'll do something cutting edge and beneficial for our students but by harnessing one of Geisel's seminal strengths: its close-knit community. We are really excited about transitioning to this new phase of expanding faculty involvement in our curriculum redesign.

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