Geisel MD Curriculum
Geisel is in the midst of an exciting transition from its legacy curriculum to a new curriculum which began in August 2019 with the class of 2023. Geisel’s more traditional legacy curriculum which consists of two preclinical years followed by two clinical years provides a strong foundation in the basic sciences, exceptional clinical experiences, and broad coverage of health care delivery sciences. These are the learning experiences at Geisel that have prepared thousands of medical students exceptionally well over the past decades. In 2017, Geisel’s Medical Education Committee challenged ourselves to do even better…better coordination of topics within and across the academic years; better connections among the basic, clinical, and healthcare delivery sciences; and better opportunities for our students to prepare for licensing exams and residency.
In August of 2019, our first group of students matriculated into Geisel’s new curriculum that will better prepare students to become well-rounded physicians through a highly integrated four-year experience. Our graduates will continue to:
- Excel in the basic sciences
- Deliver evidence-based, high quality care in partnership with patients, families, and communities
- Discover and share new knowledge
- Improve the system of healthcare in which they work
The new curriculum will prepare students exceptionally well for future careers across the entire spectrum of medical practice including all clinical specialties and subspecialties, research in academic health centers, rural and urban settings, and for diverse patient populations. At Geisel, students are embedded within a world-class research setting that provides opportunities to develop scholarly work in basic and translational sciences, health care delivery sciences, and scholarly quality improvement.
Geisel’s new curriculum keeps pace with medicine’s rapid advances and complexities and ensures that students develop competencies in eight broad areas: medical science; clinical care; population health; communications skills; personal, professional and leadership development; evaluation and improvement in medicine; professionalism; and collaboration and teamwork. When students leave Dartmouth, they will have the knowledge and skills necessary for a lifetime of learning—one of the realities and rewards of practicing medicine in the 21st century.
The new curriculum comprises three phases of learning: Foundations of Medicine, Clinical Immersion, and Exploration and Differentiation.
Phase 1: Foundations of Medicine.
The Foundations of Medicine Phase begins with the Foundations of Biomedical Sciences course. This course introduces students to the basic and fundamental biomedical sciences and to normal human structure and function. The Foundations course provides an introduction to biochemistry, genetics, anatomy, physiology, pharmacology, pathology, cancer biology, ethics and human values, health care delivery science, and clinical medicine.
After the Foundations course, this Phase continues with an exploration of immunity and our relationship with the world of microorganisms. The course will include consideration of the factors involved in infectious diseases, and the role of the hematopoietic system in health and disease. This will provide the basis for understanding the implications of infectious diseases affecting different organ systems.
Beginning in January, the preclinical curriculum will initiate a series of organ-system based courses that are outlined in Figure 1. Longitudinal curricula (defined below) are fully integrated into each of the organ-system based courses. For example, while studying the cardiovascular and respiratory systems, students will dissect the chest in gross anatomy, learn about the physiology and intricate interactions of the heart and lungs, and study the histology, pathology, pharmacology, and radiology relevant to these systems. At the same time, students will also practice the history-taking and physical exam skills needed for clinical assessments. The studying will call upon the knowledge and understanding you previously acquired about cancer and infectious diseases, and students will apply those principles to the organ systems you are studying.
The curriculum also fully integrates the knowledge and skills of the social determinants of health and healthcare disparities connected to the clinical quality improvement and system analysis skills that are needed to address these issues. Epidemiology and biostatistics enhance your ability to evaluate and apply evidence in clinical, research, and improvement settings. Ethics and human values sessions are also key components of each organ-system based course. Foundational sciences are integrated and reinforced throughout the organ-systems courses.
After an 8-week summer break which provides students with the opportunity to pursue research, quality improvement, clinical, or personal interests, students return in the second academic year to complete the series of organ system-based courses (Figure 1). Each organ system is presented as a fully integrated experience, with reinforcing content from Foundational courses and longitudinal curricula, as described above.
The Foundations of Medicine Phase concludes in January of the second year with a 3-week course aimed at integrating material from the organ-based courses through a series of cases focused on more complex, multi-system disorders, such as sepsis, HIV, diabetes, and other core clinical examples. This fast-paced course will provide an opportunity to coalesce your knowledge and skills as you begin a six-week period of dedicated preparation for USMLE Step 1 and the clinical phase of the curriculum.
Foundations of Medicine Phase Longitudinal Courses
On Doctoring. The On Doctoring course is our clinical skills and introduction to clinical medicine course. The course parallels and integrates with the biomedical science courses to provide an exceptional foundation for transition to the Clinical Immersion Phase of the curriculum. Students learn the skills in history taking, physical diagnosis, communication, and clinical reasoning as well as many issues related to the doctor-patient relationship. Our clinical skills teaching occurs in small groups on our Preclinical campus as well as in a simulated clinic at the Dartmouth-Hitchcock Medical Center. In the spring of Year 1, students transition to their longitudinal community-based clinics for the remainder of the Preclinical Phase.
Patients and Populations. The Patients & Populations course marks the beginning of our four-year curriculum in Health Care Delivery Science. The course is designed to help students develop the knowledge and skills to understand, evaluate, and improve health care systems. This course gives students the opportunity to apply analytical, statistical, and problem-solving skills to real-world, contemporary problems, such as health care disparities and the opioid crisis.
- Anatomy and Embryology
- Child development, health, and illness
- Clinical microbiology and immunology
- Evidence-based medicine and informatics
- Health care delivery science
- Leadership and professional development
- Race and health equity
- Substance use and pain
- Health and Values
Phase 2: Clinical Immersion. This phase will begin in April of the second academic year (mid-May for the class matriculating in August 2019, see Transition Plan below). It includes required clerkships in seven major clinical disciplines: Internal Medicine, Surgery, Obstetrics and Gynecology, Pediatrics, Psychiatry, Neurology, and Family Medicine. These clerkships are four to six weeks in length and are completed at our two affiliated academic medical centers (the Dartmouth-Hitchcock Medical Center and the Veterans Affairs Medical Center in White River Junction, Vermont), regional teaching hospitals, regional office practices, and more distant medical centers and hospitals to provide our students with an exceptionally broad array of clinical clerkship experiences. Geisel-affiliated clerkship sites include Indian Health Service medical centers in Arizona and New Mexico; Hartford Hospital in Connecticut; Santa Clara Valley Medical Center, California Pacific Medical Center, and Children’s Hospital of Orange County, in California. The Clinical Immersion Phase allows ample time to explore specialties and electives with a schedule that allows students to take up to eight weeks of clinical electives along with the seven required clerkships.
Phase 3: Exploration and Differentiation. Starting in April of the third academic year, this phase includes one required four-week clerkships (Advanced Ambulatory Medicine) and at least one advanced four-week sub-internship in one’s field of choice. By completing required clerkships by April of the third academic year, Geisel students have 5-6 months to explore career choices through electives and sub-internships prior to needing to apply to residencies. Students may choose from a wealth of opportunities on campus, across the US, and around the world. Students can also design their own elective with the support of a Geisel faculty member. In the latter half of the fourth academic year, all students return to campus for a capstone course that focuses on knowledge and skills important in residency, including advanced clinical skills, application of foundational medical sciences to clinical care, and quality improvement. These topics prepare students to excel during their residency programs and enhance lifelong learning skills.
Our Transition to the New Curriculum in 2019
Geisel is fully committed to ensuring that our legacy and new curricula continue with high quality educational experiences. Our students completing the legacy curriculum will continue to receive the same high-quality courses and clerkships that have provided excellent preparation for a career in medicine for so many years.
However, as with any transition, there will be a need for temporary flexibility in scheduling and logistics. We anticipate several components to be addressed during the transition. We have carefully considered the logistical challenges so that there is minimal impact on students.
We will shift the clinical clerkships from starting July 1 to starting April 1 over two successive years. For these two years, our core clinical clerkships will decrease from 8 weeks and 6 weeks to 7 weeks and 5 weeks respectively. This allows a frameshift over two years to an April 1 start. Students on this temporary clerkship schedule will gain at least 6 weeks of additional elective time. The slightly decreased clinical clerkship schedule is offset by increased opportunity for student choice in clinical electives.