Curricular revision: embracing the journey

Few words strike as much fear in the hearts of medical-school faculty members as “curricular revision.” It is a long, arduous and often unsettling process. However, curricular revision is a phrase that many, if not most, of us are hearing these days.
 
A large number of medical schools have revamped their preclerkship curricula over the past decade, and many are in the process of doing so now. It is a trend that is being driven at the national level. Commonly, new curricula are marked by a move from discipline-based to interdisciplinary courses, by decreased time devoted to the foundational sciences, by the devaluation of lectures and other traditional teaching methodologies, and by the inclusion of small-group sessions and other types of learner-centered teaching.
 
The Vanderbilt University School of Medicine has undergone two major curricular revisions since 2007. The first (now referred to in the local vernacular as Curriculum 1.0) seems relatively mild by today’s standards; however, it seemed earth shattering at the time. That was when we moved from discipline-based courses to interdisciplinary blocks. After directing the medical biochemistry course for 17 years, I had to work with two faculty members from other departments to develop a new course that encompassed biochemistry, cell and tissue biology, and genetics.
 
Prior to Curriculum 1.0, the preclerkship science courses, which were run out of departmental offices, had little to do with one another. For many years, the only interaction that I had with the directors of the anatomy course (which ran simultaneously with biochemistry) was when they sent an annual message telling me when the anatomy exams would be and to make sure that I did not schedule the biochemistry exams too close to those dates. In those days, medical student courses were important to departmental missions, because they provided departments with an identity within the School of Medicine. Although it had become harder to define what a biochemist actually was, everyone knew a biochemistry course when they saw it. Discipline-based courses also gave course directors a certain level of status within their departments. Directors had a time-consuming and often thankless job, and most faculty members were grateful that the responsibility for the course rested in someone else’s hands.

Class
Images courtesy of Vanderbilt University and Medical Center.

After the initial shock of our mandate for Curriculum 1.0 wore off (along with all of the now-familiar questions: Why are we doing this? What was wrong with the old curriculum?), we settled into our task.
 
Our first foray started with three coordinated semi-independent courses. We soon abandoned this idea and decided that it would be best to work together rather than as separate entities. After several months and many different approaches, we arrived on a mutually acceptable interdisciplinary schedule and christened our new course Molecular Foundations of Medicine. To help set up the block, I generated a color-coded spreadsheet of the classes. I lined up the lecturers for biochemistry (blue) and my co-directors lined up the lecturers for cell and tissue biology (red) and genetics (green). Once we had everyone scheduled, I changed the color scheme to denote the type of class: Blue now stood for lectures, red for exams, green for patient sessions and so forth.
 
“That was the day that everything changed.”
 
Although altering the color scheme seemed like a minor modification at the time, it turned out to be a pivotal point in the development of Molecular Foundations of Medicine and in my development as an educator. The block became more than the sum of the individual disciplines. We stopped caring, for instance, whether a lecture on membranes was cell biology or biochemistry and started caring more about how everything in the block fit together. After all was said and done, Molecular Foundations of Medicine was far better than any of the courses that it replaced; it allowed us to place important scientific information into a more logical, appropriate and meaningful cellular context.
 
The block turned out to be a startling success with the medical students, which was music to my ears after so many years of running biochemistry, “the course that all physicians loved to hate.” I found it much more rewarding to teach as a member of a faculty team than to go it alone. Faculty members from other departments and administrators soon became my colleagues and valued friends. For the first time, I felt that I could translate the creativity I put into my research into my teaching. Although my value to the mission of my department had diminished, my value to the mission of the school had grown enormously.
 
In 2011, only five years into Curriculum 1.0, we learned that we would be moving to a new model, Curriculum 2.0, starting in autumn 2013. This time around, I had greater responsibilities. In addition to being a block director, I was one of four faculty members charged with developing, implementing and overseeing the entire preclerkship science curriculum. The task was daunting, especially in light of the far more radical (or cutting-edge) demands of Curriculum 2.0.
 
We had to decrease the preclerkship time for the foundational sciences from two academic years to one calendar year with a later reintroduction of the foundational sciences in the clinical years. Moreover, the individual science blocks were much more heavily integrated with one another than in the previous curriculum. My eight-week Molecular Foundations of Medicine block morphed into a six-week Human Blueprint and Architecture block that included several hours of pathology, anatomy and pharmacology in addition to its previous core elements. Furthermore, the blocks contained less time for lecture and featured a unifying thread of weekly small-group sessions that taught the sciences in the context of patient cases. These case-based learning sessions were critical to the success of Curriculum 2.0 and were allocated six hours a week of in-class time.
 
Despite the complexities of Curriculum 2.0, our experiences with Curriculum 1.0 prepared us for the interdisciplinary and collaborative approaches necessary to develop the science blocks in a model that was unique to Vanderbilt. In contrast with the curricula at many other medical schools, Vanderbilt’s Curriculum 2.0 deftly incorporated a variety of teaching modalities and valued them all. Students, according to their block evaluations, greatly appreciate this approach.

Group

We now have completed our first year of Curriculum 2.0. By all accounts, it has been very successful. Initial evidence suggests that students who have participated in the curriculum are scientifically inquisitive, display strong reasoning and teamwork skills, and can effectively apply these underlying scientific concepts to clinical scenarios.
 
The successful implementation of the curricular revisions at Vanderbilt required a strong working relationship between the faculty and the administration. Each group valued the other as an educational partner. Although the administrators established the guardrails for and oversaw our curricular revisions, they did not micromanage the process. They trusted the faculty members to implement a creative and appropriate set of science blocks. This trust allowed the faculty members to take ownership of their blocks, which was a critical contributor to our success and serves as a model for how administration and faculty members can work together on critical projects.
 
I am looking forward to our next major curricular challenge: the insertion of the foundational sciences into the clinical curriculum. I am already certain regarding one aspect of the process: If we want our students to reinvest themselves in the biosciences while on the wards, we cannot separate the science from the clinical experience. We have to repackage the foundational sciences in terms of their patients’ illnesses, symptoms, test results and treatments rather than in terms of the traditional disciplines that once defined our teaching. Pilots of such integrated courses show promising results.
 
Finally, although our two curricular revisions have had a profound effect on the way that we teach our medical students, in many respects they have had a more profound effect on me. By embracing the journey rather than fighting it, I have gone from being a teacher to an educator to an educational leader and have written a new chapter in my three-decade academic career.

Need help with curricular revision?

If your department or institution requires assistance with curricular revision; the adoption of new teaching methods; or the development of learning objectives, assessment items or competencies, the Association of Biochemistry Course Directors can help.
 
Founded by the Association of Medical and Graduate Departments of Biochemistry in 2008, the ABCD is a membership organization of nearly 300 biochemistry (and related) faculty members from about 170 schools of medicine, dentistry and pharmacy. ABCD members are educational and curricular leaders who have tremendous experience and expertise in all aspects of curricular design and integration, learner-centered teaching modalities and educational scholarship.
 
If you are involved in teaching the molecular sciences to professional students, consider joining the ABCD. Faculty members at all levels of experience are encouraged to apply for membership. For more information, visit www.abcd.wildapricot.org.
Neil OsheroffNeil Osheroff (neil.osheroff@
vanderbilt.edu) is a professor of biochemistry and medicine and holds the John. G. Coniglio chair in biochemistry at the Vanderbilt University School of Medicine. He is a master science teacher, a founding member of the Academy for Excellence in Teaching, and has led a National Institutes of Health-funded research program for the past three decades. He also chairs the executive committee of the Association of Biochemistry Course Directors (www.abcd.wildapricot.org).

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