What do medical students need to know about renal & genitourinary medicine? The renal theme “dream team” searches for answers
Kathleen A. Jones, M.D. — Department of Pathology,
Scott & White Memorial Hospital & Texas A&M University System
Health Science Center, Temple, Texas
Introduction
In medical education, some faculty focus narrowly on their own course, clerkship or lecture. But how often do we step back and look at the big picture? At our institution, we struggle to make each curricular component better, but we don’t always focus on how each piece contributes to the global education of our students. Faculty are not always conversant with the collective goals of the educational program, hindering integration. I would argue that we are not alone, as this seems to be a common problem in medical education (1). In our medical school, the problem is compounded because the preclinical portion of the curriculum is delivered on a university campus, while the clinical portion is delivered on hospital campuses ninety miles away.
Given that many miles separate faculty, students and sites of curriculum delivery, I wanted to try a different approach to designing an integrated four-year medical school curriculum. I propose a model in which a systems-based theme team, composed of content experts from our faculty, develops global goals and objectives related to renal and genitourinary (GU) medicine. These global goals and objectives will then be incorporated into the curriculum deliberately and logically.
Statement of the problem and program objectives
Medical schools strive to provide the optimal curriculum for graduation of competent physicians. We have made modest attempts to integrate our curriculum, but have not succeeded across all four years. Seeking to organize an integrated, four-year curriculum around body systems, we asked: What do medical students really need to know about renal and GU medicine? (See Figure) Can we develop a model for designing an integrated, systems-based four-year curriculum?
The objectives for this project include:
Figure. Medical disciplines which could contribute to curricular content in renal and GU medicine (percentage contribution has been arbitrarily assigned).
Description of the project/intervention
Some portions of our curriculum are delivered around a systems-based model. Expanding on that idea, we seek to design an integrated, four-year curriculum in renal and GU medicine, using a faculty team approach. If successful, this process could be used in our school as a model for curricular design and integration.
Project steps include:
• Solicit help from course directors on both campuses
• Ask directors to provide any and all relevant goals and objectives for courses and curricular components
• If goals are not available, write broad goals for the curricular component, based upon lecture materials
• Ask for volunteers in an e-mail addressed to all medical school faculty
• Contact and personally recruit certain faculty, chosen for previous educational contributions and expertise in renal and GU medicine
• Build theme team with basic and clinical science faculty from both campuses
• Use current content as a baseline
• Meet with theme team and discuss what medical students really need to know
• Hold team meetings regularly via videoconference between campuses until task is completed
• Define “new” curricular content in renal and GU medicine, encompassing all four years
• Ask theme team to outline a four-year curricular plan for the proposed integrated content
• Address “pacing and spacing” of that content
• Survey faculty to ascertain feelings about this approach to curriculum design
• Present proposed renal and GU medicine curricular plan to medical students at various levels of training
• Ask students if they believe an approach like this would improve their education
• NOTE: Objective evidence about this design process will not be available until after implementation of the newly designed curriculum.
Findings to date/Evaluation to date
Current curricular content related to renal and GU medicine has been catalogued, and the renal theme “dream team" has formed. Meetings are scheduled for the theme team to begin defining necessary and appropriate content for an integrated, four-year curriculum.
• OBSERVATIONS
• Curriculum currently “lives” in individual departments
• Our medical school is in the process of entering our curricular data into CurrMIT, the AAMC’s curriculum management tool
• Courses and clerkships vary widely in their use of specific goals and objectives for teaching
• In courses with clearly stated goals, most are focused on knowledge, with less emphasis placed on skills, attitudes and behaviors expected of a student
• SUGGESTIONS
• Designate a centralized curriculum repository, accessible to faculty and students, to facilitate curriculum use, review, integration and development
• Encourage use of a curriculum management tool, due to the wide range of applications (2)
• Adopt policy that all courses and clerkships design curricular components around specified goals and objectives, in order to better facilitate students’ learning, and afford more uniformity in expectations and student assessment (1)
• In future curriculum design, consciously address not only the knowledge base, but also the skill sets,, attitudes and behaviors that we wish to develop in our students
2. Forming the renal theme “dream team". This step posed unique challenges and held some surprises. Despite time constraints, faculty were enthusiastic and willing to participate.
• Renal theme “dream team" currently includes M.D.s, Ph.D.s, and a lawyer (J.D.)
• Disciplines represented include physiology, anatomy, pathology, medical humanities, urology, genetics, radiology and internal medicine
Key lessons learned so far and next steps
Based upon progress thus far, I believe this project is a timely one in our medical school’s evolution. A number of faculty have lent support to the project and agree that we should be asking the question “What do our medical students really need to know about a particular topic?” Most faculty agree that basic scientists and practicing clinicians should discuss the issues and together decide appropriate curricular content, in keeping with comments in current literature (3).
A few key lessons learned in the course of this project include:
• A centralized curriculum repository could facilitate curriculum review and development
• A curriculum management tool could prove helpful in a number of ways
• Courses vary widely in their use of specific goals and objectives for teaching, and a policy mandating use of goals and objectives within curricular components should be considered
• Although we tend to focus on curricular goals related to knowledge, we should also address goals related to skills, attitudes and behaviors for our students
• Some faculty are not only receptive, but enthusiastic about a team-based approach to curriculum design
Future steps include:
Questions
Literature cited
1. Armstrong, EG, Mackey M, Spear SJ. Medical education as a process management problem. Acad. Med. 2004; 79(8):721-728.
2. Cottrell S, Linger B, Shumway J. Using information contained in the curriculum management information tool (CurrMIT) to capture opportunities for student learning and development. Med. Teach. 2004; 26(5):423-427.
3. Davis MH, Harden RM. Planning and implementing an undergraduate medical curriculum: the lessons learned. Med. Teach. 2003; 25(6): 596-608.
