Proposed Models for Curriculum Redesign Updates from the Curriculum Subcommittee November 21, 2017

Guiding Principles The Geisel curriculum will help each student establish a strong foundation in the biomedical sciences The revised curriculum will aim to begin clinical clerkships earlier (for example, it may be 2 to 6 months) and concurrently maintain a robust pre-clinical curriculum. The curriculum will assure material is covered at the depth appropriate for a medical student and practicing physician

Guiding Principles Foundational medical science will be integrated vertically, including recapitulation in clinical settings, to emphasize the importance and applicability of this knowledge Which courses become vertically integrated into a systems based approach, and which maintain status as independent courses is still under evaluation. We will be actively seeking guidance on this from the MEC and individual course directors.

Guiding Principles The schedule will foster and include time for students to attend to their personal and professional growth 22-24 classroom hours per week The Year 1 summer provides for scholarship, career, and personal opportunities, efforts will be made to maintain the length of the summer break 8 Week summer break is maintained

Aug Sept Oct Nov Dec Jan Feb Mar Apr May Foundations of Med Science 110 hrs/5 wks Imm/ID 150 hrs/16 curricular weeks GI - Metabolism 122 hrs/13 curricular weeks Cardio 108 hrs/16 weeks Endocrine 74 hrs/13 weeks Resp 74 hrs/16 weeks Repro 66 hrs/13 weeks Aug Sept Oct Nov Dec Jan Feb Mar April Heme 40 hrs/7 weeks Neuro 122 hrs/14 weeks Study for Step 1 Clerkships Derm 24 hrs/7 weeks Psych 62 hrs/14 weeks Renal 74 hrs/7 weeks Musculoskeletal 78 hrs/14 weeks

Aug Sept Oct Nov Dec Jan Feb Mar Apr May Aug Sept Oct Nov Dec Jan Feb Calendar Year 1 Aug Sept Oct Nov Dec Jan Feb Mar Apr May 3wks 4wks 5wks 3.5wks Foundations of Medical Science ~110 hrs Invaders and Defenders ~ 174 hrs Musculoskeletal ~ 78 hrs Homeostasis Hematology ~40 hrs Cardiovascular system ~108 hrs Respiratory system ~ 86 hrs Renal system ~ 74 hrs Integration exercises The Complete Physician Calendar Year 2 Aug Sept Oct Nov Dec Jan Feb 3wks 4wks 5wks 3.5wks Control and Regulation ~ 125 hrs Nourishing the Body ~183 hrs Reproduction ~ 73 hrs Psychiatry ~62 hrs The Complete Physician

Aug Sept Oct Nov Dec Jan Feb Mar Apr May Calendar Year 1 Aug Sept Oct Nov Dec Jan Feb Mar Apr May 3wks 4wks 5wks 3.5wks Foundations of Medical Science ~110 hrs Invaders and Defenders ~ 174 hrs Musculoskeletal ~ 78 hrs Homeostasis Hematology ~40 hrs Cardiovascular system ~108 hrs Respiratory system ~ 86 hrs Renal system ~ 74 hrs Integration exercises The Complete Physician Major topics/threads: Biochem, CTO, Anatomy, Path, Pharm The beginning of the course focuses more on cells – the end more on organ systems. Cell structure Cell injury and death Cell/tissue adaptations Basics of pharmacology Oncogenesis Transcription Translation Enzymology Epigenetics Protein folding/misfold Basics genetic disorders Early embryology Cong malform basis Tissue structure Intro to Imaging Overview body systems Major topics/threads: Immunology, ID, CTO, Path, Dermatology, Pharm The first part of I/D focuses on skin as a defender. Derm content is introduced (normal skin), and then skin cancer is discussed to tie with foundations. The unit then moves to immunology/infectious diseases with other skin issues woven in. Dermatology Hypersensitivity Autoimmunity Tumor immunology Thrombosis Anemia Hematologic malignancy Inflammation Pathology of Infectious disease Histology of immune organs Major topics/threads: Bone, CT, Anatomy, Pharm Embryology of MSK Joints Rheumatology Orthopedics Major topics/threads: Phys, CTO, Anatomy, Path, Pharm Cardiac/Resp/Renal histology Cardiac/Resp/Renal anatomy Cardiac/Resp/Renal physiology Cardiac/Resp/Renal pathology Cardiac/Resp/Renal pharmacology Cardiac/Resp/Renal embryology Imaging of chest/urinary system Integration exercises – an opportunity at the end of the year to do some cases or other exercises that show how the systems work together *The Complete Physician is a course that includes content from On Doctoring, P&P and Health & Values curriculum – basically anything that is clinically oriented rather than basic science

Aug Sept Oct Nov Dec Jan Feb Calendar Year 2 Aug Sept Oct Nov Dec Jan Feb 3wks 4wks 5wks 3.5wks Control and Regulation ~ 125 hrs Nourishing the Body ~183 hrs Reproduction ~ 73 hrs Psychiatry ~62 hrs The Complete Physician Major topics/threads: Neuro, HAE, Endocrine, Pharm Neurons Neurulation CNS PNS ANS Special senses Endocrine system – general mechanisms of hormone action Major topics/threads: Metabolism, CTO, Anatomy, Endocrine Phys, Endocrinology, Path, Pharm, Nutrition GI tract anatomy/histo GI pathology GI pharmacology Lipid metabolism Glucose metabolism & regulation Calcium regulation Glucose intolerance Metabolic syndrome Osteoporosis Hypertension Atherosclerosis Abdominal imaging Embryology of GI tract Nutrition Major topics/threads: CTO, Anatomy, SBM Repro, Endocrinology Reproductive anatomy/histo Reproductive pathology Embryology of reproductive organs Hormones that affect reproductive organs

Questions to be answered: How many courses/block Longitudinal vs. Integrated Courses Content and duration of the Foundations of Medical Practice course Currently a 5 week/110 hour course in proposed models Timing of Step 1 USMLE Board Exam Timing of courses to best facilitate early patient interactions within the preclinical curriculum (e.g. On Doctoring)

Pros and Cons of 1,2 or 3 courses per block

Longitudinal curricular material Need to decide the best model, or maybe multiple models Option 1: Longitudinal course on its own but deliberately paired through collaboration with block courses Examples, On Doctoring, P&P Should the major curricular material use this model, such as Anatomy, CTO, Pharmacology? Should what was previously themes or VIGs use this model, such as Imaging, Nutrition, Health and Values, etc…? Option 2: Material integrated within the block course, ensured to be covered through careful formation of Objectives, but block course director ultimately makes determination of course format and material (with collaboration from longitudinal curricular collaborators) Examples, SBM Themes

Pros and Cons of Longitudinal Courses Provides a full curriculum--need assessment, objectives, learning methods, and assessment (of both the students and the course) for important longitudinal curricular material Longitudinal course directors have direct control over their curricular content, and can propose objectives, innovative and well established learning methods in their field, and assessments Cons Potential for redundancy and uncoordinated curriculum--repeat sessions, sessions not timed ideally with different courses under different leadership More components within individual blocks, increasing the chance for excessive work demands due to coincidence of projects in multiple courses. Basic material may have to be revisited more frequently since they didn’t get a chance to be reinforced as consistently as they would be in a regular course

Pros and Cons of Longitudinal Themes within Courses Enhances integration Easier to control workload (easier to coordinate work demands on students among a smaller number of and integrated courses) Cons Potential for course directors to “short-change” important themes. Conversely, potential for theme directors to not have control over introduction and teaching of their curricular content Core curricular material (important themes) could potentially not be treated as a full curriculum--- with Objectives, Learning Methods, *AND* assessment (of both students and curriculum). That is, the Core Course will be the curriculum, including assessment, and the longitudinal theme will still need to have some way of being assessed Potential that the longitudinal theme will be a scattered/one-off/broken curricula where the longitudinal content is handled within the Core Course and there is not a big picture longitudinal curricular integrity to theme across the years. Certain curricular content does not integrate perfectly or fully with Core Biomedical Science courses

Plan to Survey Current Course Directors Do you feel your course is appropriate for integration in the revised curriculum as an integrated subject within the systems based model? Do you prefer that your course be a longitudinal course, independent from the systems based blocks, but coordinated by content?

Foundations of Medical Practice To include material to prepare students for the systems based core content Gen outline of body Cell Structure, Tissue Structure Cell Injury and Death Cell/tissues adaptations Early embryology and Congen Malformation basis Basics of Pharm Oncogenesis Transcription/Translation Enzymology Basics of genetic disorders Epigentics Protein folding/misfolding Needs to also include the current introductory On Doc material of the first 4-6 weeks Include material from the other SBM themes (intro to themes) too: Genetics Cancer Rehab Pediatrics Imaging Nutrition Palliative Care Pharm Path Health and Values

Looking forward to Years 3 and 4 Some ideas have been put forward, but no specific models proposed at this time MEC recommendation to fully integrate the 4 years into a cohesive curriculum was duly noted

Intersession – 4 weeks (or Elective time? Med or Neuro?) Apr May Jun July Aug Sept Oct Nov Dec Jan Feb Mar Block 1 (eg Surg 8 weeks Block 2 (eg Peds 8 weeks) Intersession – 4 weeks (or Elective time? Med or Neuro?) Block 3 (eg OBGYN 6 weeks + 2 weeks elective) Block 4 (eg Medicine 8 weeks) Block 5 (eg Fam Med 6 weeks + 2 weeks elective) Intersession – 4 weeks (or Elective time? Med or Neuro?) Apr May Jun July Aug Sept Oct Fall Winter Spring Block 6 (eg Sub-I 4 weeks + elective 4 weeks or Amb Med or Neuro) Block 7 (eg Psych 6 weeks + 2 weeks elective) Intersession – 4 weeks (or Elective time? Med or Neuro?) Block 8 (eg Elective x 8 weeks or Amb Med or Neuro) Interviews and Electives or Amb Med or Neuro Capstone, Advanced Foundational Science, QI,Healthcare system P&P, Acute Care, Residency Readiness Interview and Electives or Amb Med or Neuro

Timing of Step 1 Exam? Several schools have moved to taking Step 1 after clinical clerkships Some research shows improved scores with this model Could this reduce test anxiety about Step 1 or just prolong it? Could the current curriculum models allow for this option? Postponing Step 1 could lead to Clerkships starting significantly earlier Clerkships starting in February of 2nd year? Could the clerkships accommodate this change or is it too drastic?

Aug Sept Oct Nov Dec Jan Feb Mar Apr May Foundations of Med Science 110 hrs/5 wks Imm/ID 150 hrs/16 curricular weeks GI - Metabolism 122 hrs/13 curricular weeks Cardio 108 hrs/16 weeks Endocrine 74 hrs/13 weeks Resp 74 hrs/16 weeks Repro 66 hrs/13 weeks On Doctoring P&P Aug Sept Oct Nov Dec Jan Feb Mar April Heme 40 hrs/7 weeks Neuro 122 hrs/14 weeks Clerkships Derm 24 hrs/7 weeks Psych 62 hrs/14 weeks Renal 74 hrs/7 weeks Musculoskeletal 78 hrs/14 weeks On Doctoring P&P

Block 3 (eg OBGYN 6 weeks + 2 weeks elective) Feb Mar Apr May Jun July Aug Sept Oct Nov Dec Block 1 (eg Surg 8 weeks Block 2 (eg Peds 8 weeks) Block 3 (eg OBGYN 6 weeks + 2 weeks elective) Block 4 (eg Medicine 8 weeks) Block 5 (eg Fam Med 6 weeks + 2 weeks elective) Block 6 (eg Study for Step 1) Jan Feb Mar Apr May June July Aug Sept Fall Winter Spring Intersession – 4 weeks (or Elective time? Med or Neuro?) Block 7 (eg Psych 6 weeks + 2 weeks elective) Block 8 (eg Sub-I 4 weeks + elective 4 weeks or Amb Med or Neuro) Block 9 (eg Sub-I 4 weeks + elective 4 weeks or Amb Med or Neuro) Block 10 (eg Sub-I 4 weeks + elective 4 weeks or Amb Med or Neuro) Intersession – 4 weeks (or Elective time? Med or Neuro?) Interviews and Electives or Amb Med or Neuro, Step 2 Capstone, Advanced Foundational Science, QI,Healthcare system P&P, Acute Care, Residency Readiness Interview and Electives or Amb Med or Neuro

Next Steps Survey Course Directors MEC vote on proposed models Develop a plan for Integrated vs. Longitudinal Courses Continue to work on year 3 and year 4 curricula

Questions?