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

2. 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

3. 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.

4. 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

6. 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

7. 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

8. 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

9. 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

10. 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)

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

12. 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

13. 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

14. 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

15. 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?

16. 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

17. 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

18. 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

19. 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?

20. 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

21. 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

22. 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

23. Questions?