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Stanford Report, January 5, 2000

Curriculum reform gets a jump start


The move to revamp the School of Medicine's education program got a jump start in December with the arrival of R. Ruth Linden, PhD, a sociologist with broad experience in the academic world, who will serve as the full-time director of curricular reform.

Linden will oversee an initiative begun last February at a medical school retreat, where faculty and students agreed on the need to update the teaching program, focusing on the tools and information students will need to practice first-class medicine in the decades ahead.

Linden is a writer and researcher with interests in the sociocultural aspects of science, technology and medicine. She has taught in the Program in History and Philosophy of Science at Stanford and is currently a lecturer in the Department of Family and Community Medicine at UCSF. She is an affiliated scholar at the Beatrice M. Bain Research Group at UC Berkeley and has administrative experience, having served as associate dean at John F. Kennedy University in Orinda, Calif.

With her arrival on campus, "The wheels [of curricular reform] will start to turn in a more perceptible way," Phyllis Gardner, MD, senior associate dean for education, told the School of Medicine Faculty Senate at its Dec. 15 meeting.

Gardner noted that progress already has been made on some aspects of the reform effort.

For instance, retreat participants agreed that the teaching program should focus less on fact-based learning and more on the development of critical-thinking skills and deep scholarship. In response, Gardner has proposed an expansion of the Medical Scholars Program to encourage medical students to spend an extra year in a scholarly endeavor that would be fully paid for with scholarship funds. This could include a year spent in bioengineering, basic science, clinical research, the arts and humanities or public service, with students earning a second degree for their work. Gardner's proposal for the restructured program was approved by the school's executive committee on Dec. 18, she said.

Retreat participants also discussed the need for a required core curriculum for graduate students to give them a common body of knowledge and bring together the dispersed graduate community. The Committee on Graduate Admissions and Policy (CGAP) has developed a pilot program, consisting of six core courses, which went into effect at the start of the current academic year, Gardner said.

In addition, Kelley Skeff, MD, PhD, associate professor of medicine, has been working with colleagues to develop a Center for Faculty Development, which would help train faculty in the art of teaching. The program would make Stanford a model for faculty development and use teaching methods, such as online technologies and video, that Skeff has pioneered and that are being used around the country, Gardner said.

The biggest task ahead, however, involves simplifying the pre-clinical and clinical core curricula with an eye to eliminating the course redundancies and overlaps that now exist, Gardner said. Another goal is to better integrate the basic science and clinical experience through case-based learning and other methods, she said.

"It's not an issue of throwing out the baby [with the bathwater]," she said of the reform effort. "It's a matter of fine-tuning."

The reform process is politically complex because the teaching program is now tied to the operating budget, with departments paid on the basis of how much time faculty members spend in the classroom, Gardner said. School officials will focus initially on developing a new structure for the curriculum and then address the financial issues, finding some mechanism to compensate departments for any reductions in teaching time, she said.

While Linden will oversee the process, four faculty members will provide major leadership, working with a larger steering committee of 15 faculty members from the basic and clinical sciences. The leadership team includes Gardner, Skeff, Dan Herschlag, PhD, associate professor of biochemistry, and David Cox, MD, PhD, a professor of genetics and recent chair of the Committee on Courses and Curriculum. The steering committee also will determine the membership and key issues to be addressed by five working groups that will deal with the pre-clinical and clinical medical curricula, the graduate curriculum, the combined degree programs, faculty development and information technology.

Linden said her goal is to make the process as inclusive and as open as possible.

"I'm committed to making our communication, deliberation and decision-making as transparent as possible, with an array of communication links and opportunities for involvement by all members of the medical school community," she said.

"I want to engage the faculty in a way that doesn't ask them to shoulder another burden. That will involve beginning a conversation in which we talk about incentives and the faculty's needs and concerns," she added.

Gardner said she expects the process to take about 18 months, with the new education program ready by the 2001 school year. Changes are likely to be phased in over time, Linden noted. SR