By SUSAN IPAKCHIAN
The Stanford University School of Medicine has a message for prospective students: If you think you’ll have to set aside your personal interests in medicine while you hit the books, think again.
In September, Stanford will transform the way physicians are trained with the launch of a new curriculum. The heart of this training will be a multiyear project in which students will explore a specific aspect of medicine that excites them, making Stanford the only medical school where future physicians develop specialized scholarly interests early on. School officials hope the in-depth projects will ignite a desire to improve human life that will burn throughout the students’ careers.
Several differences distinguish the new curriculum for Stanford medical students from the current education plan, as outlined above. Students accepted into this fall’s class will be the first to experience the new curriculum. Chart: Office of Medical Communication
"Our students will have the opportunity to do something unique and interesting that they’re passionate about," said Julie Parsonnet, MD, senior associate dean for medical education at Stanford and associate professor of medicine. "Students are very idealistic when they come here. We want them to be even more idealistic when they leave. We want to help them acquire the expertise and skills to make meaningful changes in the lives of patients and in the field of medicine."
The goals and concepts behind the new curriculum were unanimously approved last week by the medical school’s Faculty Senate. Students accepted into this fall’s incoming class will be the first to participate in the new curriculum, which Parsonnet said is already drawing the attention of medical schools around the country. Its key elements include:
• In-depth study in a specific topic area that will span the student’s years at Stanford. From a broad range of areas — possibly including public service and molecular medicine — each student will identify a specific field in which to develop expertise.
• Better integrating the basic science and clinical portions of the curriculum so that students spend more time developing their clinical skills during the early years of school while refreshing their basic science knowledge in the latter two years, which have been traditionally devoted to clinical experience.
• Restructuring courses to focus on individual organ systems to avoid the redundancies that now occur by teaching each discipline as a separate subject. For instance, students will learn all aspects of the heart-lung system — anatomy, histology, pathology, pharmacology, physiology — at one time while also working with patients who are experiencing problems in those organ systems.
• A reduction in classroom instruction to give students more time to better integrate what they are learning and to explore diverse intellectual opportunities offered on the Stanford campus, such as engineering, law and humanities, with the aim of applying aspects of those fields to medicine.
Through this training, Stanford officials expect to produce multidimensional physicians who will have the skills and passion to improve health in a diverse spectrum of communities through research, innovation and leadership.
The new curriculum is part of the school’s strategic effort to align its education, research and patient-care activities with its mission of translating research into clinical practice. "Knowledge will continue to evolve and explode in the decades ahead, and we want our graduates to be leaders in finding ways to improve life," said medical school Dean Philip A. Pizzo, MD, the Carl and Elizabeth Naumann professor of pediatrics and of microbiology and immunology. "We believe the new curriculum will produce outstanding clinicians who can also expand the boundaries of knowledge in a diverse array of disciplines."
Parsonnet said a team of faculty members and students has worked for more than a year to identify ways of strengthening the school’s medical education program. Stanford currently follows the traditional pattern in which medical students spend their first two years in the classroom learning basic science, followed by two years of working with patients in a variety of clinical clerkships. Many Stanford students spread their education over five years to incorporate a year of research.
Integrating basic, clinical sciences
The move to better integrate the basic and clinical phases was based largely on input from students, who expressed a strong desire to begin working on their clinical skills much earlier. "When you’re learning the basic science by itself, it isn’t always clear how it’s going to apply," said Al Taira, a third-year medical student who has been involved in the development of the curriculum. "The new curriculum will integrate patient contact with the coursework so that you’re interviewing patients in the area that you’re studying."
The content of the courses is also being restructured to be more effective, said Neil Gesundheit, MD, associate dean for medical education and associate professor of medicine (endocrinology). For instance, rather than teaching the anatomy of the entire body during one intensive quarter, the subject will now span two quarters. Students will learn the anatomy of the torso and limbs during the first quarter and will study the anatomy of the head and neck in the second quarter when they will also be taking neurobiology.
Integrating later courses around organ systems will also ensure the information is delivered in a more cohesive way, Gesundheit said. "Students won’t be getting the same information several times in different courses. This will be more efficient and more meaningful," he said.
These efficiencies, coupled with plans to begin the fall quarter three weeks earlier than usual, will make it possible to reduce weekly classroom instruction time without sacrificing content, Gesundheit said. It will also give students time each week for research or for taking graduate-level courses in specialized areas of the basic sciences or in other areas of interest.
How each student spends that time for research and other courses will likely be driven by the new in-depth research project — the aspect of the curriculum generating the most enthusiasm among students and faculty members. "A number of medical schools are trying to integrate the basic and clinical sciences. What makes us different is that, through these in-depth concentrations, the students will decide for themselves how to intertwine the basic and clinical sciences as it relates to their own intellectual interests," Parsonnet said.
The concentrations are similar in function to the majors used in undergraduate education. The school is currently selecting six to eight in-depth concentration areas from among the 21 suggested by faculty members. By the end of the students’ first year, they will select a concentration area and will later identify a specific topic they wish to explore. Students can choose whether to devote a year to original research or to use available information to investigate a question they develop. Students whose interests fall outside the concentrations can create their own in-depth study area under the supervision of a faculty member.
An example of an in-depth project might be a comparison of the effectiveness of different types of stents — tiny tubes that hold open clogged arteries to improve the flow of blood and oxygen. In addition to seeking out published data regarding various stents, the student might also spend time working with biomedical engineers and cardiologists to evaluate which stents are most effective in treating specific problems. The student could use this knowledge in caring for patients, working with companies to develop better devices or advocating policies that would make effective treatments widely available.
"We want the skills developed in the pursuit of in-depth knowledge to be sustained throughout our graduates’ careers," Parsonnet said.
"In the perfect world, physicians should represent the ideals of society. As our students choose their in-depth projects, we want them to look at the role of physicians in the community and learn how to become advocates for individuals and for biomedical science."
The road ahead
The first year of the new curriculum is being finalized and the framework for the following years has been established, Parsonnet said, noting that details of the later years of the curriculum will be rolled out in coming months. She added that the curriculum has received widespread input from faculty members, alumni and students. She praised the efforts of several key groups — the medical school Faculty Senate’s Committee on Courses and Curriculum, the Office of Medical Education, the dean’s office and the "extraordinarily dedicated" course directors — for their contributions in framing and developing the new curriculum.
Word about the curriculum is already spreading throughout the country. Parsonnet said she has received inquiries about the in-depth concentrations from schools interested in doing something similar.
School officials are also hoping to build a new classroom and library facility that will provide the physical resources to support the new curriculum; plans for the Stanford Medicine Information and Learning Environment, known as SMILE, are being developed. In addition to classrooms, the facility would contain high-technology communication and learning systems, simulation devices, immersive learning environments and an advanced information/library system. Officials hope to have the facility built and ready for use in 2008.
"We want to give students a variety of methods from which to learn by attending classes, working in small groups or engaging in a variety of simulations. The SMILE project will provide that variety," Parsonnet said. "We expect that it will also give the medical students and the graduate students a place to interact and share ideas."
School officials are in the process of determining how to raise money for the SMILE project as well as funds to support the curriculum. "We’d like to endow the in-depth concentrations so that we have an ongoing source of funds, and we’d also like to endow more student research," Parsonnet said.
Stanford Report, April 30, 2003