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Stanford Report, September 10, 2003

Passions pursued under revised medical curriculum Chance to focus on specialized interests awaits new students


Known for its prowess in scientific research, the School of Medicine launched a different kind of experiment this month by transforming the way in which physicians are trained.

The heart of the new curriculum is the "scholarly concentrations" — the equivalent of medical majors in which students will explore an area that excites them. This makes Stanford the only medical school where future physicians develop specialized interests early in their education.

First-year med students who will experience the revised curriculum include (from left) Deepika Nehra, Jasmeet Ahuja (a recent Stanford grad but not a medical student), Juan Carlos Montoy, Leanne Komorowski, Philip Kurien and Matt Bucknor. They gathered Friday at a traditional ceremony where new students receive their stethoscopes. Photo: Eric Weissman

That was part of Stanford’s appeal for Steve Ortiz, who now has the first few days of medical school under his belt. "I think this is going to be a great opportunity for us to turn our attention to a specific area of medicine early on, rather than waiting until possibly our residencies to focus on what our future in medicine will be," said Ortiz, who is considering becoming either a cardiothoracic or transplant surgeon who also conducts research. "I was a little concerned that we were the guinea pigs, but so far it seems like a nice fit. Everything here seems very well-planned."

Ortiz and his 86 first-year classmates are the first to participate in the new curriculum, which school officials say is already drawing the attention of other U.S. medical schools. Its key elements include:

• In-depth study in a concentration area that will span the student’s years at Stanford.

• Better integration of the basic science and clinical portions of the curriculum.

• Restructuring courses to focus on individual organ systems to avoid the redundancies that now occur by teaching each discipline as a separate subject.

• Reducing weekly classroom instruction to give students more time for research and academic exploration.

"Stanford is not simply about training physicians or clinicians," said Philip Pizzo, MD, dean of the medical school. "That’s a really important thing to do and we will continue to do that, but we want to do something more. We want to equip our students with skill sets that will enable them to become leaders who will help to shape the medicine of the future."

Stanford had previously followed the traditional model 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. About 70 percent of Stanford students spread their education over five years to include a year of research.

But officials at Stanford and other medical schools recognize that the traditional model doesn’t fit the realities of 21st-century medicine. Today’s medical students face a world in which knowledge is evolving so rapidly that some elements of their scientific training may be outdated by the time they complete their residencies. Consequently, they will need to re-educate themselves throughout their careers to stay current with the latest discoveries.

Pizzo said a primary goal of the new curriculum is to prepare students to continue learning throughout their careers and to feel at home in the world of basic science. In addition to the science coursework during the first two years of the curriculum, students will get refreshers on basic science topics during the latter two years of medical school. The clinical portion of the curriculum is also being enhanced; students will work on developing their clinical skills each week of the first two years and will work with patients experiencing the disorders being studied in the classroom.

Courses will be integrated around organ systems to ensure that information is delivered in a more efficient, meaningful way. These efficiencies, along with adding three weeks to the fall quarter, will make it possible to reduce classroom instruction without sacrificing content, school officials say.

How each student spends those open hours will likely be driven by the scholarly concentrations — the aspect of the curriculum generating the most enthusiasm among students and faculty members. The concentrations are similar in function to the majors used in undergraduate education. Students will be expected to devote at least 200 hours of work to a project in the concentration area they select. They can choose whether to spend a year on original research or to use available information to investigate a question they develop.

"Through the scholarly concentrations 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 and associate professor of medicine (infectious diseases). "As our students choose their 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 initial eight scholarly concentrations are biomedical ethics and humanities; bioengineering; biomedical informatics; immunology; public service and community medicine; women’s health; health services and policy research; and molecular and genetic medicine. Five others — international health, imaging, infectious disease, cardiovascular medicine and clinical investigation — are being developed, Parsonnet said.

Ortiz, who has several months before he needs to select a concentration area, is already intrigued by the immunology track and is planning to spread his education over five years to incorporate a year of research. Ortiz, who earned his undergraduate degree in neurobiology at UC-Irvine, said his classmates are looking forward to their training under the new curriculum.

"Everybody seems to be happy that we’re here under the new system," he said. "I am excited that we’ll be exposed to aspects of clinical medicine earlier than in previous years and that there will be more correlations between the clinical medicine and the basic sciences."

What they’re saying about the new curriculum (4/30/03)

Curriculum reform gets a jump start (1/5/00)