A Bold Leap into the Future
Personalized medicine is key to the new Genes to Society curriculum.
Illustration by Sherrill Cooper
The impressive glass façade of the Anne and Mike Armstrong Medical Education Building stands as a fitting symbol of the transformation taking place within. We opened this state-of-the-art building this fall in concert with the start of Hopkins’ new Genes to Society curriculum—a totally different approach to training physicians.
I believe our curriculum overhaul—six years in the making—could prove as important to 21st century medicine as Hopkins’ trend-setting medical education model was in the early part of the 20th century.
We have literally turned the curriculum on its head to meet the challenges posed by a genetics-based future, which were so accurately predicted by Hopkins Professor Emeritus Barton Childs.
Starting in 2003, I sat down with Vice Dean for Education David Nichols for a series of in-depth discussions on the likely shape of 21st-century medicine. How should we re-tool our education program to keep Hopkins on the academic cutting edge? David presented that question to our faculty. They wrestled with hundreds of issues, such as:
• How do you incorporate the explosion of biomedical knowledge, new technologies, and emerging multidisciplinary topics into four years?
• How do you shift the physician’s perspective from “fixing” the abnormal to dealing with individual variability?
The result of their grappling: A truly pioneering curriculum that takes a systems approach to understanding all levels of the human being—from the genes, molecules, cells, and organs of the patient on one end, to the familial, community, societal, and environmental components on the other end. We’re radically integrating every aspect of medical education, with the ultimate aim of better serving each patient through personalized medicine.
This stunning break with the past has changed how we teach. Large lectures are giving way to small discussion groups in learning settings designed specifically for the new curriculum. Patient-centered education is woven into basic science courses throughout the four years. The Simulation Center next door lets students master a broad range of patient procedures in a safe environment.
One of the things I find exciting is the immediate integration of clinical experience with the basic sciences. That didn’t happen in my med school days at the University of Rochester. Back then, the first two years focused on the sciences. We had morning lectures on anatomy, biochemistry, physiology and microbiology, followed by afternoons in the lab with lots of hands-on experiments. The last two years were the exact opposite: Clinical rotations with faculty mentors, an externship and nearly nothing on the basic sciences.
It was as though we had to endure the dull but essential book learning before we could get to the good stuff. These critical aspects of medicine weren’t connected for us. So when I finally saw a patient with severe rheumatoid arthritis in my fourth year, there was no one to remind me of the immunology I had learned in my first year to help me make an informed diagnosis.
That won’t happen in Hopkins’ new curriculum, where the intermingling of fundamental scientific knowledge and clinical practice follows students throughout. This should make basic science more relevant and hopefully more integral to the students’ long-term career goals.
The Class of 2013 will follow patients over time, not simply on a one-visit basis. Public health and environmental aspects of patient well-being assume larger curriculum roles, too. So do courses on patient safety, communications skills, and teamwork.
We want graduates to know how internal factors—the genes, proteins, cells and organs—interact with external factors—such as an individual’s family history and surroundings—so our physicians make the right diagnosis and prescribe the right regime for each individual.
This curriculum requires the faculty to make major adjustments. It’s one thing to stand in front of a class of 125 and deliver a rapid-fire lecture. It’s another to discard the standard courses of biochemistry, pharmacology, pathology, and physiology (and others) in favor of a more collaborative approach, in which faculty experts work together to explain individualized variation based on genetic, societal, and environmental differences. Our faculty’s commitment to this new path has been remarkable. Clearly, they are the linchpin of this program.
Genes to Society will be deemed a success if our graduates are well-grounded in scientific and clinical medicine as well as genetic and environmental factors contributing to human health; if they are compassionate physicians; if they gain the skills to access emerging medical information that will constantly alter their practices, and if they never lose the desire to incorporate research and education into their careers.