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New medical school curriculum integrates science and medicine as never before

October 2008--The quirky medical drama House may be embellished for public consumption, but beneath the surface lies a TV show that well defines the challenges facing modern medicine. To solve mysterious and complex illnesses, the physician House and his team apply the Socratic method, interdisciplinary collaboration, and their strong knowledge of physiology, genetics and other basic sciences. They also dig into their patients’ lives for clues to their sicknesses.

With its new Genes to Society (G2S) curriculum for medical students, the school of medicine is emphasizing the importance of such skills for real-world physicians.

Rather than seeing disease as something that “happens to” people, G2S will encourage students to see how individuals’ characteristics—their genetic and physiological makeup, personal habits and cultural environment, for instance—may combine to produce illnesses.

“In traditional courses, patients are generally considered as being all average,” notes David Valle, director of the Institute of Genetic Medicine and one of the curriculum’s architects, “when in truth each patient brings a unique set of genes and experiences to the table.”

But along with this paradigm shift will come increased demands for teaching by some basic science faculty, not to mention changes in their teaching style, as they help students make stronger connections between science and clinical encounters.

These new responsibilities stem from the structure of the new curriculum, which will launch in August 2009. Students, who currently get little formal clinical experience until their third year, will get that exposure throughout the four-year program.

Meanwhile, coursework in physiology, genetics and the like will also be spread out across all four years instead of being concentrated in the first two, as is the case in the current curriculum.

The greater number of science course options will add to the teaching responsibilities for basic science faculty.

The new course structure reflects the reality that “our knowledge is far exceeding what can be taught in a yearlong lecture course,” observes Gerald Hart, director of biological chemistry, who also helped plan the curriculum. “The students are facing an information overload.” G2S therefore aims to shift the medical school paradigm from “teaching” to “learning,” a subtle yet revolutionary switch that will encourage students to think rigorously, independently and about individuality. As Hart explains, “we’re going to teach them the basic principles needed to understand a scientific journal article and let them learn the rest on their own.”

Making the transition to the new curriculum will raise logistical challenges. G2S will need much more oversight than the current teaching model. “Our curriculum as of now is much like the feudal system where each block within a course is a kingdom unto itself,” says Jon Lorsch, associate professor of biophysics and biophysical chemistry. “Each block instructor is basically free to present their lecture as they see fit, which can lead to gaps or redundancy. With the G2S courses all being shorter, we can’t let that happen. Efficiency is critical.”

The dynamic, interactive nature of many G2S sessions will likely require more preparation than cut-and-dried lecture courses.

Lorsch will head up a course titled Basic Science Research Experience, which he plans to conduct in a very hands-on manner, letting the students run their own experiments. It will be difficult to know in advance exactly what’s going to happen each week, he says. Other courses, jointly taught by a clinician and basic scientist, will look at medical problems and the molecular and cellular defects causing them, a teaching model that will require greater coordination and planning.

Lorsch will head the Scientific Foundations of Medicine course as well as Basic Science Research Experience. In such cases as his, where faculty members teach significantly more in the G2S curriculum, the School of Medicine will support a larger portion of their salaries to make up for time that’s no longer devoted to research. He doesn’t believe a slight uptick in teaching responsibilities— going from, say, giving one lecture to three—for other faculty members will interfere with their research or efforts to find grant funding.

While it may seem a bit unfair to put more of the burden of teaching medical students on the shoulders of basic scientists, bringing research and medicine closer together has a strong upside, points out Valle. “I believe that G2S could help stimulate research interests among many medical students, whether they decide to get a Ph.D. as well or just incorporate some research into their medical career.”

--Nick Zagorski

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