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The University of Michigan Medical School

Curriculum for the M.D. Degree Description

(updated November 14, 2003)

In December 2000 members of the University of Michigan Medical School faculty began a process of identifying intended learning outcomes for an educational program that enhanced learning within the structure of the curriculum and to support lifelong learning, and that addressed current challenges in medical education including effective clinical teaching for faculty under pressure to generate revenue, and improved professional skills for providing medical care to an increasingly diverse patient population. Over 70 learning outcomes spanning the domains of knowledge, skills, attitudes and behaviors were identified, and guided efforts to create a new curriculum infrastructure that integrated more effective learning paradigms and that also assured continuance of the many outstanding components of the current curriculum.

Throughout this process, faculty discussed the need to use methodologies that guide students along a progressive developmental path, helping them to mature cognitively and emotionally, and ultimately to achieve goals including skills for lifelong learning, critical and independent thinking, complex problem-solving, and independent decision making. Students are expected to assume responsibility for their own learning and to use self-regulated learning strategies including personal goal setting and self-assessment of progress and performance. With guidance and feedback, they are given responsibility for peer learning, and professional and patient presentations. Faculty have also worked to assure that students will acquire appropriate clinical and communication skills to provide the highest-quality medical care, in the context of understanding the perspectives of patients with cultural heritages, health beliefs, sexual orientations, and life experiences different from their own.

The first-year curriculum is now interdisciplinary and organ-system based, covering the normal cell, normal organ systems, immunology, microbiology, and infectious diseases. As appropriate and as much as possible, material is presented in a clinical context and supported by brief patient cases that illustrate application of principle concepts. An introductory ÒPatients and PopulationsÓ course provides students with a foundation in genetics and disease, and equips them with the knowledge and skills to construct clinical questions, conduct literature searches, and evaluate the evidence they obtain from these searches and from databases and other sources. These skills are reinforced in a variety of contexts throughout the first and second years.

The second-year curriculum continues to be interdisciplinary and organ-system based, covering the abnormal organ systems. Within most of the organ systems sequences, a longitudinal patient case is introduced and reinforced in the classroom to provide more global understanding of the material to be learned, and discussed in small groups that provide opportunities for students to master important skills and make contributions to learning. These cases are robust and are unfolded to students in three to four progressive segments. Each case includes comprehensive personal, cultural and medical information and is accompanied by intended learning outcomes, specific questions and problems to augment learning, and thought questions to help students understand how patients and families experience illness. Questions are assigned to pairs of students in advance of small group meetings that are scheduled during the sequences; in each small group sessions the pairs present what they have learned in a format that is active and encourages group participation, and with material that is supported by a synthesis of literature searches and other resources. Faculty serve primarily as facilitators, helping students to make connections between the cases and what was learned in the classroom.

Students begin the two-year Family Centered Experience (FCE) early in the first year. Pairs of students are assigned to families that have been recruited as important resources to help them understand how health changes, chronic conditions, and serious illnesses affect patients and those close to them. Students explore important connections between health care and issues such as culture, health beliefs, age, gender, and support systems. They also learn about rapport between patients and their physicians. There are four to five family visits scheduled each year. Students use a workbook with readings, resources, and questions to guide them in their interviews with the patients and families. Thought questions help them reflect on their own experiences with illness and family dynamics and the experiences they are discussing with patients and families. Each visit is focused on a particular theme (e.g., patients and families, patients and their doctors) and is followed by a small group meeting where students share their experiences (personal and with families) in the context of specific assignments related to the theme for that particular visit.

Assessment of student performance in the longitudinal cases and the FCE are designed to cultivate and encourage skills embedded in the Goals for Medical Student Education and implied in many of the intended learning outcomes. In both experiences assessment is based on preparation, creativity and quality of presentations, efforts to facilitate peer learning, depth of understanding and presentations, participation in discussions, and quality of work outside the classroom.

Clinical Foundations in Medicine (CFM) modules are scheduled during breaks between the sequences to allow students to focus on clinical and communication skills without distraction. The modules are each one-week long and include clinical observations, hands-on physical examination skills, patient demonstrations, and topic-based small group discussions that include professionalism and the doctor/patient relationship. Writing assignments (often accompanied by readings) are graded and include essays designed to help students with critical thinking and reflective judgment skills. They are presented with difficult issues that constitute personal or professional dilemmas and they are challenged to describe their decisions and how they were reached.

The clinical clerkships and electives remain discipline based, and will now include expanded opportunities for career exploration with clerkships designed specifically to introduce students to various disciplines. Required clerkships include Internal Medicine, Surgery, Obstetrics/Gynecology/WomenÕs Health, Pediatrics, Family Medicine, Neurology, and Psychiatry. Emergency Medicine is recognized as an important context for learning how to provide high-quality, multi-disciplinary care in acute situations, thus challenging students to use the skills they are developing for reflective judgment and critical thinking, and will become a required experience. Weekly Seminars in Medicine will continue to provide learning in more complex clinical contexts that crosses disciplines and advances previous learning.

Clerkship assessments will include observation of specific skills, introduced and reinforced in the first two years, that signify continued maturing and development. These include goal setting, self-assessment and self-directed learning, patient presentations, leadership, and independent decision-making in complex situations.

Standardized Patient Instructors (SPIs) remain an integral element within and across the four-year curriculum. SPI exercises help students to master communication skills in challenging contexts such as patients from non-Western cultures with chronic diseases, patients with acute complaints who cannot agree to standard treatments because of religious beliefs, senior patients with unclear mental status, and patients who must be told that their disease has progressed to where palliative care and hospice care must be discussed.

This new program introduces a pedagogical foundation and specific learning designed to assure achievement of high-level intended learning outcomes developed within the framework of the Goals for Medical Student education. Faculty have integrated some new methodologies for learning and assessment into this program and have also continued many that were already aligned with the outcomes and goals. Continuing challenges include monitoring student learning within a multi-disciplinary and dynamic curriculum, identifying and improving upon assessment methods for measuring achievement of outcomes, and maintaining the high quality of our educational program for the M.D. degree.