Miller School of Medicine Dean Henri R. Ford, M.D., M.H.A., issued a bold challenge to participants in a showcase of proposals from the NextGenMD curriculum renewal planning teams: “We need to bring together the convergence of all the excellence that exists at the University of Miami to devise a new curriculum that is truly going to be Miller School specific — which hopefully in the next five to 10 years will become the envy of other medical schools in the country, if not the world.”
The chairs of eight planning teams, which have been meeting to consider what various elements of the new curriculum should look like, each presented three wide-ranging proposals for the faculty, residents and students at the showcase to consider. The participants then divided up into discussion groups to decide which proposals are most likely to lead to a groundbreaking, distinctive curriculum for the future of medicine.
As a result of those recommendations, Miller School leaders are now advancing significant changes including earlier and integrated clerkship experiences for students, an emphasis on personalized plans for second degrees and certifications and leadership skills development, an opportunity for some students to enter residency early, and an overhaul of the way students are evaluated.
“The new curriculum will produce physician leaders who will have the opportunity to shape the future of medicine, direct health systems, and champion discovery and its translation into clinical interventions,” said Laurence B. Gardner, M.D., executive dean for education and policy. “One of the things we are moving toward is a game-changing transition from infrequent, multiple-choice, high-stakes assessments to frequent, low-stakes assessments using a variety of methods that document for us and the student the pathway toward the achievement of competence.”
“Renewing our curriculum and our entire approach to education is going to take a tremendous effort, but will also be a lot of fun,” said Alex J. Mechaber, M.D., Bernard J. Fogel Chair in Medical Education and senior associate dean for undergraduate medical education.
The first question on the April 22 showcase agenda was: How do we admit the right students for this ambitious new curriculum? Robert W. Irwin, M.D., professor of physical medicine and rehabilitation, co-chaired the “Building from the Right Substrate” committee, which explored the changes the school should make to renew the admissions process.
“What do we want? We want smart people,” Dr. Irwin said. “We’re looking for someone who’s maybe a bit more mature, someone who has a more advanced learning style, who wants to have a dual degree, who wants to do something more than just medicine. … And we’re looking for diversity in all realms – not just cultural or gender or any one thing.”
Curiosity, creativity, compassion, leadership, research experience, mentorship and teaching experience, and writing ability are important considerations as well. “Do they have work experience with underserved populations?” Dr. Irwin asked. “That’s a key demographic here – this is our neighborhood.”
The committee also devoted a great deal of attention to what prospective students are looking for, including an innovative curriculum and grading system, extracurricular activities, scholarships, and, for many, a proximity to their families.
Amar Deshpande, M.D., assistant dean for medical education and competency assessment, summarized the new world of medical education: “As our understanding of adult learning has evolved and technology has transformed the need for just memorizing huge sums of medical knowledge, we are leveraging our unique strengths and attributes to remodel the curriculum to develop the future leaders and change agents of medicine locally and globally.”
The renewal committee for Phase 1, the pre-clerkship year, considered what foundational and translational sciences should be taught, through symptom-based virtual clinics that incorporate health systems science, social determinants of health and core clinical skills. A Phase 2 team looked at a redesign of the core clerkship experience, proposing detailed models for the best ways to learn the science, art and practice of medicine, and help students plan their future areas of concentration.
Phase 3 allows all students to develop a personalized pathway of excellence in a specialized area of interest, consisting of scholarly or dual degree pursuits. Early transition to residency will be offered to students whose career interests are well-developed and whose performance, based on entrustable professional activities, has been outstanding.
The “Medicine as a Profession” team considered themes important to the physician of the future, such as clinical skills, health system science, social determinants of health, public health, and nutrition. One key outcome might be that “health systems science” becomes the third pillar of medical education along with basic and clinical science. The committee emphasized that skills and attitudes such as leadership, teamwork, communication, and empathy must be part of what counts in the evaluation of students. “We need faculty with time, training, and support to teach and coach, mentor and advise,” the team’s report says.
The “Scholarly Concentration” committee looked at opportunities for dual degrees, advanced research, and pathways of emphasis. Central to their philosophy is providing a structural framework within the curriculum to teach students how to produce scholarly work. Among the key values they emphasized is creating a culture of social responsibility, community engagement, and equity. “Our graduates will be thoroughly grounded in population and public health, as well as the business of medicine,” Dr. Gardner said.
The “Assessment and Entrustment” group looked at how and when students should be entrusted with rising levels of responsibility for patient care. They considered how to expand the Miller School’s assessments to better evaluate critical thinking and clinical reason, and to better evaluate the entrustable professional activities.
“NextGenMD will use a robust, competency-based approach to assessments using simulation, standardized patients, inter-professional education and communication,” Dr. Mechaber said.
“Education as a Pillar” is imagining a redesign of the funding structure and resources to ensure the program’s success. Recommendations included transparency of funds flow to support educators, integrating students into existing ambulatory sites, and developing a robust faculty development component.
“This has been truly an amazing experience,” Dean Ford said of the showcase. “I couldn’t be more excited about all the things I’ve seen and heard. We are clearly on the right path.
“I thank you for your dedication, your commitment, your passion, your excellence, and everything else about you. This is fantastic!”