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6/9/03. Curriculum Debriefing. Basic Structure. Year 1- Basic Structure. 1. Molecules and Cells Biochemistry, Cell Biology, Genetics 2. Normal Body How normal organs work and look 3. Body and Disease How the normal body can go wrong Possibly some diagnostics and therapeutics.
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6/9/03 Curriculum Debriefing
Year 1- Basic Structure 1. Molecules and Cells • Biochemistry, Cell Biology, Genetics 2. Normal Body • How normal organs work and look 3. Body and Disease • How the normal body can go wrong • Possibly some diagnostics and therapeutics
Year 1 Changes • Integrated: organ-system based • For “Normal Body” and “Body and Disease” • Addition of embryology and psychopathology • Addition of Normal Human Behavior Course • Eating, sleeping, sexual behavior, stress response, psych development • Schedule to incorporate one half day “off” per week for independent study • Need to extend year by 3 weeks • 2 weeks earlier start • 1 week out of Christmas break
Year 1: Question 1 How would you feel about an organ systems based approach to learning in the first year? • I would support the organ systems approach • I’m neutral on the issue • I think it’s a bad idea
Year 1: Question 2 Do you like the idea of having a half-day of independent study per week? • Yes • Undecided • No
Year 1: Question 3 What effect do you think a half day per week for independent study would have on your overall retention of the material? • Increase retention • No impact • Decrease retention
Year 1: Question 4 How would moving the start date two weeks earlier impact your decision to come to Duke? • I would have chosen another school • This would have negatively affected my decision, but I would have come to Duke for other reasons • This would have had no impact on my decision
Year 2 Basic Structure • Begin with 2 wk “OCY” • Intro to wards, practice H&P’s • 5 blocks of 8 weeks • Medicine (8 wks) • Surgery (8 wks) • Peds (6 wks) + Elective (2 wks) • Reduced from 8 wks, new schedule not decided • Ob/Gyn (6wks) + Elective (2 wks) • Reduced from 8 wks, decreased outrider experience • Family Med (4 wks) + Psych (4 wks) • Psych reduced from 6 wks • MPHS moved to fourth year • Additional elective (4 wks)
Neurology • Was a requirement that could be met in second year or in fourth year • New requirement: 2 week experience some time in medical school • 2-4 wk elective in 2nd year • 4 wk 4th year elective • NICU as a 4th year • Neurology clinic as ambulatory care experience • Can do neurosurgery selective as a part of surgery • The net result opens up elective time in the SECOND year
Interterms • 1 week period that precedes every 8 wk block • Why Now? • A way to better prepare for clerkships • Meets LCME mandates not elsewhere in curriculum in an active way • Integrate the curriculum • Meet clinical reasoning goals • Get acquainted with issues about access to health care • Learn about cost issues and health care
Interterm Goal: Prep For Clerkship • Review relevant basic science • Anatomy before Surgery • Introduce relevant basic science topics not already covered in first year • Clinical skills workshops
Interterm Goal:Develop Clinical Reasoning • Cases based on “common” clinical situations • Cough, fever, chest pain, back pain, etc. • Cases incorporate “orphan” topics • Pain, nutrition, palliative care, delivering bad news, cultural issues, etc. • Health systems, cost, policy, ethics relevant to cases wil be reviewed • Example of a similar case presented to an expert attending • Small group work to work through case issues and final presentation at end of the week to attending
Interterm Goal:The Health Care Team • Students will arrange to meet with other members of the health care team to better understand their roles • Chaplain • Pharmacist • Physical therapist • Hospice • Rehab • Etc.
Year 2: Question 1 How useful do you think the interterms will be? • Very useful • Somewhat useful • Not at all useful
Year 2: Question 2 What do you think should be the main emphasis of the interterms? • Basic science brush up for clerkship • Orphan topics • Ethics • Case-based learning of common diseases
Year 2: Question 3a - 1st Years • Would you rather have neurology required in the 2nd year or have elective opportunities prior to 4th year? • Neurology in the 2nd year • Electives in the 2nd year
Year 2: Question 3b - 2nd years • Would you rather have neurology required in the 2nd year or have elective opportunities prior to 4th year? • Neurology in the 2nd year • Electives in the 2nd year
Year 2: Question 3c - 3rd Years • Would you rather have neurology required in the 2nd year or have elective opportunities prior to 4th year? • Neurology in the 2nd year • Electives in the 2nd year
Year 2: Question 3d - 4th Years • Would you rather have neurology required in the 2nd year or have elective opportunities prior to 4th year? • Neurology in the 2nd year • Electives in the 2nd year
Year 2: Question 4a - 1st Years • What do you think about reducing the time for Pediatrics in favor of a two week elective? • Support • Unsure • Opposed
Year 2: Question 4b - 2nd years • What do you think about reducing the time for Pediatrics in favor of a two week elective? • Support • Unsure • Opposed
Year 2: Question 4c – 3rd years • What do you think about reducing the time for Pediatrics in favor of a two week elective? • Support • Unsure • Opposed
Year 2: Question 4d – 4th years • What do you think about reducing the time for Pediatrics in favor of a two week elective? • Support • Unsure • Opposed
Year 2: Question 5a – 1st years • What do you think reducing the time for Ob/Gyn in favor of a two week elective? • Support • Unsure • Opposed
Year 2: Question 5b - 2nd years • What do you think reducing the time for Ob/Gyn in favor of a two week elective? • Support • Unsure • Opposed
Year 2: Question 5c – 3rd years • What do you think reducing the time for Ob/Gyn in favor of a two week elective? • Support • Unsure • Opposed
Year 2: Question 5d – 4th years • What do you think reducing the time for Ob/Gyn in favor of a two week elective? • Support • Unsure • Opposed
Year 2: Question 6a – 1st years • What do you think about reducing the time for Psychiatry? • Support • Unsure • Opposed
Year 2: Question 6b - 2nd years • What do you think about reducing the time for Psychiatry? • Support • Unsure • Opposed
Year 2: Question 6c – 3rd years • What do you think about reducing the time for Psychiatry? • Support • Unsure • Opposed
Year 2: Question 6d – 4th years • What do you think about reducing the time for Psychiatry? • Support • Unsure • Opposed
Year 2: Question 7 • What do you think of including a four week elective? • Support • Unsure • Opposed
Year 3 • Choose 10 months or 12 months of research • Minimum was 8 months previously • Thesis requirement - due last day of research • Can be graded for honors at your request • Stats module, IRB/IACUC modules required • Can take course work if approved by study program director and if pertinent to project • PRACTICE: Continuity clinic • Up to a half day per week of clinic if approved with your mentor and study program director • Otherwise, a fourth year ambulatory care elective is required
Year 3: Question 1 • What do you think about the third year being at minimum 10 months? • It’s a good idea – less than 10 months is not enough time to allow me to get a real project done • It does not make a difference to me • It’s a bad idea – 8 months should still be an option
Year 3: Question 2 • What do you think about taking classes outside the medical school (i.e. clinical research design, genetics, cancer biology)? • I am looking forward to them • It does not really matter to me, but I like the option • They shouldn’t be allowed; classes take too much time away from research time
Year 3: Question 3a • What do you think about the continuity clinic during the third year? • Great idea - allows me to keep clinic skills sharp • Unsure • Bad idea - experience takes too much time away from research
Year 3: Question 3b - 4th Years • What do you think about the continuity clinic during the third year? • Great idea - allows me to keep clinic skills sharp • Unsure • Bad idea - experience takes too much time away from research
Year 4 - New Requirements • Required sub-internship and a separate “intensive” (ICU/ER/Anesthesia) experience • 4 week capstone class • What you need to know to be an intern • Law and medicine • Financial realities, insurance, licensing and credentialing, etc. • Advanced basic science
Year 4: Question 1 • What do you think about the sub-internship being a requirement? • It’s fine; I would have done it anyway • I would not have done it without the requirement, but it will be useful • A Sub-I should not be a requirement
Year 4: Question 2 • What do you think about the “intensive” (ICU/ER/Anesthesia) experience being a requirement? • It’s fine; I would have done it anyway • I would not have done it without the requirement, but it will be useful • An “intensive” rotation should not be a requirement
Year 4: Question 3a • What do you think about the capstone? • Support the idea; it addresses a lot of questions I may have • Unsure; it may be of benefit • Oppose; it is a waste of time and these topics should have been taught earlier
Year 4: Question 3b – 4th Years • What do you think about the capstone? • Support the idea; it addresses a lot of questions I may have • Unsure; it may be of benefit • Oppose; it is a waste of time and these topics should have been taught earlier
Year 4: Question 4a • Which part of the capstone do you think will be most useful? • What you need to know to be an intern • Law and medicine • Financial realities, insurance, licensing and credentialing, etc. • Advanced basic science
Year 4: Question 4b – 4th years • Which part of the capstone do you think will be most useful? • What you need to know to be an intern • Law and medicine • Financial realities, insurance, licensing and credentialing, etc. • Advanced basic science
Community Partner • Meets goals not currently met • Goals • Understand chronic illness and the impact on the individual and his/her family over time • Understand reality of cost and access to care problems • A longitudinal patient experience • Each student assigned to a family for two years and meets with them periodically • Would debrief PRACTICE group about patient progress
Community Partner - Question 1 • What do you think about the community partner? • Beneficial - it will address issues that are lacking in the current curriculum • Unsure - may be of benefit, but could be too time consuming • Bad idea - these issues are addressed elsewhere in the curriculum and this may not address these issues anyway