Integrated Curricula

1. Integrated Curricula

2. Objectives • Describe the arguments for integrating medical content in the context of student learning. • Cite examples of at least three means of integrating basic science and clinical content. • Demonstrate an appreciation of the logistical and human barriers to achieving integration. • Describe how an integrated preclinical curriculum might look.

3. Why integrate? • The dreaded question: “What have you had on this before?” • What is different about an integrated curriculum? • Does it have to be absolute? • What does it require?

4. Integrated Curriculum Rationale Why a System-based Curriculum? • University of Virginia School of Medicine • In response to several national trends in medical education and healthcare as well as the research, recommendations, and subsequent discussions of the Curriculum 2020, Education Task Force, and Working Group on Clinical Skills Education, the School of Medicine is creating a system-based curriculum that is more content-integrated, learner-centered, and clinical performance-oriented. Specific reasons for this change include: Scientific (i.e. evidence-based) teaching and learning decisions create learner-centered classrooms and more significant learning experiences which, in turn, lead to better academic outcomes. • Cognitive psychology has demonstrated that teaching, practicing, and assessing knowledge and skills in the context in which they will be used leads to better recall and application. The learning of medicine then should occur within a clinical context or framework to energize students and improve retention of knowledge, skills, and attitudes.

5. The USMLE Gateway Format will result in a more integrative and competency based licensure examination program. The USMLE redesign will lead to a substantial increase in and emphasis on fundamental medical science in clinical contexts as well as clinical decision making based "on the doctor's ability to access relevant information, evaluate its quality, and apply it to solving clinical problems" (see Comprehensive Review of USMLE and USMLE Moves to Next Step in Design Review). • The Curriculum 2020, Education Task Force, and Working Group on Clinical Skills have uniformly called for a content-integrated and learner-centered curriculum that develops the competencies required of a contemporary physcian. • The LCME expects an integrated, outcome-based medical education curricula comprised of well-defined learning objectives and active learning activities and appropriate assessments of students' clinical competencies. Medical school applicants have similar expectations.

6. The shift to an integrated, systems-based medical curriculum represents a national trend and is certainly not unique to the University of Virginia School of Medicine. Scores of medical schools have already or are currently creating system-based system curricula and/or incorporating active learning into each phase of medical education. Visit the Johns Hopkins University, Stanford University, University of Pittsburgh, UNC-Chapel Hill, University of Pennsylvania, Vanderbilt University, University of Vermont, and Yale University websites to read about a few of them. 

7. Issues to consider • Full integration vs. “choreography” • Informed choreography • Engaging the clinical faculty • Someone takes charge • Some are easier than others

8. What will be your format? • There is more than one way to integrate • Integrate around: Disease states Organ systems Life stages Environments AOA Competencies PBL presentations Comlex Is anything wrong with a hybrid approach?

9. Documentation is critical • Do the maps in detail • Utilize technology (CurrMit) • Do not underestimate admin. support needs • Ask the students if it is making sense to them… just because you have to label it as a subject does not mean you are de-integrating

10. Integrated Curriculum • The UCF M.D. program curriculum fully integrates basic and clinical sciences across all four years. The first two years of the curriculum are structured into modules, with the first year focusing on a fundamental understanding of how the various basic science disciplines relate to the normal human body. The second year takes an organ system-based approach and applies the basic knowledge of the first year to the study of clinical disease, pathological processes, and treatment. In concert with these aspects of medicine, the curriculum also covers psychosocial issues, cultural differences, communication skills, and physical diagnosis skills as they relate to the different topics in medicine. • The third and fourth years of the curriculum are devoted to clinical experience through clerkships, selectives, and electives. The clinical curriculum provides practical patient experiences complemented by basic science lectures, simulations, journal clubs, and conferences throughout the six core clerkships. Integrated throughout all four years of the M.D. program, Longitudinal Curricular Themes (LCT’s) will emphasize critical aspects of medicine and medical care that are not addressed in the basic core curriculum. The LCT’s include Ethics and Humanities, Gender-Based Medicine, Medical Informatics, Medical Nutrition, Geriatrics and Principles of Palliative Care, Culture, Health and Society, and Patient Safety. Each of these themes will be highlighted when appropriate in the core curriculum and reinforced through a variety of interactive experiences. • Overall, the four year medical curriculum at UCF is designed to fully integrate basic science and clinical medicine, provide students with appreciation of cultural diversity and the need for sensitivity in treating patients, foster professionalism in all interactions, and ignite a passion for life-long learning.

11. INTEGRATED CASE EXERCISE Students will be provided a case history for each patient along with questions to facilitate a subsequent discussion within the small group emphasizing: • the epidemiology and genetics of the patient’s disorder • the patient’s clinical features that are typical or atypical Of the disorder • the features of the disorder the patient has not manifest • the immunologic mechanisms contributing to the patient’s disorder • cellular, biochemical and/or immunologic targets for treating the disorder • current areas of investigation relevant to the disorder • Group reports summarizing the case discussions will be submitted, followed by a review session convened with the entire class to review the patient presentations and discussion questions. The review session will also emphasize summer student research opportunities in the Division of Clinical Immunology and Rheumatology applicable to the respective disorders.