Integration of Foundational and Clinical Sciences Across the Medical School Curriculum

1. Integration of Foundational and Clinical Sciences Across the Medical School Curriculum Neil Osheroff, Ph.D. Cathleen C. Pettepher, Ph.D. Tyler E. Reimschisel, M.D. Vanderbilt University School of Medicine

2. Curriculum 2.0 • To create a responsive, agile system of lifelong learning that: • Embraces innovation and improvement • Fully integrates learning with patient care • Rapidly translates discovery into practice • Supports the professional growth of teachers and learners • Creates physician leaders

3. Traditional Medical School Curriculum Pre-clerkship Clerkship Clinical Basic Sciences Clinical Basic Sciences Years 1-2 Years 3-4

4. Foundations of Medical Knowledge (FMK) Foundations of Clinical Care (FCC) Immersions Old Curriculum (pre-2007) Discipline/department-based courses Little (if any) integration of disciplines No crosstalk between courses No crosstalk between years Mostly passive learning Basic sciences, social sciences, & clinical separated Current Curriculum (1.0) Interdisciplinary courses Individual courses are highly integrated Some crosstalk between courses Little crosstalk between years Largely passive learning Basic sciences, social sciences, & clinical separated New Curriculum (2.0) Interdisciplinary blocks Individual blocks are extensively integrated Extensive crosstalk between blocks (horizontal & vertical) Extensive crosstalk between all phases Mostly active learning Basic sciences, social sciences, & clinical integrated Foundations of Healthcare Delivery (FHD) Learning Communities/Colleges Vanderbilt Curriculum 2.0

5. FMK Phase Professionalism Health Care Health Care Systems Leadership Infection & Antimicrobials Immune Response Inflammation Autoimmune Diseases Rheumatology Endocrinology GI/Nutrition Reproduction Neuroscience Brain/Neurology Mind (Psychiatry/ Behavior) Musculoskeletal Cardiovascular Pulmonary Renal Hematology Proteins, Nucleic Acids Signal Transduction Metabolism, Genetics Cell & Tissue Biology Fundamentals, Introductory Pathology, Anatomy, and Pharmacology All disciplines (including anatomy) are incorporated into every block

6. FMK Phase Weekly Schedule Educational modalities include: Large group sessions, Flipped classroom, Case-based learning, Team-based learning, Patient sessions, Laboratories (CTB, Path, GA) Students are treated as young professionals from the beginning of medical school

9. Assessment in FMK Phase Ultimate grading is Pass/Fail Weekly assessments: MCQ quizzes, essay questions (other: TBL, etc) Mid-block formative peer, self, and facilitator assessment of small groups (competency-based milestones) End-of-block summative assessment: 2-3 days (depending on length of block) 1-2 days self-regulated learning before assessment Integrated essay examination (includes all components taught during the block) Practical examination (tissue biology, pathology, and gross anatomy) NBME multiple-choice examination End-of-block formative peer and facilitator assessment of small groups (competency-based milestones) Students must receive a passing grade in knowledge and small group work in order to pass the block

10. Foundational Sciences in the Clinical Phases Foundations of Clinical Care Phase Continuation of Learning Communities Overt Discussion of the Foundational Sciences as Part of the Clerkships (Underlying basis of illness, symptoms, treatment, etc) Diagnosis and Therapy Course

11. Foundational Sciences in the Clinical Phases Immersions Phase Highly individualized phase tailored to the interests and needs of the student

12. Foundational Sciences in the Clinical Phases Immersions Phase Acting Internship (AI): Close approximation to internship Advanced Clinical Electives (ACE) Formal curriculum (objectives, competency-based assessment) Deliverable from student to care team Integrated Science Course (ISC) Multiple disciplines in focused clinical area Cancer, critical care, obesity, global health, congenital malformations, etc Topics Courses (Classroom-based) Focus on knowledge in focused area (statistics, development, policy) Master Adaptive Workplace Learner (MAWL) Students in ACE courses identify a patient-driven problem and in conjunction with a clinical and basic science mentor research the problem and report (written and oral) back to the clinical team Research/Scholarship (3-6 months)

13. Congenital Malformations ISC 4-week course for third and fourth year students Offered once a year Interprofessional care of children with complex congenital malformations Students work in pairs in 1 of 4 areas each week Urology, cardiology, craniofacial, and neurogenetics Sciences: molecular biology, developmental genetics, embryology, histology, anatomy, physiology, pathophysiology, pharmacology Other threads: systems of care, developmental disabilities, communication skills, interprofessional teams Clinical venues: OR, PICU/NICU, wards, clinics, cath lab Other venues: family resource center, community agency visits

14. Congenital Malformations ISC Classroom Learning Flipped classroom for core sessions (2-3 hours/wk) Research presentation (1 hour/wk) Simulation on conducting difficult conversations Team project using challenge cycle “Parent guide to the care of a child with CL/CP” Team presentations at end of course Early morning or early evening group check-ins each week for debriefing, Q&A, and feedback