Report Card for a Curriculum: Inaugural Class Graduates From Downstate Integrated Pathways this May
SUNY Downstate’s medical curriculum took a decade to plan and implement
The SUNY Downstate Class of 2017 will be the first class to graduate from four years of the College of Medicine’s new Integrated Pathways curriculum, launched in August 2013.
“They seem to be doing very well,” said Dr. Jeanne Macrae, Senior Associate Dean for Academic Affairs. “Before we declare victory, we want to see how the Match comes out, but they have certainly given us some very good feedback. They said they’ve felt very competent, clinically. Objectively speaking, their test scores are very good. By all the indicators we have, we expect them to do very well.”
A total of 150 faculty members and students restructured Downstate’s curriculum between 2008 and 2013. One goal was to introduce patient-focused clinical study earlier in the medical school career.
“It involved blowing up the entire schedule of the first two years and redoing it hour-by-hour with new activities,” said Dr. Macrae, the longtime residency program director for Internal Medicine who served on the curriculum steering committee. She now oversees Downstate’s four-year curriculum, overall.
“We have the patient wrapped as much as we possibly can into the entire scope of the curriculum,” she said.
Medical school traditionally starts with two years of basic science followed by two years of clinical study, as alumni are aware. Now, basic science comes paired with clinical instruction. An overview of body systems early in Foundations of Medicine, for example, is followed by a lesson on how to perform a physical exam.
“Let’s say they’re learning about the knee,” Dr. Macrae said. “They dissect the knee on their cadaver; learn about the radiology of the knee, and how to examine a patient’s knee. They learn how to talk to a patient about problems with the knee, and the diseases that occur in the knee, and doing this all in the same week.”
Downstate now also starts its small-group, problem-based learning sessions by interviewing a live actor to reflect realistic information gathering. First years who start school in late August are observing physicians in actual clinical environments by October.
Each of six pre-clinical courses ends with a weeklong assessment. Students are tested for medical knowledge and clinical skills, graded on patient interviews and examinations, and on the student’s professionalism and communication skills. If they fail any component, they fail the unit and undergo remediation. The assessments have teeth, Dr. Macrae said.
Downstate began its curricular update almost 10 years ago, with many other US medical schools. Healthcare was changing, and still is. The trend is toward patient-centered care, medical care in teams verses solo practices, more data, and more readily available data.
“There is a whole new set of competencies that doctors need to have,” Dr. Macrae said.
Downstate also needed to comply with changing LCME standards and to make sure students were fully prepared for national tests and licensing exams.
An earlier start to the clinical rotations, now the April of second year, also helps fourth-year students make more informed choices about residency.
“If you really didn’t know what you want to do, come July of fourth year, it is really very hard to arrange enough experiences to make a rational decision about what to do,” Dr. Macrae said. “Plus, in some of the competitive residencies, they weren’t taking people who hadn’t done a rotation in that field at home, plus one in their institution, plus other activities. So, there was felt to be a need for students to have a longer period of time to deal with these residency-related issues.”
The curriculum divides the four years of medical school into three phases. The first phase, Foundations of Medicine, focuses on basic science. During the second phase, Core Clinical Medicine, students complete paired clinical clerkships over a total of 48 weeks. The third phase, Advanced Clinical Medicine, follows late in the third year, lasts 14 months, and rotates students thorough the full spectrum of sites of care: emergency room, inpatient floors, critical care units, palliative care services and nursing homes. Students also complete five months of elective rotations.
“There is less basic science initially,” said Dr. Macrae. “We end basic science three months sooner than we used to.” However, basic science is also woven back in to the final years of medical school for a complete integration.
Learn more about the Integrated Pathways curriculum on the SUNY Downstate site.