The Shared Discovery Curriculum
The Michigan State University College of Human Medicine is once more at the forefront of national efforts to improve the medical school experience.
Our Shared Discovery Curriculum is a truly innovative approach to medical education that is both patient-centered and student-centered. It promises to drive students further along the path to excellence in medical care while reducing student stress.
For decades, medical schools have delivered their curriculum in a "2 + 2" model, one in which the first two years are predominantly dedicated to learning basic and disease sciences followed by two years dedicated to clinical experiences that use observational and apprenticeship methods for learning. These typically have included lectures, small group learning, and numerous multiple-choice exams. This model has worked very well in training most physicians. So why make a radical change in curriculum delivery?
Michigan State University and the College of Human Medicine have longstanding histories of pedagogical innovation and success. The delivery of medical care is undergoing change, and physicians need new kinds of knowledge and skills to provide excellent care. In response to this, we have designed and developed a new approach to adult learning in medical school that we call the Shared Discovery Curriculum (SDC).
The SDC is an integrated curriculum that integrates underlying necessary basic and disease sciences along with clinical experience throughout all four years of the educational program—progressively building upon previously learned material. Students learn the clinical skills and necessary science they need to take care of patients throughout the entire curriculum. The curriculum emphasizes learning by doing and being useful in real clinical settings within the scope of your capabilities.
Students and faculty work and learn together in partnership to build strong relationships. The curriculum is designed to provide an assessment of students' progress on the path to graduation and as such, fewer tests are given. With fewer tests, though, comes a stronger emphasis on frequent feedback, quizzes, and the production of portfolios that document where you are in your journey to becoming a doctor (and what still needs to occur).
Learning societies are the intellectual home for learning in the Shared Discovery Curriculum. Each learning society of 20-25 students is composed of smaller Scholar Groups of 8-10 students supported by a lead clinical faculty member, four additional clinical professors, one biomedical scientist/professor, and one humanities professor. Faculty members within the learning societies serve as small group leaders and as advisors. On a regular basis, they review progress through the curriculum and coach students in the development of an individual learning plan that personalizes their educational journey.
Components of the Curriculum
There are four main components to the Shared-Discovery Curriculum:
- Preparation for Early Clinical Experience (PECE)/Early Clinical Experience (ECE)—MAROON
- Middle Clinical Experience (MCE)—ORANGE
- Intersessions (IS)—BLUE
- Late Clinical Experience (LCE)—GREEN
Preparation for Early Clinical Experience (PECE)
The primary goal of the PECE is to get students prepared to be safe (for themselves and in patient-care activities) in clinical settings. The curriculum emphasizes universal precautions, blood-borne pathogens, and basic physical exam and communication skills. Additional topics will include confidentiality, patient-physician relationships, caring for diverse patient populations, teamwork, and dealing with mistakes. In other words, it serves as a platform for initiating foundational knowledge for the study of necessary sciences and humanities of medicine.
The curriculum also initiates pertinent biomedical and bioethical topics, simulation with debriefing, large group activities, lab experiences, and highly structured independent study modules that form the foundation for early learning.
Early Clinical Experience (ECE)
As an integrated part of the ECE, ambulatory (outpatient) experiences introduce students to patient care. Students serve a useful function in the primary care clinical setting. These clinical experiences are integrated with foundational biomedical science, utilizing group and independent learning strategies.
As a member of a clinical patient care team, you learn and perform the roles of medical assistants (rooming patients, taking vital signs, reviewing medications/vaccinations, performing minor procedures like diabetic foot exams), function as patient education and care managers (phone call follow-up, medication tolerance/side effects, smoking cessation, healthy diet), and perform focused patient histories and physicals (focused on common patient complaints and concerns like hypertension, immunizations, upper respiratory infections, shortness of breath, painful urination, high and low blood sugars, immediate severe abdominal pain, joint and back pain, dizziness, mood-problems, and overall health maintenance and disease prevention).
The weekly curriculum includes simulation, large and small group sessions, labs, and independent study.
Middle Clinical Experience (MCE)
The MCE provides more advanced clinical experience in both ambulatory and inpatient care environments. The format/structure of learning remains similar to the ECE with continued integration of clinical work and necessary science. Students rotate through multiple clinical settings, learning with and from attending physicians, residents, respiratory therapists, physical therapists, pharmacists, social workers and other members of the health care delivery team.
|H&Ps in Emergency Department||4 weeks|
|OB/GYN Office||4 weeks|
|Adult Inpatient Wards||4 weeks|
|Pediatric Inpatient Wards||4 weeks|
|Pharmacy (including dosing services)||2 weeks|
|Newborn Nursery||2 weeks|
|Respiratory Therapy||2 weeks|
|Social Work||2 weeks|
|Palliative Care/Pain||2 weeks|
Students engage in various four-week course blocks placed strategically after the ECE and MCE, which allow for tailored study based on individual needs and interests. Intersessions allow students to learn foundational material and focus on areas of relative weakness, offer time to explore other areas of health (research, public health, etc.), and provide dedicated preparation time for USMLE exams.
Late Clinical Experience (LCE)
The LCE contains traditional disciplinary clerkship experiences (Internal Medicine, Family Medicine, Pediatrics, Obstetrics and Gynecology, Surgery, Psychiatry, and intensive care), which adjust the time spent on each of these disciplines based on previous clinical experiences. Having functioned in outpatient and hospital environments, your role on the health care team reflects the skills and experience you have acquired, enabling more robust participation in patient care. Ample opportunities for elective experiences are available. Integration with necessary sciences (Advanced Skills and Knowledge) continues through learning societies. There is time to pursue individual “certificates-of-emphasis”, such as public health, research, ethics, rural health, medical education, etc.
The Progress Suite
Advancement through the curriculum is assessed twice a semester through progress suite exams, in which students across all four years of the curriculum take the same exams, testing the entire body of knowledge for medical school. Rather than aiming for mastery of a small bit of knowledge on an exam, the goal is incremental improvement over time of all disciplines.
By using this approach to learner assessment, binge learning (and forgetting) is discouraged. Competency-based assessments include multiple choice tests as well as standardized patient encounters, feedback from peers and members of the educational and health care team, and student personal learning plans and portfolios.
Interspersed between progress suite exams are opportunities for extensive formative feedback. Quizzes, simulations, and portfolio reviews occur frequently and serve as a basis for practice and mastery of material. These low-stake, formative assessments with faculty feedback occur largely within the learning society. Through the use and development of personal learning plans, students and faculty work together in setting one’s goals and tracking progress to graduation and residency.
Course Integration and Grading
Traditional medical school basic sciences curriculum is fully integrated up and through the MCE. Throughout this part of the curriculum, each semester is one competency-based course graded on a pass/fail system. Curriculum is integrated and delivered across all experiences and disciplines.
Performance on the progress suite exams determines progress through the curriculum during the ECE, MCE, and Intersessions. During the LCE, departments also provide clerkship grades and retain the option of an Honors/Pass/Fail grading system. These grades become part of the student’s portfolio and contribute to the portfolio review and individual learning process. Progress suite exams determine the grade students receive in the Advanced Medical Knowledge and Skills course that takes place concurrently with the clerkships and electives.