Tree as Symbol
We felt that the tree was a fitting symbol for this new curriculum. The tree has three parts, a strong foundation and roots, a sturdy trunk, and an expansive canopy of Branches.
Our curriculum changes proposed a strong professional and scientific foundation, progressing to core clinical experiences for the general physician, and finishing with an exploration of professional commitment and excellence in the expansive field of medicine.
The new curriculum continues the tradition of developing clinically excellent physicians who are ready for the practice of medicine. There is an increased emphasis on leadership and the preparation for a path of influencing positive change in health and health care no matter where our graduates serve.
Faculty developed eight essential elements of the new curriculum. The major changes to the structure of the program would begin in August 2016 with phased implementation over the ensuing five years. The elements evolved as pilots and experience drove further review and revision. All changes were subjected to approval by the Curriculum Policy Committee.
The original eight elements as written and approved in 2012 outlined the following curricular changes and additions (see current curriculum highlights):
Elements #1 and #2
Scientific and Clinical Foundation (the “Trunk”): The major curricular component for the first two years of medical school focuses on developing the foundational scientific and clinical skills for the general physician graduate. The first year is science-focused; main elements of the Scientific Trunk (Year 1) include:
- A “Launch” program at the beginning of medical school — providing an introduction to learning, leadership, and the clinical setting.
- A foundational course in science to provide a critical overview of the key constructs and scientific principles for learning medicine, as well as a course that introduces Diagnostics and Therapeutics.
- Fused organ system courses in which normal and abnormal principles and knowledge are taught together around a particular organ system, built upon the previous courses.
- A Chief Concern course to enhance the relevance of the science through clinical reasoning and case study.
- An Optimizing Patient Care curricular thread that will integrate shared decision-making, patient-centered communication, and evidence-based medicine throughout the Scientific Trunk.
- The second year is clinically-focused with two phases; main elements of the Clinical Trunk (Year 2) include:
- Phase I is where students will encounter and interact with patients with core conditions in the first half of each day followed by opportunities for deeper scientific and clinical learning related to those conditions through modules and scheduled seminars in the second half of the day.
- Phase II is where students learn through departmentally organized clinical rotations, working in teams to learn and provide patient care in the inpatient, outpatient, and emergency department settings. This is similar to the current clerkship model, but will include greatly enhanced coordination across rotations and departments and with other learning sessions.
- Leadership sessions, Paths of Excellence seminars, Optimizing Patient Care curricular thread, and the Doctoring course are also an integral part of the Clinical Trunk.
Advanced Professional Development (the “Branches”): This curricular component follows the Trunk, and allows the student to develop advanced skills and knowledge within clinical domains. Students will progress through one of several flexible developmental tracks (“Branches”) with milestone-facilitated transitions between medical school and graduate medical education programs. Key features of each Branch include:
- Clinical Experiences: Branch specific sub-internships, clinical electives within and outside a Branch, residency prep courses, and core Emergency Department and intensive care unit rotations.
- Scientific Learning: Branch-specific science seminar series, online courses, scientific electives, enhanced opportunities to continue scientific research.
- Professional Activities: self-directed projects (including research), Paths of Excellence electives and capstone experience, optional coursework at other schools.
- Individualized Learning Plans to align with professional intention, fostered by deliberate career development and mentorship. Students are allowed to change Branches, and no Branch will limit the choice of career.
- Competency-based assessments will occur frequently through the Branch, and progress will be governed by the achievement of medical student and residency milestones.
Paths of Excellence: This curricular element will educate students on domains relating to health care and medicine at the systems level. Students will learn core content within each Path. In following years, students will identify a Path (e.g., health economics, global health, ethics, scientific discovery, among others) to develop a more in-depth understanding through seminars and project work. Six to 12 Path options will be developed with the ability for students to choose a customized path. Each student must complete a capstone project by graduation, to demonstrate proficiency in his or her chosen Path.
Leadership Development: This longitudinal program aims to develop collaborative physician leaders through specific skills training, professional development coaching, and integrated learning with other curricular components. Content will center on the themes of teamwork, communication, systems proficiency, and problem solving. There will be leadership training for all students throughout each year of the program. Additionally, Doctoring faculty will help coach students on leadership and professional development.
Interprofessional Education: This set of curricular experiences will help develop physician effectiveness in a care team setting. Students will learn from allied health professionals (as well as from patients and physicians) in longitudinal clinical learning experiences during the first year of the curriculum. Increased cooperation with the other U-M health profession schools will result in co-learning opportunities in classroom and clinical interprofessional environments in later years.
Integrated Assessment System: This component presents a new framework and approach to assessment, in order to better align undergraduate medical education (UME-medical students) to graduate medical education (GME-residents and fellows). The Integrated Assessment System will feature more formative low-stakes assessment strategies in the “Trunk” portion of the curriculum, gradually transitioning towards competency-based assessment elements in the “Branches.” Competencies in the new curriculum will be more closely aligned with ACGME competency domains as well as UMMS-specific objectives.
“M-Home” Learning Community: This new structure encompasses longitudinal learning communities in which students will be grouped into one of four diverse “Houses.” Each of the four Houses will consist of students, Coaching and Doctoring faculty, a House Director, and learning and support staff. A four-year Doctoring Course will be anchored in the M-Home, taught in a small-group seminar format. The course lays the foundation to develop an emerging mastery of diagnostic and clinical skills, critical reasoning, teamwork, communication, and effective collaboration with patients/families and health care providers to treat disease, alleviate suffering, and optimize health.
In addition, there will be learning experiences to support the student’s development of his or her professional identity, and enhanced attention to personal wellness and support for others through this community. The M-Home structure will facilitate group learning, social support, and professional mentoring.
2015 Faculty Vote Q&As
In anticipation of any questions current and prospective students and faculty may have had about the curriculum transformation at the time of the June 2015 faculty vote, the Curriculum Policy Committee created the following list of Q&As.
Find the most up-to-date information about the curriculum.
Why change the curriculum if students are getting good outcomes and matches?
We acknowledge that UMMS graduates are finding success in matches and receiving good feedback from residency programs. We anticipate that the directed professional development portion of the new curriculum (Branches) will extend the competitive advantage of our graduates in this respect even further. We also have to acknowledge that health care is in need of change, and medical education has the responsibility to produce the physician leaders capable of leading change in health care.
What is this new curriculum about?
The new curriculum is designed to graduate physician leaders who can affect positive change in health care. There are four major aspects to the curriculum that contribute to the development of an excellent physician who is also oriented toward leading change.
- Scientific & Clinical Foundation. Focuses on foundational scientific knowledge and clinical experiences. Also develops learning and thinking skills for students to be lifelong learners.
- Longitudinal Learning Community. Supports the development of the student’s clinical skills and professional identity within a small-group, mentored learning environment.
- Directed Professional Development. Provides meaningful choices and learning experiences based on the professional direction of the student.
- Applied Leadership Education. Prepares students for leadership in the general clinical environment and for specialized contexts (e.g. health care policy).
Are we condensing three years of content into two years of the “Trunk”?
The new curriculum has a fundamentally different structure from the current curriculum. So it's hard to compare them side-by-side. For example, the new curriculum will teach science in all (four) years, with the content adaptive to the clinical direction of the student. Also, there will be more foundational clinical experiences up front to set the context for learning within medicine.
Are we de-emphasizing science in the new curriculum?
No. Science is a cornerstone to modern medicine, and the School is committed to the learning of science and scientific thinking. It is important in the learning of science not to focus solely on memorizing facts. With the explosion of scientific knowledge, we must also develop the ability to access and manage information. In the new curriculum, science will be taught every year (not only in the first two), with the opportunity to deliver scientific content relevant to the professional and developmental context of the student.
Will students be able to make informed choices about their “Branch”?
In developing physician leaders, it's very important for students to develop strong professional identities and to make meaningful choices of professional direction. The early portion of the curriculum will focus heavily on providing the experiences and the mentoring support needed to make informed choices. Students will have the some flexibility to change “Branches” if they so choose.
What is the timeline for the changes?
At the beginning of 2013, the School began the process of developing a forward-looking curriculum that will allow our graduates to thrive in the rapidly changing health care environment. We have been implementing small-scale educational innovations as a part of this effort. We have identified a suitable curricular model and are designing the structures and content within the model.
Students who matriculate in 2015 will have a similar architecture to the current curriculum. The major architectural changes to our program will begin in 2016 and be progressively changing over the ensuing 3 to 4 years.
How will the graduate of the new program be different?
With this new proposed curriculum, we believe every medical student who graduates from the University of Michigan will be able to lead change in health, health care, and health care science. Leadership for our students encompasses being able to work effectively in teams, communicate at all levels and provide influence, problem solve, and understand and navigate health care systems. The capabilities of the graduate will continue to center on an outstanding foundation of knowledge and skills, with a demonstrated commitment and excellence in patient care. In addition, the graduate will develop the habits of lifelong learning, driven by a passion for inquiry and discovery. Learn more about our vision for the graduate.
What are the main differences between the old and the new curriculum?
The primary differences are threefold:
- The new curriculum has 8 different components, as opposed to only a preclinical and clinical phase;
- The new curriculum provides an integrated foundation in the first two years, with both science sessions in the clinical setting, and early clinical experiences from day one that will drive learning;
- The new curriculum provides opportunities for students to rigorously explore their interests and passion in depth through Professional Development Branches and Paths of Excellence, progressing at a flexible pace that is determined by their capabilities and specific achievement toward the goals of graduation.
When will the changes be implemented?
Leadership events, initial Paths of Excellence, and an interprofessional course have been put in place the past two years. In fall 2015, we launched the M-Home and new Doctoring course, new Paths of Excellence, Initial Clinical Experience (now Interprofessional Clinical Experience) for M1s, and an early version of the learning Portfolio. The newly renovated medical education center in the Taubman Health Sciences Library also opened. The structure of a 2-year preclinical and 2-year clinical curriculum will remain in 2015. In August 2016, the proposed new structure with a foundational Trunk of integrated science and clinical experiences will launch, accompanied by expanding Leadership and Paths of Excellence programs, a new Assessment system, a maturing M-Home, and more Interprofessional Education offerings. The second year of the Trunk will be implemented in September 2017, and the full set of Professional Development Branches will be offered in Fall of 2018.
Are you just creating a 3-year medical school?
Absolutely not. The approach to the new curriculum will be competency-based, meaning that students will be able to graduate from medical school after they have not only completed requirements, but also can show that they are ready to enter supervised practice in residency. This will be done through the measurement of their capabilities through assessments that are based on what is expected to enter a profession, and what students must be able to do on day 1 of residency. We fully expect that the majority of students will be able to complete their requirements in 4 years, but some may be able to finish in 3.5 years, and some may require longer than 4 years.
Aren’t you just shrinking science into the first 13 months of medical school?
No. Science is a cornerstone to medicine and the School is committed to the learning of science and scientific thinking in all phases of the new curriculum. The new curriculum will teach science in all years with the content adaptive to the clinical direction of the student, with an added emphasis on developing the ability to access and manage information. Science instruction will happen in both the Trunk and Branches. Students will develop a foundation of scientific understanding in Year 1 of the Trunk in lectures and small groups. This progresses to specific scientific learning that is driven by clinical experiences in Year 2 through seminars and small-group sessions. Students will then deepen their understanding of the science in the clinical setting as they develop through their chosen Branch, encountering science-specific rotations, performing research, and being deliberately taught about the scientific underpinnings of illness in their subinternships and bootcamps.
What is the overall structure for Foundational Science experiences?
Foundational Science experiences initially occur in the Scientific Trunk (Year 1 of the curriculum), beginning in August 2016, lasting through September 2017 (13 months total). After an Overture (where students begin the year with 2 weeks to experience their learning community and the health system), students will encounter a sequence of “building block” courses, including Science Foundations, an Introduction to Diagnostics and Therapeutics, and an Immunity and Defense course. Students will work through organ system-specific “fused” courses where science is presented in the context of normal and abnormal processes. Finally, these courses will be interspersed with Chief Complaint modules, part of a year-long course where students will dive into clinical problems that stimulate clinical reasoning, inquiry habits, and application of science in the case discussions.
Student will encounter a more consistent schedule to each week, with a heavier emphasis on small group active learning sessions (i.e., labs, case discussion) on specific half days, and time allocated to prepare for these sessions.
What are the required clinical rotations in the new model?
The Clinical Trunk (Year 2 of the curriculum) is slated for launch in Fall of 2017. Students will transition into this component through 2 phases. The goal of Phase 1 of the Clinical Trunk (3-4 months) is to provide structured, deep scientific learning in the clinical setting. Students will rotate through interdisciplinary, organ-system specific clinical experiences (e.g., cardiopulmonary), where they will work directly with patients and also have deliberate time to learn about the science connected to the patients and illnesses they encounter. In Phase 2 of the Clinical Trunk (8-9 months), students will learn through departmentally organized clinical rotations, working in teams to learn and provide patient care in the inpatient, outpatient and emergency settings. Unlike the current clerkship model, coordination of education and clinical encounters across the different rotations will be greatly enhanced. Heavy emphasis will be placed on scientific learning and debriefing of key issues in health care that students encounter in their patient care activities. Phase 1 and Phase 2 will differ in their standardized weekly schedule, reflecting their different goals. Students will then enter the clinically rigorous experiences in the Branches in Year 3 with a greater ability to care for patients, and learn from their care.
How will students continue to do research in medical school?
A large percentage of our students participate in research in medical school; expect that to continue and even grow. Medical students will continue to have the opportunity to participate in our Student Biomedical Research Program, supported by both our NIH T-35 grant and additional funds in the Dean’s Office. There will be a summer break towards the end of Year 1 of the curriculum. In addition, all students will be required to complete a capstone project by graduation, as part of their Path of Excellence, the large percentage of which we expect will include research. Finally, students will have time to engage in inquiry-based research during their chosen Professional Development Branch. Capstone projects will need to be rigorous, and also written or presented as a scholarship artifact.
How will students find time to work on their Path of Excellence (PoE) in the new curriculum?
As a core element of the new curriculum in 2016, the medical school is allocating dedicated time and a program structure to maximize our medical students’ success in this component. First, there are 4-6 hours per month of required classroom time in the M1 year dedicated to the foundational material across Paths of Excellence. Second, students will be expected to spend approximately an equal amount of time outside of the classroom engaged with their own PoE curriculum. Third, Path-specific learning communities will periodically come together in all years (during M-Home time) to enhance shared reflection and learning. Finally, it is anticipated that most students will take at least one block “course” within their PoE during the Branches to work on their capstone experience. An additional elective course during the Branches will be available for students when their capstone warrants it.
What are the different types of Professional Development Branches?
Professional Development Branches are scheduled to be launched in Fall 2018. Currently, there are 4 different types of pilot Branches:
- Patients & Populations: Focus on community based care and population management.
- Systems-Focused and Hospital-Based Practice: Focus on care within hospitals and large health systems.
- Procedures-Based Care: Focus on comprehensive care of patients and systems as they come together through the perioperative journey.
- Diagnostic and Therapeutic Technologies: Focus on the diagnosis of disease and the role of advanced technologies in health care.
Can you explain the basic elements of a Branch?
All students will work with their mentor to develop an individualized learning plan towards the beginning of the Branch, driven by educational goals and needs. Each Branch will have core elements or requirements that provide clinical training and exploration. These will include a clinical experience in the Emergency Department, intensive care unit, and Branch-specific sub-internships. Each Branch will have opportunities to pursue professional interests, chosen based on milestone assessments and their individualized learning plan. Each Branch will have rigorous scientific learning with clinical practice, designed to complement a student's’ professional development, comprised of science rotations, experiences that bring science to the bedside, and the opportunities to deepen their research activities. Finally, each Branch will have time for developing a professional intention with a plan, designed by the student and their mentor to develop a broad range of skills to become leaders in medicine. This will include residency prep courses and capstone experiences where learners develop their specific readiness for residency and the professional domain they will be entering.
Why are you asking students to declare their career choice earlier?
We do not anticipate a change in the timeline in which students must declare a career choice. Branches are being designed to support all students who decide at different times in their education. There will actually be a significant increase in the amount of time that students have for career exploration (nearly 10 months, up from 4 months currently), both to pursue their goals, and also to determine if their own abilities are a good “fit” for that field. Students will have to declare a Branch to pursue, but not until after a period of exploration in the early phase of the Branch, nor will a Branch decision preclude applying to any field, and student will also have the opportunity to switch Branches.
How will the M-Home and Houses be structured to benefit the students?
The M-Home, as the new longitudinal learning community, will serve as a home base for each of the students. Each house will have consistent, clear support structures that will engage students from Day 1, including a House Director, Doctoring faculty, counselors and a learning specialist. The integration of support within the Houses over the entire curriculum will allow for the enhancement of student wellness during periods of stress that naturally happen. In addition, students will be able to connect with each other in small groups over time, providing more individual attention. Finally, there will be integration with students in other years to foster meaningful engagement, support and mentoring.
Learn more about the current M-Home.
You said that every student will be able to lead change. What do you mean by leadership, and how will their activities prepare them to be leaders?
Every physician leads. Leadership is required to bring about positive change in health care in all of its domains. Leaders must work in teams, influence and communicate effectively, understand systems of care, and solve health care problems. These are the four domains we will focus on in our Leadership Development program for this new curriculum. Our curricular program will develop students through large events (like visioning, competing values activities, improvisation work and messaging training), small group interactions, and didactics. There will be a strong emphasis on practical application of leadership principles in all components of the new curriculum, and in extra-curricular settings. In addition, leadership coaches will help students with reflection and personalized professional growth.
Learn more about the current Leadership Program.
What are M1 students going to get out of being in the clinical setting from the beginning?
Students will be part of the Initial Clinical Experience (now Interprofessional Clinical Experience) from Day 1, immersed in the clinical setting as part of the Overture, and then biweekly during Year 1 in the Longitudinal Clinical Experience. In both of these settings, students will have four activities – to inquire, observe, reflect, and analyze.
Students will focus on:
- Models of communication among health care providers in teams and with patients.
- Roles of other health care providers in the patient care setting.
- Systems of care delivery in different settings.
The ICE will foster a Patient-Centered approach to systems and teams, and will stimulate habits of inquiry among students.
Learn more about the current Interprofessional Clinical Experience.