Years 1 & 2
First- and second-year students study basic and clinical science in a hybrid curriculum that makes extensive use of small group learning, supplemented by large group interactive sessions. Previous department-based courses such as biochemistry, physiology, and microbiology are integrated and presented in the context of clinical problems to encourage a more logical sequence of learning and to highlight the clinical relevance of the basic sciences. This helps students learn in a context that more directly applies to how they will care for patients.
The emphasis on an integrated approach to teaching and lifelong learning begins in the first year to help students learn the structure and function of the human body as well as understand social and behavioral aspects of medicine. It continues in the second year, which emphasizes pathophysiology and clinical decision making. Basic science is also revisited through the clinical skills course.
Year One Sample Week
During year one, AU/UGA Medical Partnership students spend time in small and large group learning environments, as well as in histology and anatomy labs.
Adjusting to the Academic Challenges in Medical School
In August 2013 our fourth class of 40 students entered their first year here at the Medical Partnership. They come from good schools, are well prepared and very talented, and they have achieved success in all their prior academic pursuits. Yet just like each class before them, they are learning they must adjust to the academic and professional challenges of medical school. What makes the experiences of learning and studying in medical school so different from their prior experiences? Here are twelve factors to consider:
- The volume of knowledge to be mastered in each week of school is enormous. For most students, the volume is much more than they learned in college, even in their toughest courses.
- The complexity and intrinsic difficulty of the knowledge is also great, as the subjects pick up where their advanced courses left off. Most students are excited to learn this material, but it is still challenging.
- They are expected to connect the knowledge across subjects into coherent explanations. Since human structures and functions are linked together, students are expected to learn them together. This integration across subjects is unfamiliar to most entering students.
- They are expected to make their learning cumulative across weeks and courses. Understanding the biology of human health and disease and the foundations of doctoring requires the retention and integration of knowledge across time. For many students, this may be their first real experience with this expectation.
- They are expected to apply what they learn to authentic clinical cases, both in our case-based small group learning and elsewhere. This requires not only learning the knowledge itself, the “what”, but also learning the “how” and “when” to apply what they’ve learned to patients’ situations. Most students are excited to learn this, but it can still be challenging.
- They are expected to engage in a wide variety of learning activities, ranging from the more familiar large group or laboratory session to the less familiar team-based learning, small group learning, and service learning activities. For many students, this may be their first experience with such a wide range of formats.
- They are expected to engage in active and interactive learning nearly every day of every week. While this style of learning is more effective, it can also be more demanding of students’ attention and their abilities to think and learn “on their feet”.
- They are expected to work and learn in teams, such as in case-based small group learning, anatomy lab, and community health projects. Learning this way is also very effective, yet most students are relatively unfamiliar with this approach.
- They undergo frequent assessments, including weekly quizzes, laboratory practical tests, module final examinations, and assessments of their clinical skills. For most students, these occur much more frequently than in their prior experience. As students mature and their motivations to learn move from mostly externally-focused, such as by grades, to become mostly internally-focused, such as the professional goal of excellence in caring for patients, they come to recognize these assessments help them gauge their learning progress toward their goals.
- They may no longer be the “best student” in the class. For many students, this may be their first experience being in a whole class full of people just like them – talented, knowledgeable, hard-working high achievers. Yet as they collaborate with, rather than compete against, their peers, and as they mature, most students come to value their colleagues and develop appropriate confidence in their ability to contribute to the team.
- They are expected to develop their identities as professionals. Most students are excited to put on the white coat, both literally and figuratively, but for most this is their first experience with this degree of professional responsibility and all of its implications.
- As part of their professional responsibility, they are expected to seek help when they need it. Many students have had little prior need to ask for academic help, so they may feel anxious or ashamed in doing so. Also, they may be unfamiliar with a school that offers as much help to them as they have available at the Partnership.
In the face of these challenges, our experience here at the Partnership is that while every student must adjust, nearly all rise to the occasion and adapt successfully. There are many people to help, including their small group facilitators, their large group presenters, their faculty advisors, and their upper class mentors. In addition, the Student Affairs office checks with each student regularly to see how they are negotiating these adjustments. The Curriculum office also meets with many students for counseling on topics such as study skills and test-taking strategies. Both offices collaborate to monitor students’ academic and professional progress and proactively reach out to students who may need help. The Student Affairs office can also facilitate referrals for additional outside help, if needed. Here at the Partnership, we take this partnership with students very seriously – we want every student to succeed in meeting the academic and professional challenges of medical school.
- by W. Scott Richardson, M.D., Campus Associate Dean for Curriculum
Learning Science Through the Use of Medical Cases
One of the defining characteristics of the curriculum at the Medical Partnership campus is how we learn medical science through the study of clinical cases. Three days per week, both first and second year students work in small groups to study authentic clinical cases that are written and selected to fit the week’s curricular themes. The cases are divided into segments that are revealed sequentially, so they unfold over the week. This gives students the opportunity to discuss each segment and learn new knowledge before moving to the next segment. It also gives students the chance to find gaps in their understanding during the sessions and then fill these gaps between sessions.
In the first year, learners study one case per week, and questions prompt students to pursue a broad range of relevant knowledge, from genes to society. In the second year, learners study two or three cases per week, moving at a faster pace and demonstrating more independence in their clinical reasoning.
In both years, the main emphasis is on how to connect knowledge from several scientific disciplines and on how to link this knowledge to the clinical decisions involved in the cases. At a deep level, these cases show students how to use scientific knowledge while thinking and learning like doctors.
We have organized our curriculum this way because of all that we have learned from our collective teaching experience and from the scholarship in medical education and the learning sciences, summarized in the following six notions. First, cases provide authentic context in which the knowledge to learned is used. This helps in two ways – at the beginning, it helps students find motivation to learn and understand their need to know the material; toward the end, it provides students with realistic opportunities to apply their new knowledge, thus reinforcing their learning.
Second, students become engaged in an active process where they work together to solve problems and make decisions by pooling their existing knowledge. This active, collaborative inquiry leads to more complete understanding.
Third, cases provide an effective way to organize each week around an important theme, select the learning activities and resources to fit this theme, and align the assessments to check students’ learning achievement. Fourth, cases provide an effective means for us to integrate the learning, both ‘horizontally,’ i.e. how several sciences fit together in context, and ‘vertically,’ i.e. how the sciences fit into clinical decisions and actions.
Fifth, learning science with cases aims to increase our students’ ability to transfer knowledge learned in the classroom to the care of their patients in clinical settings like doctors’ offices and hospitals. Sixth, learning sciences with cases serves to remind students why they are here – to learn how to care for the whole person in each patient.
- by W. Scott Richardson, M.D., Campus Associate Dean for Curriculum
12 Notions of the Medical Partnership Curriculum
The Turtle on the Fencepost: Twelve Notions for Our Curriculum
As the saying goes, if you see a turtle sitting on a fencepost, you know it didn’t get there by itself. And so it is with curriculum – we have designed the curriculum here at the Partnership using what we’ve learned from the ideas, writings, and experiences of many scholars in medical education and the learning sciences in general. From the many, twelve notions stand out as essential:
- Person-centered – We aim to provide education that is aligned for the care of whole patients and whole communities, with attention to the development of the professional identity of the physician as a whole person.
- Knowledge-focused – We emphasize building sound knowledge (i.e. not only explicit propositional knowledge, the “know what”, but also the implicit experiential knowledge, the “know how”) that is robust enough for the full range of tasks on the cognitive taxonomy (i.e. not only recall and application but also analysis, synthesis, and higher order tasks), as well as emphasis on being well-equipped to rebuild sound knowledge and experience over the course of one’s career.
- Competency-based – Starting with our Partnership Campus mission (which can be paraphrased as ‘to educate excellent physician leaders for 21st century Georgia), we have used the Medical College of Georgia of AU’s adaptation of the ACGME 6 Core competencies to deliberately align the curriculum to help students reach developmental milestones as they grow to reach professional competence in doctoring by the time they graduate.
- Multi-dimensional – We have intentionally designed and implemented the curriculum to help students grow in both ‘content’ and ‘process’ in all 4 main dimensions of learning: cognitive, affective, psychomotor, and conative, to help them prepare themselves for a lifelong career of sound decisions, sound actions, and sound learning.
- Developmentally sequenced – We have conceptualized the learning tasks as occurring along a spiral learning trajectory that returns and builds on prior learning achievement, and includes the purposeful scheduling of deliberate practice to develop expertise.
- Evidence-based – We have deliberately used the best available research evidence in making decisions about both the ‘content’ (i.e. what we should learn) and the ‘process’ (i.e. how we should learn) for the curriculum, as well as in deliberately helping students build their skills for high-quality, evidence-based clinical practice over their careers.
- Balanced formats – We have intentionally employed an adaptive combination of both active and passive learning strategies and activities aimed to optimize student engagement and learning achievement.
- Contextualized – We have sought to provide authentic health care contexts, whether in individual patient care or in serving communities, for most or all of the content students are expected to learn.
- Collaboration – We have deliberately designed learning activities that involve all students in learning together in teams, not only to emulate the situation of the majority of clinical practice settings to which they are headed and to build their skills in teamwork and altruism, but also to capitalize on the observation that most students who learn together achieve more academically, too.
- Cognitive scaffolding – We have developed and introduced a variety of explicit structures for several different types of knowledge that students must learn, and have deliberately used these structures as scaffolding in assignments, to help students identify and focus on what is important to learn, and organize their knowledge in structures that will be useful throughout their careers.
- Coherence – We have deliberately built and used coherent explanations in planning the weekly themes, in selecting and aligning the content to those themes, and in the engagement of students in regularly assembling coherent explanations for their learning summary assignments, to optimize students’ learning by maximizing the meaning, rather than simply assembly of unrelated facts.
- Integration – We have made deliberate use of integration in our curricular design and implementation, including both ‘horizontal’ (across disciplines usually taught in similar years) and ‘vertical’ (across disciplines usually taught in different years), as well as at both ‘macro’ and ‘micro’ levels within learning activities.
These twelve ideas aren’t the only ones that influenced the development of our curriculum, yet they do represent many of the most important notions that guided our decisions along the way. We continue to develop and refine our curriculum each year, at a ‘slow and steady’ pace that befits a turtle, and we return to these notions over and over to help us stay on course.
- by W. Scott Richardson, M.D., Campus Associate Dean for Curriculum