Whereof what's past is prologue; what to come,
In yours and my discharge.
William Shakespeare - The Tempest
C21 is moving along. We've determined the "What" of a new curriculum by adopting a strong edifice for teaching and learning in the form of a spiral curriculum anchored by thematic pillars, three of which (Atherosclerosis, Colon Cancer and Diabetes) have been recently populated with content. Determining the "How" appears to be our next task and is the subject of this posting.
We might begin by asking if there is a model "out there" that could provide a starting point. I believe the answer is "Yes" and it exists not, as you might think, in another medical school but in our own "institutional memory", specifically in my Class of 1962's memory! Let me take you back to the year 1958 when few of you were born. Life and learning at the the New York University School of Medicine was formative, exciting, challenging, and rewarding. Why? Aside from the School of Medicine's usual superb faculty and peers, the New York City location, and the unique and marvelous clinical experience at Bellevue, an outstanding feature of the educational experience at this medical school was an exquisitely balanced and coherent curriculum that emphasized active-learning throughout the basic science years.
What do I mean by a balanced and coherent curriculum? Well, the curriculum was designed to both deliver knowledge and, most significantly, have us immediately apply that knowledge. To achieve this, the activities that comprised the curriculum consisted of a continuously repeated pattern of activities -- a small number of lectures on a particular topic accompanied by reading assignments that were immediately followed by hands-on, minds-on laboratories with an occasional conference thrown in. Lectures, which started at 8AM, were limited to about 2 per day (including Saturdays!!). On three days a week a laboratory (Anatomy, Biochemistry, Histology, Microbiology, Neuroanatomy, Pathology, Pharmacology, and Physiology) began at about 10AM and generally ran until 3 or 4PM. Thus we spent about 2 and 1/2 times more in the dynamic environment of a laboratory than in lectures!
Biochemistry, Physiology, and Pharmacology laboratories were special! In these laboratories, we worked in groups to solve problems or performed experiments on ourselves or on animals. Knowledge was applied and analyzed in a collaborative learning environment. Groups were formed either by assignment or by choice and generally stayed together for an entire course or, in some cases, beyond. My group became a cohesive learning team that functioned in the lab as a cohort of "budding scientists" and outside of the classroom as a study, support and social group. In the lab, the group was responsible for reaching consensus and reporting out answers to problems and documenting and interpreting experimental results. Individual accountability in a course was obtained in two ways, via summative assessments (e.g. quizes and exams) and by having each student keep a laboratory notebook that was critiqued and graded periodically by faculty. While quizes (mostly multiple choice, matching and fill-in-the-blank) tended to test for knowledge acquisition, larger examinations assessed knowledge application (essays, step-wise problem solving etc.). Each of us also received a laboratory grade that was determined by some combination of our group's performance and our individual performance. Thus, there was balance, coherence, and continuity among exercises and assessments that promoted knowledge acquisition and those that promoted knowledge application. There was a balance and consistency between activities that promoted individual achievement, responsibility and accountability with those that fostered group achievement, responsibility and accountability. There was a coherence and continuity of learning in the tight coupling of knowedge acquistion and its application. Moreover, to the Class of 1962, the scientific method was not an abstract ideal but one that we lived daily! Our communication and analytic skills were constantly being honed. In this environment, learning was evidence-based, learning was fun; learning was relevant; learning was social. No wonder it was an easy transition to the clinical years. No wonder that in the clinical years, we were able to link our basic science knowledge to clinical encounters.
Are these "old timer" memories just rose-colored visions of a lost era or do they really have relevance to our C21 deliberations? I strongly believe the latter. Our current curriculum, for many reasons, has become imbalanced. In the vast majority of our basic science courses, active-learning exercises constitute less than 20% of learning activities. Laboratories are long gone having become extinct about a generation ago. Problem-solving exercises are few and far between. Small group exercises, originally introduced to be active learning exercises, are frequently little more than lectures under a different guise. Aside from being required to show up, a student's responsibility and accountability in seminars and conferences is virtually non-existent. In most basic science courses, neither the individual student's preparation nor the quality of his/her participation in seminars and conferences is assessed. Teams or longitudinally constituted working groups of students are not part of the educational experience in the basic science years.
We should seize this once-in-a-generation opportunity to rectify the current curriculum imbalance by resurrecting the essence of our past to move forward. By "essence" I mean the 1958-1962 emphasis on active-learning, problem-solving, and peer-teaching. But the old model will need adjustment. The past must always morph in its particulars and be improved upon to be relevant to the present. To achieve the "How", we'll need to rely heavily on our world class information technology capabilities. Since today, we can't experiment on ourselves, on each other, or on animals we'll need to turn to a variety of simulation types to become the new peer-teaching, experimental, and problem-solving laboratories. The lecture format (both face-to-face and online) should be retained but must be reduced in number. Sets of lectures, organized by topics, should be tightly coupled to online self-assessments and simulations. Asynchronous online forums should complement face-to-face conferences as places for students and faculty to rub elbows and exchange ideas. The combination of all of these activities, properly sequenced in the context of a spiral curriculum that is anchored by thematic pillars, will promote cohesion and continuity of learning throughout the curriculum. ALEX and LAMS (the Learning Activity Management System contained within ALEX) will empower faculty to plan and implement these digital activities. ALEX will also host student portfolios that will document the progress of individual students as measured by each student's own statements of educational goals, self-evaluation, peer evaluation, faculty critiques and suggestions, project efforts, and the results of a variety of assessments.
Is it feasible to do this? Without a doubt, "Yes!". In fact, we already have successful early prototypes for each of these IT activities. In the second year Mechanisms of Disease Course, a set of lectures and a conference, provide the backdrop to a mannequin Simulation on the Pharmacology of the Autonomic Nervous System run by Lewis Nelson, M.D. (Department of Emergency Medicine). The Surgery Clerkship's Cyber Classroom pioneered by Mary Ann Hopkins, M.D. and currently shepherded by Marc Hochberg, M.D. is a remarkably effective example of a forum that has been in use for several years. Several faculty have and currently are experimenting with LAMS. An early adopter, Amy Rapkiewicz, M.D. (Department of Pathology) has used LAMS to create and deliver online lectures and self-assessments (see Hemodynamics) as preparation for a highly interactive entire-class exercise.
Thus, it is quite clear that we know "How" to resurrect the essence of the past and improve upon it. Let's start that process for C21 now.
