Educating the Next Generation of Physicians with the Curriculum of the Future

By: Dr. Robert Hasty, DO, FACOI, FACPProposed Idaho College of Osteopathic Medicine, Founding Dean and Chief Academic Officer

The practice of medicine has changed dramatically over the past 50 years. In addition to the incredible breakthroughs and advancements in medical knowledge, there has been a revolutionary change in the delivery of healthcare. Specialties such as hospitalists, medical informatics, and palliative care didn't even exist just a few decades ago and now are integral to modern healthcare. There is also a growing demand for physicians to have administrative and leadership skills. For example, there has been a growth in physicians serving as hospital CEOs since a 2011 report suggested better outcomes (in terms of ranked quality) with a physician CEO. Expectations of knowledge and skills of physicians graduating from medical schools have expanded in parallel to these changes.

Over the past 20 years, the concept of "core competencies" has emerged in medical education that has helped categorize other areas of physician knowledge and skills. The core competencies include areas such as systems-based practice (e.g. population health, health policy), practice-based learning and improvement, communication, and professionalism. While medical school curricula have covered these areas in the past, more training in these areas has expanded dramatically.

Another area that has gained significant attention is the assurance of how medical school curricula are meeting the public trust as well as the expectations from residency program directors. The medical licensure exams have done much to protect the public by assessing cognitive skills in the past and, more recently, assessing behavioral skills. The concept of "entrustable professional activities" (EPAs) has emerged over the past several years as an area where medical education communities have defined specific skills that they can expect from all graduating physicians.

The question of how we can start with a blank slate and design a medical school curriculum that will ensure that our graduates will meet the current and future needs of the public trust, while using our knowledge of the evidence behind adult learning to create the best outcomes, has been central to my team at the proposed Idaho College of Osteopathic Medicine (ICOM). The proposed curriculum that we have developed at ICOM is an innovative curriculum that would look very novel to many practicing physicians. 

We first approached how our future medical students will learn in the preclinical, as well as the clinical settings. The evidence shows that more active learning results in better outcomes. Our proposed curriculum will use multiple active learning modalities such as high-fidelity simulation and problem-based learning approaches. We will use a highly-integrated approach that interleaves various disciplines as it systematically progresses through the curriculum. We will also include a great deal of assessment as adult learners have better outcomes when they are assessed and especially if it includes spaced intervals between the assessments, like we have designed for our proposed curriculum. These approaches progress throughout all four years of our proposed curriculum. 

We have also put incredible thought into the content of what we will teach in our very modern proposed curriculum. Our vision is that our medical students will graduate prepared to become leaders of the healthcare team that will be highly-skilled, competent, and caring physicians. Twenty-five percent of an ICOM’s student’s educational time will focus on the core competencies other than medical knowledge and patient care.

This important portion of our proposed curriculum will range from teaching an in-depth understanding of medical legal issues to leadership skills and other areas such as ethics to practice management. There will also be an emphasis on training medical students on application skills rather than just recalling facts that can go out of date over time.

During our feasibility study, we did an in-depth needs assessment. One of the most important things that we discovered is that stakeholders felt that training a caring physician is paramount. The published literature suggests that Jefferson Scale of Empathy scores decline during medical schools. One goal that we have set is to have our students increase their empathy skills during medical school. To facilitate this, we will have a director of caring curriculum as well as a course with a focus on training and assessing empathetic skills.

Our vision of our proposed curriculum will be tested in the years ahead. We are hopeful that generations of patients will be benefited by what we are developing, just as the planning by our forefathers on current medical school curricula have benefited so many patients over the years. The one certainty is that expectations of the physician of the future will be very different than the past, and we are eager to meet those needs. 

About the proposed Idaho College of Osteopathic Medicine (ICOM)

The mission of the proposed Idaho College of Osteopathic Medicine is to train osteopathic physicians prepared for caring for persons in Idaho, Montana, North Dakota, South Dakota, Wyoming and beyond. ICOM received pre-accreditation status from AOA COCA on May 4, 2017 and is currently seeking provisional accreditation.