In the 2017-2018 academic year, the University of Kansas School of Medicine launched the most sweeping redesign of the school’s curriculum in 20 years. Four years in the making, the overhaul was a response to the explosion of new medical knowledge and rapid changes in the technology and delivery of health care over the last two decades. It also mirrored a national trend as medical schools across the country re-evaluate how they train physicians to practice medicine in this brave new world of health care.
The new ACE (Active, Competency-based, and Excellence-driven) curriculum is designed to produce physicians who are lifelong learners and can adapt to the ever-evolving science and practice of medicine; who understand the health care system and how it affects patient care; who are comfortable working in interdisciplinary teams and using new health care technology; who consider the health of populations as well as individuals; and who are skilled in research, patient safety and continuous quality improvement.
The curriculum also reflects the ways today’s students learn. In your grandfather’s medical school, professors lectured while students took notes, but that model no longer suits a world in which students can look up information electronically in mere seconds. The foundation of the ACE curriculum is active learning: interactive and often group activities related to the material. The new Health Education Building at the University of Kansas Medical Center, with its open study spaces and simulation facilities, facilitates these hands-on, collaborative ways of learning.
In May 2018, the first class of medical students following the ACE curriculum completed their first year. We spoke to a panel of three KU School of Medicine faculty and two students explained more about how the new curriculum works and reflected on how things are going so far.
Giulia Bonaminio, Ph.D., is the associate dean for medical education and a research professor in the Department of Family Medicine.
Brice Dean just finished his first year as a student at the KU School of Medicine—Wichita.
Tomas Griebling, M.D., MPH, is the senior associate dean for medical education and the John P. Wolf 33 Masonic Distinguished Professor of Urology.
Joseph Fontes, Ph.D., a professor in the Department of Biochemistry and Molecular Biology, is the director for the Molecular and Cellular Medicine block of the ACE Curriculum.
Ann Herrick just finished her first year as a student at the KU School of Medicine and serves as the student communication liaison for the ACE curriculum, gathering and providing student feedback to faculty and the Office of Medical Education.
What are the biggest changes from the prior (Legacy) curriculum?
Tomas Griebling: In the Legacy curriculum, instruction was delivered using a combination of lectures, labs and PBL (problem-based learning) small group sessions. Students in the ACE curriculum spend a maximum of only five hours in lectures per week. They spend most of their time working in small groups, what we call learning communities.
Students also now learn in flipped classrooms, so instead of learning content by listening to a lecture in the classroom, they learn it ahead of class by reading or by watching a podcast and then use time in the classroom to apply that what they learned to solve a problem posed by the instructor. There is also much more direct faculty involvement with the students. Each student has a faculty coach who works with them on their progress and professional development.
Giulia Bonaminio: Another change is the integration of basic science and clinical skills. With previous curricula, students spent the first two years learning foundational science, such as anatomy and physiology, and then next two years learning clinical skills, such as performing medical procedures. The ACE curriculum does away with that division between the preclinical and clinical years, and students start learning clinical skills the first year. Starting in their third year, students begin their clerkships, working in clinics as “apprentice doctors.”
Material is now organized around a “block structure.” Blocks are based largely around organ systems; Respiration and Circulation is one block, and Muscles and Movement is another. Students learn the basic science and clinical skills related to that block at the same time.
Could you give us some more details on the block structure?
Joseph Fontes: Except for the first block, Introduction to Doctoring, and the last block, the Medicine Capstone, all blocks are nine weeks long, broken up into two-week units with an exam at the end of each. The ninth week is used for assessment, remediation and enrichment activities.
Typically each week begins with an experienced clinician presenting a “big case.” For example, the big case might be rheumatoid arthritis. The clinician lays out the critical clinical and foundational science knowledge necessary for assessing and managing a patient with this condition.
In subsequent activities, such in learning clinical skills in the simulation lab or solving problems with their learning community, students might learn about the basics of the immune system and autoimmunity, the social and behavioral aspects of a chronic condition like rheumatoid arthritis, and the genetics and epidemiology of autoimmune disease. The big case puts a human face on all the molecules, statistics and mechanisms and allows students to reflect upon the human aspects of the biomedical, social and behavioral sciences they’re learning in activities as lectures throughout that week.
The block organization make the material more accessible, but they are not strict silos. For example, in the Brain, Mind and Behavior block, students might encounter a patient who presents with the symptoms of a stroke or kidney disease that must be taken into account. They then apply principles from everything they have learned before, in multiple settings.
