The mission of the new Shared Discovery Curriculum (SDC) is to nurture, educate and graduate students who are ready, willing and able to be exemplary new residents and practicing physicians. The vision for this new curriculum puts real and simulated patients at the center of the educational enterprise, and emphasizing:
- Early and ongoing clinical experience for students,
- Integrated basic and clinical sciences throughout the curriculum,
- Collaborative learning for faculty and students,
- Alignment of evaluations with curricular content and real-world performance,
- Assuring competence and striving for excellence.
The SDC is an experience-based curriculum. A week in the life of a first year (Early Clinical Experience) student is made up of a large group experience, two learning society scholar group meetings, two half-days in an outpatient clinic setting, a half-day in a simulation center and of course, anatomy and histology labs. For second year students, the Middle Clinical Experience has the same basic structure except that clinical experiences involve a variety of ambulatory and inpatient rotations organized to emphasize the integration of clinical work and the basic and social sciences underlying patient care. There is only one learning society small group per week to accommodate a rotational small group focused on the students’ clinical rotations.
The first class of SDC students matriculated in 2016; these students are now in the middle of their second year of medical school. What have we learned so far?
At the end of their first year, the SDC students were more satisfied with the quality of student-faculty interactions compared to legacy students (3.9 vs 3.6) and found their learning experiences to be more meaningful (3.8 vs 3.1). Otherwise their ratings of the CHM learning environment largely were the same as students in the legacy curriculum.
Based on data from the mid-semester evaluation, most students agreed or strongly agreed that they felt supported by faculty (86%) and peers (84%) within their learning society scholar groups. Similarly, students reported that the rotational small groups related to their clinical experiences worked effectively together (84%). Interestingly, while students agreed or strongly agreed (69%) that the simulation sessions helped them learn course content, a smaller proportion of students indicated enjoying their simulation sessions (39%). A more complete summary of results available here.
Students were asked to indicate the extent to which each component of their educational experience contributed to their learning of course content. A summary of their ratings is presented in the chart below. Students’ evaluation of the learning experiences varied widely. For six of the 10 experiences rated, over half of the students agreed or strongly agreed that the experience contributed to their learning. Based on the feedback from this mid-semester evaluation, changes were made to the Large Group Activities to enhance their value to students.
Assessment in the SDC is based on a progress testing model, which is a comprehensive assessment of knowledge and skills twice each semester. The assessment is a graduation test for the MD degree, measuring the entire body of knowledge that a student should master by the end of medical school. Rather than aiming for mastery of a small amount of knowledge, progress testing assesses incremental improvement in student performance over an extended period of time. A recent paper provides a review of the educational literature related to progress testing.
For the knowledge component of our progress test we use the Comprehensive Basic Science Examination from the National Board of Medical Examiners (NBME), supplemented with NBME customized assessment exams. The graph below shows the knowledge gain by content area for current MCE students (2016 matriculants) compared to the ECE students (2017 matriculants) based on data from the customized assessment tests. As expected, the second year students outperform the first year students in all science content areas.
The NBME customized exams provide specific feedback by content area whereas the NBME Comprehensive Basic Science Exam (CBSE) is an indicator of USMLE Step 1 readiness. The graph below shows the progression of CBSE scores for the first SDC student cohort over three test administrations. From September to February there has been a 10-point increase in the mean score.
The graph below compares the CBSE score distributions of legacy and MCE students tested in fall semester of their second year. The distribution of the SDC students (in blue) shows higher scores than the legacy students (in red) at the same point in their education, with the overlap represented in purple. These data suggest that we would expect higher Step 1 pass rate as a result of the new curriculum.
Overall, the early returns on students’ opinions and performance suggest that our efforts to enhance a collaborative learning environment for students and faculty have been successful. The curricular structure integrating basic, social and clinical science in the context of patient complaints and concerns challenges students. Meaningful clinical experiences provide students a context for learning. While the SDC implementation has not been without its challenges, these data provide evidence of our success to create a more supportive and effective medical school experience.