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The newspaper of The Johns Hopkins University October 13, 2003 | Vol. 33 No. 7
Review Set for Medical Curriculum

David Nichols, vice dean for education, said that the review was necessary due to the many scientific, technologic and societal changes of the last 10 years.

Goal is to ensure best program for future leaders

By Greg Rienzi
The Gazette

Substantive change could be in store for the School of Medicine's academic fabric.

In May, Dean Edward D. Miller convened a Curriculum Reform Committee charged with examining the school's current curriculum to ensure that Johns Hopkins is providing "the best and ideal education for future leaders in medicine."

To date, the committee has met eight times and plans to spend the remainder of the academic year and well into next dissecting both the strengths and perceived weaknesses of the current academic structure.

David Nichols, vice dean for education at the School of Medicine, said that the review became necessary due to the many scientific, technologic and societal changes that have occurred since the last curriculum reform, which took place 10 years ago.

Specifically, Nichols pointed to such factors as the sequencing of the human genome, the demographic change in the population, advances in medical technology, the emerging role of alternative medicine and the increased need for communication training in an age of the 15-minute doctor's appointment.

Nichols said the school's leadership felt that the structure and framework of the curriculum deserved re-examination because of these new trends and issues.

"The risk we run if we do not do this review is that we would not utilize our students' time as effectively as possible," Nichols said. "I have faith that the faculty are already presenting this information as it organically evolves, but the concern is that it is not integrated into a rational whole. Our job is to give [students] a structure in which this information can be laid down as efficiently as possible."

For example, Nichols said genetic variables and their implications need to be put into a matrix that students can understand.

In terms of demographics, he said that the aging and the increased diversification of the population need to be properly acknowledged in the classroom.

"The role of medical education is to adapt to demographic change," he said. "The elderly population will increasingly draw upon our medical resources, and we need to prepare for that. As for diversification, a physician graduating from Johns Hopkins today is as likely to see any ethnicity, or disease, right here in Baltimore as he or she would anywhere else in the world."

Another major focus of the reform committee will be to look at how communication skills are being taught. Nichols said that the practice of the country doctor spending an entire day with a patient has become a vestige of the past. Today, physicians need to effectively communicate with patients in relatively short time spans, he said.

"The pressures of medical economics are not going to disappear instantaneously. So, within that context, we have to work on ways to give patients the true sense that they have been heard and also give doctors the opportunity to appropriately convey information back to the patients that they can hear, understand and act on," he said. "There is very clear data that good communication improves compliance with medical directions."

Nichols said that another area of dramatic change is the emergence of alternative medicine, including the use of herbs, vitamins and a variety of nontraditional therapies, such as acupuncture.

"The American public has grabbed onto these therapies in a major way, and physicians are going to have to respond to this," he said. "They at least need to understand the implication of the interaction between those alternative therapies and traditional therapies."

The committee's review will look at the entire four-year M.D. degree program, from bedrock courses such as human anatomy and immunology to clinical rotations or clerkships.

The school took a similar rigorous look at its curriculum in 1993, an effort that resulted in the creation of independent, or unstructured, study time for first-year students and the introduction of the Physician in Society course, which explores the legal, ethical, emotional and cultural issues with which physicians contend.

Nichols said it is entirely possible that this review will call for the addition, subtraction or melding of courses.

"We haven't gotten down to that level of detail yet. We are dealing with broad issues and broad concepts at this early phase," he said. "But the committee is not constrained. Its charge was to have the best medical education that can be provided anywhere come out of Hopkins. If [adding or dropping courses] is what it takes to provide a good medical education, I think that will happen."

In recent months, School of Medicine faculty have been asked to give committee members the title and a short description of each of their educational interactions with students. Nichols estimates that there are 700 individual lectures presented in the first two years of training alone. He said the committee will look for overlap in these lectures to ascertain whether the school is saying the same thing twice, and it also will look for omissions.

"We want to know if there is something we think students really should know that is not being said, and then put that into the new curriculum," he said.

The work of the Curriculum Reform Committee will include the review of curricula at peer institutions such as Harvard, Stanford and the University of Rochester, particularly those that have undergone similar reforms in recent years.

Charles Wiener, vice chair of the Department of Medicine, has been appointed the committee's chair.

Nichols said Wiener brings with him "great experience in medical education." For nine years Wiener directed the school's second-year program, and he is currently the director of the Medicine residency program at The Johns Hopkins Hospital.

"He has an important perspective of knowing what students learn early on and also seeing what happens to students after they finish medical school," Nichols said.

As chair, Wiener leads and facilitates the interactions of the faculty in all aspects of curriculum design.

In September, six working groups were formed. The groups and its leaders are:

Science Basic to Medicine: David Valle, professor in the Department of Pediatrics; and Charles Flexner, Clinical Pharmacology.

Clinical Sciences: Tina Cheng, Pediatrics; and Patricia Thomas, Medicine.

Communication/Professionalism: Debra Roter, Health Policy and Management; Frank Herlong, Medicine and associate dean for students; and Randy Packard, History of Medicine.

Outcomes — Leadership/Research/Community: Antony Rosen, Medicine-Rheumatology, and Gerald Hart, director of Biological Chemistry

Assessment/Learning Methods: John Shatzer, assistant professor of Health Sciences Informatics.

Incorporation of Technology: Harry Goldberg, assistant dean and director of the Office of Academic Computing.

The intensive review will likely take two years to complete, Nichols said. The new curriculum — once it has been finalized and approved by the dean and the advisory board of the medical faculty — is expected to be implemented for fall 2007.

"As with many things, it's more important to get it right than rush through this complicated process," Nichols said. "We are trying, within the confines of space and time, to make this as much an open town hall-meeting kind of atmosphere as possible, as we grapple with lots of details about the curriculum."

The committee encourages input from all constituents of the Johns Hopkins medical community, and each working group welcomes committed volunteer participants.

Minutes of all committee and working group meetings can be found on the BlackBoard Web site, located at

Comments and/or questions can also be sent to Charles Wiener at


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