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
courses.med.jhmi.edu.
Comments and/or questions can also be sent to Charles
Wiener at
cwiener@jhmi.edu.
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