This fall, the
School of Medicine will fully implement its new Genes
to Society curriculum, the
first wholesale academic overhaul at the school in two
decades.
The curriculum, nearly six years in the making,
centers on advances in understanding of the
human genome and will feature a slew of new courses and
modified existing ones — and ultimately
render some elements of medical training obsolete.
The changes, some of which have already been
integrated into the academic schedule, are
grounded in the Human Genome Project and the concepts of
human variability, risk and the ability to
alter disease presentation and outcomes. Genes to Society
also incorporates a wealth of new
knowledge in the social and behavioral sciences, as well as
public health and policy content, with an aim
toward improving societal health outcomes.
As a basic principle, students will now experience a
more integrative, holistic approach to health
from the first week of medical school.
"This is a very substantial change in our outlook and
the delivery and continuity of care," said
David Nichols, vice dean for education at the School of
Medicine.
Other major modifications include a new career
preparation course with a scholarly project, a
longitudinal clerkship, translational science
intersessions, transition courses at milestones in the
curriculum and improved assessment and evaluation. For the
longitudinal clerkship, students in their
first and second year will follow patients over an extended
period, not just on periods of
hospitalization.
The balance of lecture and active learning strategies
will change with the new curriculum, which
will prominently feature the use of simulations.
While the school updates the curriculum every so often
in order to meet accreditation
standards, the curriculum has not been so dramatically
altered since the tail end of the 1980s.
"In this instance, we did not look at accreditation,"
Nichols said. "We stood back and asked what
medicine will look like in the future and what we need to
do to prepare our students."
The ambitious effort dates back to 2003 and began with
a simple question: How will medicine be
practiced 10 years from now?
To start the process, the school's leadership formed a
strategic-planning group comprising basic
and clinical scientists, former patients and
policy-makers.
The group worked for six months and came up with a
general framework. Then came the next
question: How will the school prepare its students to
practice this new brand of medicine?
In spring 2004, the Dean's Office formed a Curriculum
Reform Committee charged with
developing the new training. The committee was chaired by
Charles Wiener, vice chair of the
Department of Medicine, and eventually included up to
30 faculty, staff and students.
"We wanted to start to work out the details of what
this new curriculum would look like,"
Nichols said, "but not just a curriculum that would
function, one that would keep us in a leadership
position."
As a jumping-off point, Nichols presented key
committee members with a copy of the book
Genetic Medicine: A Logic of Disease by Barton
Childs, a professor emeritus at the School of
Medicine. In the book, published by The Johns Hopkins
University Press in 1999, the author lays out a
vision of medical education based on the impact of genetic
advances.
For the next two years, the group convened on a
regular basis and divided into working groups
such as Faculty, Research, Basic Sciences and Clinical
Clerkships.
Nichols said that the committee early on in the
process realized that the endeavor was much
broader in scope than it had anticipated.
"Changing how we prepare our students for professional
careers is also linked to how faculty
spend their time, our facilities, tenure, class and lab
schedules, all the elements of what a medical
school does," Nichols said.
To work through all the issues, the Curriculum Reform
Committee met with department heads,
hosted town hall meetings and periodically went on
retreats, in addition to holding its regular
meetings. Nichols said there were many "spirited debates"
along the way, but eventually an outline for
the new curriculum came into view.
To help implement the changes, an Integration
Committee was formed in 2006 and continues to
meet weekly.
The yearlong Genes to Society course will be the
centerpiece of the new curriculum. The
course, which will begin in the students' first year, will
cover the major biological aspects of training.
The students will seek to understand how various internal
factors (genes, molecules, cells, organs) and
external factors (family, community, environment) interact
to explain the patient's condition, or
phenotype. The curriculum will also place heavy emphasis on
communication skills, teamwork in medical
problem solving and lifelong learning.
Nichols said that the current educational model,
generally speaking, classifies people as "sick"
or "healthy," with nothing in between.
"More or less, doctors are mechanics who find out what
is broken and try to fix it and return
the person to health," Nichols said. "You look at a person
with a specific problem and treat that
problem. That is where we are now, and there is an
attraction to this model. It's one that has served
us well for a long time."
However, with advances in genomics, Nichols said,
physicians have come to learn that a patient
with a given diagnosis is not like every other patient with
that diagnosis. There are important details,
beginning with genotypes, that are unique to every
person.
"Genetic medicine has already moved into the oncology
area," Nichols said. "Over time, this level
of understanding will migrate to every specialty. This is a
huge departure from where we are now and a
main reason for why we have to change the way we train
people to become doctors."
Nichols said that the concepts of the new curriculum
literally altered the physical landscape of
the campus.
The newly opened Anne and Mike Armstrong Medical
Education Building was specifically
designed around the new curriculum. The building, located
centrally on the campus between the
Outpatient Center and the Denton A. Cooley Center, features
a variety of learning settings, ranging
from a 70-person learning studio and two large lecture
halls with seating for 180 students each to
flexible lab space and study areas for smaller groups.
Students can access the latest digital communications
technology for tapping into network data
and displaying digital images. Instead of using
conventional microscopes, students have virtual
microscopy tools composed of high-resolution monitors and
displays that show multiple images housed
on centralized servers. Large screens at the end of each
dissection table in the anatomy labs provide
students with digital reference tools.
In 2008, Johns Hopkins Medicine opened the Simulation
Center, located in the Outpatient
Center, immediately adjacent to the Armstrong Building. The
new training facility allows medical
students to learn and practice procedures, such as
inserting a chest tube, on plastic manikins and
robots before performing them on patients, ideally
enhancing both the educational experience and
patient safety.
The new curriculum will go live with the class of
2013, entering in September. Current students
will remain on their present tracks and see less-sweeping
changes to their training.
"You can't big bang something like this as we already
have students in the pipeline," Nichols said.
"So there will effectively be a three-year phase-in with
students arriving in the fall being the
inaugural class entirely under this new curriculum."
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