Dozens of first-year medical students will receive their white coats in an official ceremony later this week at the SIU School of Medicine.
The school’s curriculum has long been a leader in training doctors, and leaders recently took on the challenge of reinventing some aspects of that training – to make the students stronger.
“Our third year was a traditional one, which looked like most of the other 154 medical schools in the United States.”
Doctor Jerry Kruse is Dean and Provost of the SIU School of Medicine.
“In essence, it was divided by departments, and we had six clerkships that ranged anywhere from six to ten weeks.”
But while that curriculum – which included shadowing residents, attending lectures, and taking tests – was producing competent doctors, Kruse and others wondered if they could do better – particularly when it comes to making young physicians more comfortable in a clinical setting.
“What we found out when we studied this, is that the students were actually only seeing patients two to three hours per day, were doing the lectures – which we found were ineffective, and then were worrying about taking the test to get their grade and pass the second part of their boards.”
And the test scores in the third year showed students weren’t gaining as much ground in making diagnoses and planning treatment protocols.
“In year three, the clinical decision making skills of the residents didn’t improve. We had predicted they would improve more in year three than year one and two, which were not heavy clinical years.”
So, Kruse and his team went back to the drawing board. They developed a curriculum that gave students more one-on-one time with teachers and coaches, and increased the clinical training in the first two years of medical school.
“And then, in year three, we would actually help them learn how to be a doctor, to socialize into medicine, and give them more opportunities to determine what their career path should be.”
SIU has long been a leader in clinical training – especially early in the academic career of its students.
Problem-based learning is a hallmark of the School of Medicine’s training – and Kruse says that is only being made stronger.
“We have a course called ‘Introduction to Clinical Medicine’ in the first two years, which teaches them all of the nuts and bolts skills that they need to take care of patients, and do physical exams, take histories, write orders, and use electronic records, and all of those things.”
In addition to that class, there is a virtual program where medical students are presented with twelve different complaints in twelve different scenarios – a potential for 144 different diagnoses. The can share their thoughts, and get immediate feedback from experts.
Which leads them to the *new* third year.
“So now, the new third year, instead of being six rotations that are six to ten weeks long, there are eight rotations in eight different specialties, that are four weeks long.”
And inside those rotations, there are no longer lectures or tests. Just intensive one-on-one time with patients, under the guidance of doctors and teachers helping students reach the proper diagnosis and treatment.
Once the first set of rotations is complete, third year students spend five weeks studying medical humanities and taking the “Senior CCX” – a test normally given to fourth year students.
They then spend 15 weeks in a more individualized program aimed at preparing students for their potential specializations.
Kruse says outcomes and feedback so far have been very positive – better test scores, and more prepared students entering the medical field. He says while there is some criticism for removing some of the so-called “Shelf” tests previously given, he stands by the new way of doing things.
“Many medical schools throughout the country have used the SHELF examinations as a grading mechanism, for their rotation – they were never meant for that, ever. So I’m glad we’re not doing those. I don’t think they’re appropriate, anyway.”
Kruse says the students are more confident, and more prepared for the future – which is the goal.
“They see twice as many patients, they get two to three times as many procedures, they do well on the tests, they feel better about getting into their career choice, they feel like they’ve socialized into medicine better.”
So now, Kruse is taking the new curriculum on the road. He’s visiting other medical schools, talking with faculty and administrators about what SIU is doing and the results they’ve found.
“I’ve been asked three times. Two times, it was an astounding discussion. Just what you’d want to have in an academic environment: pros, cons, ideas going back and forth, but really positive energy. In essence, it’s like a pat on the back. ‘Thank you for thinking of this. This will make us rethink what we’re doing and get the discussion started.’ In one of them, it was a total negative reaction. One negative comment after another. But that’s what you expect, too, when you bring new ideas, I think.”
Kruse says he’s taking comments from those presentations and discussions and using them to make SIU’s program even stronger – something he says will benefit this year’s incoming students as well as their future patients.