UCSF School of Medicine develops innovative new curriculum

By Maureen McInaney

University of California, San Francisco faculty at the Center for Health and
Community (CHC) have received two grants to assist the UCSF School of Medicine
in a radical redesign of the medical school curriculum. The CHC is taking the
lead to add emphasis on culture and behavior to the curriculum, a change that
UCSF faculty hope will enhance students’ educational experiences and better
prepare them for the world of medicine, said Nancy Adler, PhD, director of the
CHC and chair of the curriculum committee.

The curriculum is being redesigned in fundamental ways, said Adler, who
explained that the School of Medicine wanted to create a curriculum which
promotes integration of disciplines, allows for an early introduction of
clinical concepts, and expedites students’ entry into the patient care setting.

The grants from The California Endowment and The California Wellness
Foundation to Adler and Melanie Tervalon, MD, UCSF assistant clinical
professor of anthropology, history and social medicine, will provide 18 months
of funding to revamp the curriculum. The old curriculum came under review
beginning in 1996, and the new one will be finalized by the fall of 2001.

Though there have been incremental enhancements in the UCSF School of Medicine
curriculum in the last three decades (including reduction of class lecture
hours in the first two years, increased use of small group learning, and
creation of interdepartmental courses), this endeavor marks the first radical
redesign of the curriculum since 1969.

To support curriculum reform, the UCSF School of Medicine has established the
Academy of Medical Educators, the first medical school organization in the
country to encourage interdisciplinary approaches, provide funding for
innovative educational programs, sponsor faculty development, and facilitate
mentoring of teachers, said David Irby, UCSF vice dean of education in the
School of Medicine.

The UCSF School of Medicine is a national leader in the way it is designing its
new curriculum, said Irby. The traditional structure, consisting of two years
of basic sciences plus two years of clinical rotations, will be replaced by a
new model divided into three stages: the essential core, the clinical core and
advanced studies and will span four years.

The first two years of basic science classes will be replaced by courses taught
in integrated blocks, each centered on clinical cases. Cases will illustrate
not only clinical manifestations of disease, but also basic science, as well as
cultural and behavioral concerns, he explained.
“The redesign is an opportunity to introduce culture, community and behavioral
issues into all levels of medical student education,” Adler said. “From the
start students will conceptualize and integrate cultural, social and behavioral
factors into their understanding of biomedical and clinical issues.”

In the new curriculum, students will spend less time in the classroom (about 24
hours per week) and lectures will be de-emphasized so students can experience
more independent internet-based and small group learning. Similarly, exams will
incorporate problem sets, presentations and projects, all designed to provide
more opportunities for active learning.
Students will begin their first year with a prologue, a case study of a
motorcycle accident patient who will gradually regain consciousness. This
paper-based case study (enhanced by live-action and videotaped scenarios) will
provide students with brief overviews of anatomy, histology, pathology,
biochemistry and pharmacology to give a general understanding of the human
skeleton and the circulatory, respiratory and digestive systems. By the end of
the prologue, Adler explained, students will have a foundation in the anatomy
of the entire body, preliminary physical examination skills, and an
understanding of cultural/behavioral factors such as prevention and stress and
wound healing. She added that more detailed information about anatomy and other
topics will be taught in future blocks wherever relevant.

Susan Masters, PhD, UCSF professor, department of cellular and molecular
pharmacology and chair of the core essentials planning committee, explained
that this new model allows for more integrated learning.

“In the current curriculum, faculty tend to teach from their own perspective in
their own disciplines. In the new curriculum there are established channels for
bringing people from diverse disciplines together to develop and implement
curriculum.” She adds that this interdisciplinary approach, combined with more
emphasis on clinical cases, makes the first two years of medical school more
relevant and exciting.
The third year curriculum will encompass 44 weeks of clinical clerkships and
four weeks of inter-sessions, an important innovation in the new curriculum.
The inter-sessions will provide time for students to leave clinical rotations
and come back as a class to explore connections between the basic and
behavioral sciences in the context of their clinical experience, explained

The general plan in year four, the advanced studies portion, is to give
students a wide selection of elective choices. These include the opportunity to
return to basic science, more time for independent scholarly and creative
pursuits, the opportunity to gain teaching skills, and opportunities for
sub-specialty rotations.

The UCSF School of Medicine is also among the first to provide stronger support
services for medical students. The new model includes a plan to divide students
into societies or smaller groups to enhance advising and guidance throughout
medical school, said Irby.
Student response to all these changes has been positive, according to Masters,
who explained that more than 30 first and second year students have volunteered
to work on committees to shape the new curriculum. Some dedicated students are
working through the summer and/or taking a year off from their medical studies
to help with the redesign, she added.

The California Endowment and The California Wellness Foundation grants (in the
amounts of $487, 331 and $25,000 respectively) will fund the salaries of those
CHC-affiliated faculty working on the curriculum redesign with expertise in
multicultural health and behavioral factors.

“The grants were given in recognition of the importance of preparing students
to treat an increasingly diverse population,” said Adler. “Social, cultural and
behavior factors are key contributors to health and illness and have been given
relatively little attention in traditional curricula.”

“The California Endowment is delighted to be one of the funders of the
development of this new curriculum,” stated Lynn Alvarez, program officer for
The Endowment. “An increased understanding of cultural differences by medical
staff will lead to improved clinical outcomes for those communities.”

The California Endowment was established in 1996 and is the largest private
health foundation in the state. The Endowment maintains offices in Los Angeles,
Sacramento, San Francisco, Fresno and San Diego, and has staff working
throughout California.

The mission of The California Endowment is to expand access to affordable,
quality health care for underserved individuals and communities, and to promote
fundamental improvements in the health status of all Californians.  The
Endowment makes grants to organizations and institutions that directly benefit
the health and well-being of the people of California. For more information on
The California Endowment, visit their web site at www.calendow.org.

The California Wellness Foundation (TCWF) is an independent, private foundation
established in 1992. The Foundation’s mission is to improve the health of the
people of California by making grants for health promotion, wellness education
and disease prevention.