UCSF Launches Medical School Curriculum for 21st Century

Students to Learn Systems Improvement Skills and Biomedical Science from the Micro to the Macro Level

By Laura Kurtzman

UC San Francisco, one of the nation’s top three medical schools, is launching a new curriculum this month to train doctors in the skills needed to navigate and engineer the complex health care delivery and bioscience systems of the 21st Century.

The new curriculum, known as the Bridges curriculum, is intended to instill habits of mind to sustain doctors through the scientific, technological and social changes likely to occur throughout their medical careers. Recognizing that the ever-increasing volume of scientific information is too vast for any one person to master, the new curriculum will increase students’ capacity and skills in scientific inquiry. Students also will be trained in continuous quality improvement and adaptive team leadership, so they can contribute toward better health care delivery. They also will be trained in how to think about social justice in medicine, meaning an attunement to the importance of the social determinants of health.

“We will continue to train our students in the timeless skills of diagnosis and treatment, but they will also learn how to work in teams and how to make systemic health care quality improvements,” said Catherine Lucey, MD, vice dean for education at the UCSF School of Medicine and the overall lead of the redesign effort.

The four-year curriculum is organized around three main elements: foundational sciences, clinical and systems applications, and inquiry, innovation and discovery. This approach moves away from the model of two years of basic science, followed by two years of clinical application, which has held sway over medical education for the last century, according to Lucey. Instead, this new model integrates basic science education into clinical training from the beginning to the end of medical school.

“This way, the art and science of medicine will be reinforced throughout a student’s education,” Lucey said.

To deepen their experience and analytical skills, students will also engage in several scholarly projects, one in the first year and a second one spanning the last two years.

“Medical education is like peeling an onion,” said Gordon “Buck” Strewler, MD, a UCSF professor of medicine who directs the four-year Inquiry program. “As you continue to pull off layers, more questions and more unknowns are revealed.”

A major innovation in the UCSF approach is the introduction of the clinical microsystems clerkship to give first year students immediate, practical experience working in complex health systems. First year medical students will be active participants in clinical teams as they seek to find ways to improve the patient experience and overall health care quality.

For example, during the pilot phase students found ways to lower the no-show rate at a busy rheumatology clinic by communicating better with patients.

The medical school will partner with UCSF Health and UCSF’s affiliated hospitals Zuckerberg San Francisco General Hospital and Trauma Center and the San Francisco Veterans Administration Medical Center to provide these training experiences. In designing this curriculum, the medical education community sought to ensure that students in the clinics would be prepared to contribute to high-quality care, not just use the clinical environment to advance their education.

“We are deeply committed to partnering with our health care institutions to improve care today, while educating our students for practice tomorrow,” Lucey said. 

Anna Chang, MD, professor of medicine, and director of the clinical microsystems clerkship, said the new curriculum will graduate physicians who know how to work with all the members of a healthcare team and who can treat individual patients as well as address community health, and never stop asking how to make the system better.

“The more we teach students about our healthcare system and the people they are working with, the more effective they will be at leading the change,” she said.

The new curriculum also incorporates a broader array of intellectual perspectives. This includes a course on data and reasoning to teach students how to integrate technology and informatics into clinical practice. Other coursework focuses on the social context of health and illness, taught from the perspective of anthropology and other social sciences, as well as health policy.

The Bridges curriculum is the culmination of four years of work that involved more than 300 faculty, staff and students, and it is the medical school’s first curriculum redesign in 15 years. UCSF was among the first eleven medical schools to be funded by the American Medical Association in 2013 to create the medical school of the future.  

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences; and a preeminent biomedical research enterprise. It also includes UCSF Health, which comprises two top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco, and other partner and affiliated hospitals and healthcare providers throughout the Bay Area