I recently saw an article about a highly innovative approach to medical education launching with this year’s entering class at the University of Connecticut called M Delta. When I reached out to UConn the head of the curriculum reform asked me for a call and provided more information about the new curriculum. It was just fascinating. Fortunately, she and her colleagues agreed to join me for this episode of Admissions Straight Talk, and you can judge for yourself.
Today’s guests are: Dr. Suzanne Rose, UConn’s Sr. Associate Dean for Education and Professor of Medicine; Dr. Christine Thatcher Associate Dean for Medical Education and Assessment; and Dr. Thomas Regan, Asst Dean of Admissions and Student Affairs. Welcome!
Dr. Rose, can you provide an overview of the three phases of M Delta? [1:45]
M Delta is making a difference in education, learning, and teaching across the curriculum. It’s an innovative curriculum reform effort that started about four years ago – really thinking about cutting edge education for the doctors of the future.
Our curriculum reform effort has been implemented in August with the class of 2020.
Stage I is 18 months long – a time of study when the class is together. Students co-learn with dental students. We’ve eliminated lectures in favor of active learning modalities. Stage II will begin in March of the second year – a 12-week introduction to clinical medicine, flexible time for electives, board study, and rotations. We’re also coupling some of our rotations so we can have longitudinal didactics where our rotations can work together and students can think together across disciplines. Stage II goes through June of the third year.
Stage III includes some required advanced clinical rotations, but students will also be involved in the scholarly process – working on a project, or a community initiative (such as public health and education).
All our students will be receiving a public health certificate, so they’ll be immersed in public health across the curriculum.
Can you dive into Stage I? [4:40]
Stage I is the Exploration stage. The centerpiece is a team-based curriculum. It’s patient centered and case based.
At the beginning of each unit, students take both individual and team readiness assessments. That’s followed by an application exercise.
The PBL (problem-based learning) curriculum spans 50 units – 50 cases, in ten week blocks.
There are other courses, too: integrated human anatomy (with virtual anatomy lab, including radiology); Intro to Doctoring; CLIC – students spend half a day in a physician’s office, generally a primary care provider; Medical Home – another innovative course, where students and teams go to an affiliated hospital to learn about the clinical environment; and the VITALS course (Vertically Integrated Teams Aligned in Learning and Scholarship), where they learn about population health, biostatistics, etc. The VITALS course is in teams across the med school continuum and with our interprofessional partners (such as dental), and it’s a flexible curriculum, covering emerging topics and trends while exploring public health objectives.
Dr. Thatcher, can you talk about assessment? [11:10]
In each ten-week block, students will take an IRAT (individual readiness assessment test) and TRAT (team readiness assessment test). Then each ten week block is followed by a two week intersession that starts with an integrated assessment – like a final exam for the ten week module. Then they have a day off for wellness, and then a day for scholarship; coaching; and career exploration. They find out how they’ve done in the previous unit, and then they have the opportunity to spend the next five days either in an Individual Learning Opportunity or getting intensive help to bring up their skills, if they didn’t do well. There’s also a chance to remediate in the summer.
From our earlier conversation, I understand that the goal is to allow people to pursue individual interests, but also to remove the stigma of remediation. Can you comment on that? [14:20]
Learning medicine is really a lifelong process. You have to be able to discard old things and accept new science. We want to make learning acceptable – there’s no stigma to getting extra help. We’re putting a learning center right in the library.
Those students who need to improve, we give them the time and opportunity to do so. We set the bar for competency very high, and we want to make sure people have the tools to get there.
Dr. Rose – can you talk about the clinical training portion of the curriculum? [16:40]
We’ve had a doctoring course for a long time, so we’re integrating those aspects. We use our Clinical Skills Center to teach clinical skills, not just for assessment. And we’ve developed a new simulation center, and we’re enabling students to get these opportunities early in med school.
And other exposure includes the Doctoring course, CLIC (immersed in the community), and Clinical Home, when they’re introduced to the hospital system.
What is the difference between Stages II and III? [18:50]
Dr. Thatcher: Stage II is Clinical Immersion, III is Transformation. “Entrustment” is upon graduation – they’ll be ready to be residents. AAMC defines certain “entrustable professional activities” (EPA) that students should do by the end of med school training, so that on graduation they’re ready for residency.
Why this radical reshaping of the curriculum? [20:50]
The goal is to train the best medical providers to care for our patients in the future. We want to enable them to meet certain goals that aren’t met in a traditional lecture based curriculum. That’s why it’s so team based. There are additional goals, such as creating lifelong learners.
It also reinvigorates the faculty and staff.
How does it do that? [23:00]
Our staff is also organized in teams, and this creates a collaborative team environment.
How is the new curriculum influencing admissions decisions? [24:00]
Dr. Regan: Medical care is increasingly team based – how do you teach a student to be part of a team? It’s a different atmosphere here – we truly believe education is a social, collaborative activity. Students have to shift from the competitive environment/mindset they had in undergrad.
It’s all about treating the patients.
We have them do a mini TBL when they come here on interview day. That’s our environment.
Do you also weigh their past team experience? [27:10]
We’re obviously looking for successful students. We look at them holistically.
Have they been exposed to the healthcare environment? (shadowing, clinical exposure, etc) Why do they want to be a physician? (Obviously, this is something all med schools look at.)
Have they been active on their campus? Active in whatever passion they have? Have they assumed leadership positions in those activities? We consider leadership and team experiences.
Are you looking for research and clinical experience? [28:20]
It’s not black and white. The biggest thing is that we like them to have explored the healthcare field, so that they know what they’re getting into.
We’re looking for community involvement.
Can you tell us about the public health focus? [30:23]
There’s a strong public health orientation. We’re a public university and it’s important to us that our students are part of the community.
It’s a strong focus with our interprofessional partners, and we’ve always had a strong course on public health.
Our faculty got really excited about creating our public health certificate. It really focuses on health disparities.
We’re really proud of this and we think it sends a strong message to our students that we value public health.
I was talking last week with a medical school professor and he expressed concern that students are focused on preparing for the Step 1 exam, given how heavily its weighed by residency programs. In his words “students are just going into test prep mode from day one and skipping the whole curriculum. All they want are study tools. What they’re missing is the career prep value in their first two years – things like clinical reasoning and professionalism are at least as important as Step 1 for their clerkships and residencies.” Do you share that assessment and how is U Conn dealing with this concern? [34:00]
Dr. Thatcher: I think a lot of what he said is true – students are definitely concerned about how they’ll do on the boards, especially if they want a specialty. You see the effects in the curriculum we’re transitioning out of, where students often stopped coming to lecture in the second year and just watched them on video. We haven’t seen the second year of our new curriculum yet.
We will have a preparatory course. I think we’re doing a good job preparing students.
Dr. Rose: I think this is a national problem and needs to be explored on a national level. There are possible solutions.
We do not teach to the boards. We expect our students to do well on the boards.
Any advice for med school applicants? [38:35]
Dr. Regan: A couple of things people should understand:
Know when the deadlines are! Get it in early. We look at 3000 applications, and will send out 300 interview invitations, for 100 spots. The ones that are there on time (i.e. earlier in the application cycle), we’re more lenient because we have more interview spots. It’s harder later on.
We’re looking holistically.
We look at non-traditional applicants – they add diversity.
Thirty to 40% of people come straight from college. But a lot of people have taken time off – for research, Americorps, etc.
If you came to medicine late and went to a postbac program, that’s great. If you didn’t do well in college but then proved yourself in a postbac, we’re not averse to giving second chances.
We’re looking for a diverse group of students who’ll share their experiences in a team-based, collaborative atmosphere. We’re looking for leadership across lots of different areas – research, sports, advocacy, teaching. Students learn from each other here and that works for us.
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