Integration of Foundational and Clinical Sciences
Across the Medical School Curriculum
Neil Osheroff, Ph.D.
Cathleen C. Pettepher, Ph.D.
Tyler E. Reimschisel, M.D.
Vanderbilt University School of Medicine
Curriculum 2.0
To create a responsive, agile system of
lifelong learning that:
Embraces innovation and
improvement
Fully integrates learning
with patient care
Rapidly translates
discovery into practice
Supports the professional
growth of teachers and learners
Creates physician leaders
Traditional Medical School Curriculum
Pre-clerkship
Basic Sciences
Clinical
Years 1-2
Clerkship
Clinical
Basic Sciences
Years 3-4
Vanderbilt Curriculum 2.0
Foundations of
Medical
Knowledge
(FMK)
Foundations of
Clinical Care
(FCC)
Immersions
Foundations of Healthcare Delivery (FHD)
Learning Communities/Colleges
Old Curriculum (pre-2007)
Current Curriculum (1.0)
New Curriculum (2.0)
Discipline/department-based
courses
Interdisciplinary courses
Interdisciplinary blocks
Individual courses are highly
integrated
Individual blocks are
extensively integrated
No crosstalk between courses
Some crosstalk between
courses
Extensive crosstalk between
blocks (horizontal & vertical)
No crosstalk between years
Little crosstalk between years
Mostly passive learning
Largely passive learning
Extensive crosstalk between
all phases
Basic sciences, social
sciences, & clinical separated
Basic sciences, social
sciences, & clinical separated
Little (if any) integration of
disciplines
Mostly active learning
Basic sciences, social
sciences, & clinical integrated
FMK Phase
Professionalism
Health Care
Health Care Systems
Leadership
Infection & Antimicrobials
Immune Response
Inflammation
Autoimmune Diseases
Rheumatology
Proteins, Nucleic Acids
Signal Transduction
Metabolism, Genetics
Cell & Tissue Biology
Fundamentals, Introductory
Pathology, Anatomy, and
Pharmacology
Endocrinology
GI/Nutrition
Reproduction
Cardiovascular
Pulmonary
Renal
Hematology
All disciplines (including anatomy)
are incorporated into every block
Neuroscience
Brain/Neurology
Mind (Psychiatry/
Behavior)
Musculoskeletal
FMK Phase Weekly Schedule
Monday
8:00
AMNoon
1:00
PM 5:00
PM
Tuesday
Case-Based
Learning
Groups
Wednesday
Case-Based
Learning
Groups
Large/Medium
Group or Lab
Large/Medium
Group or Lab
Thursday
Friday
Case-Based
Learning
Groups
Large/Medium
Group or Lab
Large/Medium
Group or Lab
Afternoons
1 day per week in Continuity Clinical Experience
1 day per week in small groups for Physical Diagnosis
At least 2 days per week protected time for study
Learning
Community
Large/Medium
Group or Lab
Physical
Diagnosis
Educational modalities include: Large group sessions, Flipped
classroom, Case-based learning, Team-based learning, Patient
sessions, Laboratories (CTB, Path, GA)
Students are treated as young professionals from the beginning of medical school
Human Blueprint and Architecture 2014 - Week 5
Monday 8/25/14
Tuesday 8/26/14
Wednesday 8/27/14
Case-Based Group Session
8A: Danielle Brady,a 4-Month8:00 AM
Case-Based Group Session
Old Girl w ith Hepatomegaly
Tissue
Biology
Laboratory:
8B: Danielle Brady, a 4and Cardiomegaly
Connective and Adipose
Month-Old Girl w ith
Case-Based Group Session
Tissue Lab
Hepatomegaly and
9A: Jane McDonald, a 24-YearCardiomegaly
9:00 AM
Old Woman with Malai se,
Time
Thursday 8/28/14
Friday 8/29/14
TBL Session: Ethics of
Genetic Testing
Case-Based Group Session
9B: Jane McDonald, a 24Year-Old Woman w ith
Malaise, Nausea, and
Abdominal Pain
Nausea, and Abdominal Pain
Speci alized AA Prod & Pur/Pyr
Complex Molecular
Metaboli sm
Metabolism: Post-translation
10:00 AM
Modification and
Learning Communities
Clinical Biochemistry:
Peroxisomes
Ethics: Ethical issues in
Hypoglycemia, Acidosis, and
Neurogenetics: Genetics and Screening, Testing, and
Hepatocellular Dysfunction
Biochemistry of
Complex Metabolism:
Therapy
Basic Response I: Cellular
11:00 AM
Lysosomes and Lysosomal Developmental Impairment
Response to Injury
Storage Diseases
Cells of Connective Tissue
and Adipose Tissue
12:00 Noon
1:00 PM
Pharmacological Concepts:
Pharmacokinetics
2:00 PM
Pharmacological Concepts:
Pharmacokinetics
Foundations of Healthcare Delivery: Students in Clinic One Afternoon During the Week
3:00 PM
Physical Diagnosis: Vital
Signs
4:00 PM
Large Group
Sessions
CBL Small Group Sessions
TB & Path Lab Sessions
TBL Small Group Sessions
GA Laboratory Sessions
Clinical Sessions
Review Sessions
Examinations
Assessment in FMK Phase
Ultimate grading is Pass/Fail
Weekly assessments: MCQ quizzes, essay questions (other: TBL, etc)
Mid-block formative peer, self, and facilitator assessment of small
groups (competency-based milestones)
End-of-block summative assessment:
2-3 days (depending on length of block)
1-2 days self-regulated learning before assessment
Integrated essay examination (includes all components taught during
the block)
Practical examination (tissue biology, pathology, and gross anatomy)
NBME multiple-choice examination
End-of-block formative peer and facilitator assessment of small
groups (competency-based milestones)
Students must receive a passing grade in knowledge and small
group work in order to pass the block
Foundational Sciences in the Clinical Phases
Foundations of Clinical Care Phase
Continuation of Learning Communities
Overt Discussion of the Foundational Sciences as Part
of the Clerkships (Underlying basis of illness, symptoms,
treatment, etc)
Diagnosis and Therapy Course
Foundational Sciences in the Clinical Phases
Immersions Phase
Highly individualized phase tailored to the interests and
needs of the student
Foundational Sciences in the Clinical Phases
Immersions Phase
Acting Internship (AI): Close approximation to internship
Advanced Clinical Electives (ACE)
Formal curriculum (objectives, competency-based assessment)
Deliverable from student to care team
Integrated Science Course (ISC)
Multiple disciplines in focused clinical area
Cancer, critical care, obesity, global health, congenital malformations, etc
Topics Courses (Classroom-based)
Focus on knowledge in focused area (statistics, development, policy)
Master Adaptive Workplace Learner (MAWL)
Students in ACE courses identify a patient-driven problem and in
conjunction with a clinical and basic science mentor research the problem
and report (written and oral) back to the clinical team
Research/Scholarship (3-6 months)
Congenital Malformations ISC
4-week course for third and fourth year students
Offered once a year
Interprofessional care of children with complex
congenital malformations
Students work in pairs in 1 of 4 areas each week
Urology, cardiology, craniofacial, and neurogenetics
Sciences: molecular biology, developmental genetics,
embryology, histology, anatomy, physiology,
pathophysiology, pharmacology
Other threads: systems of care, developmental disabilities,
communication skills, interprofessional teams
Clinical venues: OR, PICU/NICU, wards, clinics, cath lab
Other venues: family resource center, community agency
visits
Congenital Malformations ISC
Classroom Learning
Flipped classroom for core sessions (2-3 hours/wk)
Research presentation (1 hour/wk)
Simulation on conducting difficult conversations
Team project using challenge cycle
“Parent guide to the care of a child with CL/CP”
Team presentations at end of course
Early morning or early evening group check-ins each
week for debriefing, Q&A, and feedback