The Integrated Curriculum: Increasing Medical Student Awareness of Men’s Health Issues
Anthony Balcom, MD, Assistant Professor of Pediatric Urology
The old days of a medical student doing nothing but reading books and attending lectures, without seeing a patient for the first two years of medical school are falling by the wayside. Along with approximately 68 percent of United States medical schools, The Medical College of Wisconsin is revamping the entire four years of medical student education to an integrated curriculum. In the old days, medical students would read textbooks and attend lectures on anatomy, physiology, biochemistry, pathophysiology, pathology, pharmacology and embryology for two years before they ever saw a patient.
The key concept of the integrated curriculum involves education modules grouped by organ systems. For example, in a typical day, medical students learn the embryology and anatomy of the urinary tract and then have application exercises that integrate anatomy, physiology, embryology, pharmacology, pathology and biochemistry in a clinical scenario. The day’s session would typically have application exercises. An example would be the evaluation and diagnosis of a 55-year- old man who had an elevated prostate specific antigen (PSA) followed by a prostate needle biopsy. This case would be used as a springboard to discuss prostate conditions such as benign enlargement and cancer.
Urology has been grouped into the reproductive module, which includes urology, obstetrics and gynecology, and male reproductive endocrinology. In the first two years, medical students focus on establishing a diagnosis; they are not typically tested yet on treating diseases and conditions. Integrated curriculum sessions are run by having basic scientists, who have classically taught first- and second-year medical students, and clinicians, who can put the information into a much more patient-oriented, clinical perspective.
An essential component of the new integrated curriculum is called team-based learning, or TBL. Many studies show that when groups of students work through and discuss a new topic or concept together and are then tested on it, the retention rate of the learned material is much higher. The ideal group size is between six and eight students, and the format is quite different than the classic medical school format. Students are assigned pre-readings, which are typically two or three hours of material. When they arrive for TBL sessions, they take individual reading assessment tests (IRAT). This is typically six or 10 questions that come directly from the reading material, and the instructors can quickly get an idea of what material in the pre-reading made sense, and what was more complex and in need of further explanation.
The integrated curriculum also exposes medical students to patients in physicians’ clinics starting three months into their first year of medical school. This has proven to be a very popular change and was likely the reason nearly 80 students volunteered to be part of this trial curriculum (only 28 slots were available and students were chosen at random). Students spend three or four hours a week in a small group with a primary care physician mentor seeing real patients and discussing their medical conditions.
The first integrated curriculum pilot group of 28 medical students started in 2010. Over the next four years or so, the plan is to transition the entire group of 196 medical students to an integrated curriculum.
The Department of Urology at The Medical College of Wisconsin was led by Tony Balcom, MD, and also represented by Jay Sandlow, MD, Charles T. Durkee, MD, Michael Guralnick, MD, and Ken Jacobsohn, MD. This has been a very rewarding experience over the past year. We have been impressed with how eager medical students are to learn, and how hungry they are for knowledge. It has been somewhat challenging to figure out how to address first- year medical students at an appropriate level, as in the past, we interacted frequently with third- and fourth-year students. However, the students have provided positive feedback regarding the curriculum, particularly in regards to clinical correlation and early patient exposure.
Dr. Sandlow and I are confident the integrated curriculum presents a marvelous opportunity to help expose medical students to men’s health issues, and educate them about this genre at a much earlier stage than previously. This has been a gratifying and rewarding improvement in medical education. We are hopeful that by increasing medical students’ awareness of men’s health issues early in medical school, they will have a better overall knowledge base when they graduate from medical school and attend residency.