MSU Shared Discovery Mark No text

Students learning more, faster in the Shared Discovery Curriculum

Nearly two academic years into the Shared Discovery Curriculum and the pioneering cohort of students have separated themselves from the college’s historical performance on the National Board of Medical Examiners (NBME) Comprehensive Basic Science Exam (CBSE) by a standard deviation. We are excited to not only have a statistically significant difference but an educationally meaningful improvement as well.

Why is it working?

I think there are two basic reasons that the Shared Discovery Curriculum is working:

  • The curriculum is based on the pragmatic educational philosophy of Jane Addams and John Dewey, and
  • The measured student outcomes and real-world goals of the curriculum are the same.

These two reasons probably read as a nearly insulting oversimplification to those who have done the actual work of the curriculum and as an impossibly brief summary to the reader who has wandered to our project. But bear with me.

Educational philosophy from Jane Addams and John Dewey

These two American pragmatist philosophers had fascinating careers ranging across politics and disciplines from the last nineteenth to late twentieth centuries. I think both of them would have predicted that highly experiential education would be more effective than a traditional preclinical curriculum.

It is possible to apply the work of these two philosophers to much of medicine and medical school, but we focused on a few key concepts:

  • It is very useful to use practical experiences to guide theoretical learning. Jane Addams taught English to immigrants through vocational training; we teach the language of medicine through clinical experiences rather than theory-based course work.
  • Knowledge is not an independent educational assessment. We only measure knowledge in terms of performance like answering questions or using information to solve a problem. The pragmatists emphasize that an intellectual construct and its effects are inseparable. The SDC explicitly integrates the skills and the knowledge needed to demonstrate those skills as clinical, simulation, or modified Problem-Based Learning events.
  • The SDC moved our assessments toward real world objectives like answering patient questions or passing board exams rather than focusing on remembering course content.
  • Content and experiences should be oriented to the needs of the student not the thought processes of faculty. Many traditional courses are organized using a retrospective fallacy. Faculty tend to organize and simplify content with the most molecular basic science first and then “build” an explanation for larger organismal function. No curious child or curious scientist learns (or discovers the world) that way. We discover by engaging in the world and then digging down into the subject.  The SDC content is structured first by patient experience and then digging down into humanities or necessary science that underlies what we see in people. Our curriculum is organized by the patient’s Chief Complaint and Concern rather than by discipline or organ system. Our students engage with the science underlying shortness of breath based on the patient experience rather than divide dyspnea into cardiac, pulmonary, hematologic, neurologic, and other causes that the student only later integrates on the wards, or doesn’t.

Assessments match real-world performance

The close reader of this update will find a bullet about this topic in previous the Addams-Dewey section. I think both Dewey and Addams would argue that your curricular assessments should match the real-world expectations of graduates as closely as possible. This is not really a new concept, but I think we have come as close as possible to aligning the SDC’s assessments to the real-world performances of medical school graduates.

One of the innovations of the SDC is the creation of the world’s first progress clinical examination. The SDC students of all levels take the same clinical skills, standardized patient examination. In another essay we will discuss how well this progress clinical skills examination is working, but in the design of the SDC, this kind of assessment of skills used in the real-world care of patients was key to ensuring students and faculty take these competencies seriously.

A new curriculum is always a bit of an unknown, so designers need to ensure that learners are going to be ready for the next step in their careers. For early medical students, the most frightening next career step is the National Board’s USMLE licensing examination. While the examination may not be all an educator would hope for in an examination, the USMLE is a real-world performance important to students. If a medical school curriculum can prepare students for the USMLE, the educational program will be successful in the eyes of students and the outside world.

To address the USMLE and the problematic concept of medical knowledge, the SDC uses a series of medical knowledge progress examinations from the National Board designed to be predictive of USMLE performance. We’ve done away with individual courses with questions about esoteric basic science questions, and we now focus on patients’ Chief Complaints and Concerns. It turns out that understanding a patient’s primary complaint or concern (for example, cough) is very similar to reading and understanding the initial sentences of a board question about a patient with cough. Our content and assessment are lined up.

The alignment of content and assessment obviously prepares students for the examination at the end of the semester, which only seems fair. But this alignment is also a safety feature. If a methodology in the curriculum is not working well (e.g., our attempts at Team-Based Learning were viewed by students and faculty as inefficient) the faculty and students will reorganize their work to prepare for the real-world assessment rather than a surrogate assessment like a course examination.

Progress measures

After implementing the Shared Discovery Curriculum in the fall of 2016, we report a remarkable success due to the incredible talent and effort of our staff and faculty and the pioneering spirit of our students. Here are some of the key successes:

  • Students are learning more, faster than in the prior curriculum as measured by national examinations. We have graphs!
  • The rate of first year students delaying their graduation for any reason has dropped to below 1% from a prior average of 10%. This saves students money, saves the students time, and allows the college to decrease the burden on faculty and community teaching resources.
  • Staff and faulty have arranged and implemented more than 20,000 clinical assignments for first and second-year students.
  • Our students have successfully done Interprofessional education with respiratory therapists, physical therapists, nurses, case managers, medical assistants, pharmacists, nutritionists, and social workers.
  • In the first four semesters of the Shared Discovery Curriculum our students have completed CCC work place assessments and DDD simulation assessments – the Just In Time platform has been wondrous.
  • The College of Human Medicine Learning Societies have improved relationships between students and faculty, between students, and between students and the college.
  • The world’s only Progress Clinical Skills Examination is working brilliantly! We have histograms!

It will be years before we can look at how the SDC has performed overall or for different subgroups of students, but at this point we are delighted and have every reason to think the student’s progress to date will continue as it has so far.

 

Sincerely,

Aron Sousa Signature

Aron Sousa, MD, Senior Associate Dean for Academic Affairs
Michigan State University College of Human Medicine

 

Message from Aron Sousa, 2016