The novel structure and organization of the Shared Discovery Curriculum required a new system of identifying and presenting the content and objectives for the college in a clinically focused and integrated curriculum. As such, the College of Human Medicine faculty identified a group of Chief Complaints and Concerns (C3) based on international lists of core objectives and diagnoses which reflect the reasons people seek health care (i.e. chief complaints and concerns) rather than by organ systems or disciplines in the clinical and basic sciences.
The C3 documents detail the end-competencies of our undergraduate medical curriculum. The template for these documents guides faculty to list, in detail, every clinical and necessary science competencies. These documents are mapped to the USMLE Step examination blueprints, and a Comprehensive Necessary Science examination given twice a semester assures students and faculty that they are mastering the necessary material to the necessary depth for success on these licensure examinations and for an intellectually satisfying trajectory through the curriculum.
Chief Complaints and Concerns document topics are “hard-wired” into weeks of the Early, Middle and Late Clinical Experiences, as well as the Intersessions. The choice of topics for each curricular segment have been made based on what students are most likely to see during their clinical time and what they need to learn along their developmental trajectory. For example, during the Early Clinical Experience, which takes place in primary care ambulatory environments, students learn to room patients. As they take vital signs, obtain pain scores, do diabetic foot exams, and give immunizations, the Chief Complaints and Concerns topics that are programmed into each week of the ECE teach the clinical and necessary science material related to blood pressure regulation, respiratory physiology, neural pathways for pain and autonomic control, vascular structures and sequelae of blood sugar elevation, and the rationale and immunology of immunization schedules, as well as the anatomy of where the immunizing needle goes. The Post Clinic Groups that take place after each clinical half day spend some time debriefing what was seen and done in that clinic, and then accomplish the necessary science teaching related to the topic of the week.
The C3s are found in Just in Time Medicine, a cloud-based, hyperlinked curriculum content delivery and assessment platform. It is fully searchable using key words and tags. The tags identify the disciplines linked to the content (e.g. medical genetics, cell biology), and identify when learners routinely encounter content (e.g. ECE, MCE).
The resulting C3 documents include end-competency objectives for each topic and define what an exemplary new resident should know and be able to do for a patient with that chief complaint or concern. Content in any C3 document is distributed throughout the curricular segments. For example, Dyspnea content is found in the Early, Middle, and Late Clinical Experiences.
Each of the C3 documents contains:
- Capstone Assessments
- Gathers Relevant Data
- Problem List/Differential Diagnosis
- Management Plan
- Applies Necessary Science