Starting anew: how forces internal and external have led to a new curriculum

As a postdoctoral fellow at the University of California, San Francisco, Dean Robert J. Alpern, M.D., received this advice: “Don’t ever join a curriculum committee.” It came from a visiting professor—Yale physiologist Gerhard Hans Giebisch, M.D. “Many curriculum committees have met at medical schools over the years, and sometimes nothing happened because there is so much resistance to change,” said Alpern, Ensign Professor of Medicine. In 2008, a strategic planning committee recommended that the School of Medicine pursue a fresh approach to medical education, and last year the school rolled out a new curriculum. This summer, Alpern discussed the importance of scholarly medical learning with Yale Medicine.

What is driving change in medical education?
There are good forces and bad forces. A good force is the acknowledgment that education is a specialty in which there are those with expertise. For a long time, the thinking was that doctors could do everything and we thought we were experts in education. Now the two groups are working together. A bad force is a national desire to train more doctors quickly. We are at risk of a dichotomy between established top medical schools that emphasize scholarship as well as training, and other medical schools that due to costs place more focus on training doctors.

Which aspect of the curriculum rebuild was a ‘must-have’ for you?
My major impetus was to bring together the sciences with the practice of medicine. In medical school we’ve traditionally taught the basic sciences in the first year and diseases in the second year. With the new curriculum, one hour you are learning about calcium ion channels in the heart, and the next hour you are learning how to treat cardiac arrhythmias.

Why is it important to support physician-educators?
Because much of our teaching occurs in groups of 10 or smaller, tuition cannot cover the cost of education. Basic science faculty get paid to teach, but physicians do not. They generate the revenue that pays for their salary in the clinic. If they take students with them, they generate less revenue. But the faculty know this, and one of the main reasons they join the faculty at Yale is because they value education.

How has medical education changed since you were a student in the mid-1970s?
When I went through, it was mostly lectures and textbooks, with some small-group teaching. We knew the knowledge base of medicine would change over time, but we had no idea it would change so rapidly. Now the emphasis is on creating physicians who are continuous learners.