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Harriet S.MeyerMD, Contributing EditorJonathan D.EldredgeMLS, PhD, Journal Review EditorRobertHoganMD, adviser for new media
For medical educators, the name Johns Hopkins is associated with the illustrious icon, Abraham Flexner, who at the beginning of the 20th century proclaimed Johns Hopkins University School of Medicine as a model for the education of medical students. This legacy was not forgotten when MD program leaders at Johns Hopkins decided it was time to dust away the cobwebs and start designing a new curriculum.
This book presents in detail the multiyear process of curriculum change in the Johns Hopkins MD program. Chapters describe the rationale for change, objectives pursued, tactics used, main players, and initial outcomes. Most, but not all, recent curricular changes have been spearheaded by two main forces: the accrediting agency for MD programs requesting periodic curriculum evaluation and change, and the availability of substantial grants to pursue curricula geared toward enhancing the production of generalists. Johns Hopkins applied and received one of these grants, which helped finance some of the necessary changes.
A main player during the curriculum change process writes each chapter. This is an important characteristic, since different versions may be produced by different parties to the same historical events. History is usually written by the protagonists who effect change. When silent audiences are consulted, a different historical picture may result. I am thinking of Ross and Fineberg's1 account of change at several institutions after interviewing students and faculty.
The opening chapter sets the scene by deftly summarizing the main factors leading to the need for curriculum change. The next chapter gives an overview of the process and, especially, the necessary leadership provided by the dean's office. This circumstance is particularly important in curricular change, where a strong alliance between administration and faculty greatly facilitates a positive outcome.
The new curriculum's first academic year is lucidly explained. Decision makers selected a hybrid curriculum, a mix of lectures and discussion groups. The groups undertook basic science problems, in contrast to the better known clinical-case problems used in problem-based learning curricula. Although firmly grounded in basic science content, the curriculum added clinical correlation experiences and periodic contacts with preceptors, which helped students maintain their interest in medicine. The administrative difficulties of organizing the preceptorial experience using community-based private practitioners receives a brief chapter.
Another chapter proceeds to detail attempts at coordination of courses using an organ-system approach during the second academic year of the new curriculum. These courses used most of the previous curriculum content, rearranged.
A four-year course, "Physician and Society," comprising diverse elements such as bioethics, history of medicine, art, spirituality and medicine, economics, multicultural issues, and law, serves to bring class members together throughout their MD program. The clinical years received only a minor facelift and, consequently, the few changes are quickly dispatched in a dozen pages.
An extensive chapter describes aspects of educational technology as a backbone for the new curriculum. Many of the descriptions will be familiar to those trying to introduce more multimedia technology in the teaching of medical students.
A chapter on evaluation of the curriculum illustrates that it is not easy to evaluate change. It is tempting to use the word "faith" when faculty opt for one model vs another, because it is extremely difficult using present methodologies to show clearly the superiority of the new chosen system vis-a-vis the previous curriculum. Confounding variables make the evaluation process tenuous and soft.
Dr DeAngelis, as the change leader, provides the coda by expressing 12 lessons or principles that she learned from this enterprise. Anyone associated with institutional curriculum change would agree with all of them. However, as the eminent medical educator, the late George E. Miller, MD, liked to paraphrase Santayana, "In medical education, even those who don't ignore the past still are condemned to repeat it." Each MD program might benefit greatly from books like this one, to study the different solutions that others apply to known problems. However, in the long run, each school will need to develop its own pathway as it progresses through the many years required for successful change.
Though not an all-inclusive list, two similar efforts at describing curricular innovations, one from Harvard2 and one from New Zealand,3 are works that readers of this volume might also enjoy.
This helpful publication from Johns Hopkins University School of Medicine should be required reading for all who are, in one way or another, participating in curricular change for MD programs. When added to the others mentioned herein, the resulting set should provide a substantial knowledge base for curricular innovators.
Education: The Johns Hopkins University School of Medicine Curriculum for the Twenty-first Century. JAMA. 2000;283(9):1212. doi:10.1001/jama.283.9.1212-JBK0301-4-1
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