Second-year pathophysiology historically has resembled a disjointed caterpillar: a series of segmented courses, each moving on its own and not necessarily in sync with the others. Instructors did not make the connections for students between their respective specialties. To reattach and realign the parts, the new curriculum has created one year-long, longitudinal course, Human Systems, to begin in September 2007.
Under the old approach, for instance, “When students were taking the gastrointestinal course, they would hear about a patient with chest pain and think, ‘It can’t be a heart attack because we’re taking GI,’” said Barbara Cockrill, HMS assistant professor of medicine at Massachusetts General Hospital, and one of three co-directors, along with Robert Stanton and David Cardozo, for the new Human Systems. Explains Cockrill, “We wanted to make sure that the students had a more real-life approach, where you don’t know why the patient has chest pains,” and it could very well be a heart attack.
To achieve these improvements, all the course instructors planned the new year together, “so the dermatologist knows what the rheumatologist is teaching and can highlight dermatological issues that come up in rheumatology,” Cockrill explained. “Then we can look back, and the rheumatologist can say to the students, ‘As you learned in dermatology….’”
The instructional sequence also has changed. Previously, the second year opened with a stand-alone course on the nervous system and behavior from September to November led by Cardozo, HMS assistant professor of neurobiology, followed by Human Systems Module I (skin, lungs, heart, and blood) from November to February, followed by Human Systems Module II (kidneys, the gastrointestinal system, endocrinology, rheumatology, and reproduction), running from February to May.
The reformed Human Systems will begin with a two-week introductory course on principles of pharmacology in August. Nervous system has been wrapped in as an associated course under Human Systems, running from September to mid-October. Then, a three-week block will cover dermatology, rheumatology, and orthopedics.
Moving rheumatology to earlier in the year not only integrates Human Systems topics but also allows rheumatology and orthopedics to be studied alongside Patient–Doctor II, when students are learning to do the musculoskeletal exam. Indeed, “we wanted to use Patient–Doctor II [the course on physical examination that runs the entire second year, see Focus, March 9] as the glue throughout the year,” said Stanton, HMS associate professor of medicine at Joslin Diabetes Center. Now, for example, students will learn skin pathophysiology and how to do a skin exam concurrently, and cardiac pathophysiology and how to do a cardiac exam.
Students will round out the year studying, in order, lungs, heart, blood, kidneys, endocrinology, reproduction, and the gastrointestinal system. Stanton said that pathology and nutrition, while not stand-alone courses, will be woven throughout the year into the instruction, along with pharmacology (beyond the initial two-week exposure to that field). Each of these areas will be covered along with the pathophysiology of specific systems. Students will learn, for example, about the disorders of the heart, including pathology; how to treat them; and what nutritional issues pertain to the prevention and management of heart disease.
One innovation will be “integration weeks” at the end of December and April that will subject students to an integrated exam testing them on all topics covered up to that point. The comprehensive exams are modeled on a similar exam that has been given for several years in the skin/lungs/heart/blood module of the old second year.
Among the challenges, Stanton said, is teaching all this material in the newly truncated second year, which will end in April. “The curriculum is kind of packed now,” he noted.