A New Medical Education Building
Combines with a New Curriculum for the 21st Century

Introduction

After nearly 3 years of planning involving hundreds of medical faculty and students, and key members of Emory’s schools of nursing, public health, and graduate programs in the arts and sciences, Emory School of Medicine implemented an innovative medical curriculum in August, 2007.  This exciting program was carefully designed after extensive consultation with other renowned medical institutions and educational experts in the United States and the United Kingdom.  Emory’s new curriculum reflects the extraordinary advances taking place in biomedical science; meets the needs of an ever-changing local and global healthcare environment; takes advantage of the unique educational resources in Atlanta; and respects the intellectually-gifted and highly-motivated students who choose to come to Emory. 

All of this occurred contemporaneously with the opening of a new Medical Education Building on the Clifton Corridor.  Costing in excess of $60 million, this 162,000 square-foot environmentally “green” structure incorporates the historic facades of the school’s original Anatomy and Physiology Buildings, but also contains state-of-the-art classroom, laboratory, and study space that serves as a model for 21st Century scientific and medical education.

Curriculum Philosophy and Design

The specific structure of the curriculum was designed by the faculty and student leadership in keeping with the following desired characteristics of Emory School of Medicine graduates:

• Superb clinicians who demonstrate the highest degree of professionalism; outstanding clinical competency and problem solving skills; and the ability to understand and utilize basic science in the clinical setting
• Curious and creative thinkers with the ability to utilize available resources to answer clinical and research questions and to assess information critically
• Lifelong adult learners with the ability to take ownership of their own present and future educational needs
• Physicians who continue to be passionate about medicine and about making a difference; who are involved in and appreciate efforts to improve the health of local and global communities; who see medicine as profession that seeks to address issues of social justice
• Physicians committed to understanding the sociological, psychological, and economic issues of the patient, the family, and the community
• Future leaders eager and able to play leadership roles in their chosen field of medicine or biomedical science, and in their community

The academic community articulated the characteristics of a new curriculum that would produce such graduates.  The new curriculum:

• Is competency-based, through the development and assessment of core competencies as determined by the faculty
• Provides for integration of basic and clinical science--both horizontally (across disciplines) and vertically (across years)--throughout all four years
• Provides an early introduction of clinical medicine and an increase in clinical experience in the ambulatory setting, including a sustained experience in a continuity clinic
• Increases flexibility throughout the four years of the curriculum
• Provides an “in-depth” discovery phase that will enhance creativity, curiosity and the development of leadership skills.  Inherent in this opportunity is the potential of a tuition-free fifth year of study, and encouragement of year-long experiences at Emory (e.g. lab-based research, MPH at the Rollins School of Public Health) or at other institutions (e.g. CDC, NIH).
• Reduces lecture time and rely less on rote memorization with simultaneous creation of more opportunities for active learning
• Provides better methods of academic and clinical assessment closely linked to the appropriate competencies
• Increases student mentoring throughout the four years of medical school and increases exposure to master clinicians at all Emory clinical sites
• Increases use of clinical simulation and standardized patients for skills training and assessment

The structure of the curriculum provides for:

• Earlier completion of the “basic science” phase
• Completion of the core clinical experiences over the following one year (this would allow students hands-on exposure to specialty fields of medicine, such as neurosurgery, urology, and ophthalmology earlier than the conventional “fourth year”)
• Addition of a required period of discovery (which might be done in the ultimate field of choice) and the addition of a “capstone” experience to the end of the fourth year of medical school which would prepare students for entrance into House Staff training programs.

In order to achieve the desired outcomes, the new curriculum is divided into four phases:

• Phase 1:  Foundations of Medicine.  This phase provides students with the core knowledge of basic and clinical sciences.
• Phase 2:  Applications of Medical Sciences.  This phase provides students with core knowledge of the basic clinical medical specialties.
• Phase 3:  Discovery.  This phase is a structured time for students to concentrate in a specific area of interest, such as basic or clinical research, public health, community development, medical ethics, or other areas.
• Phase 4:  Translation of Medical Sciences.  This phase prepares the student for the transition to physician.  Rotations as a Sub-Intern; advanced clinical work in an ICU; experience in the Emergency Department; and a final Capstone Course prior to graduation are required.

An integral part of the new curriculum involves significant expansion of the current Society System.  There are four clinician advisors in each one of four Societies, for a total of 16 practicing physicians; these individuals are dedicated clinical teachers and mentors.  Every student is assigned to a Society and has a Society Advisor.  These faculty members are teachers of clinical skills, small group mentors, and the student’s primary link with School of Medicine and Emory University resources.  The new Medical Education Building was specifically designed to facilitate the new curriculum and the expanded role of the Society system; each Society has its own large classroom/home, offices for Society Advisors to privately meet with students, and administrative assistants that facilitate Society activities.  The Society Advisor-Student role will continue until a student graduates.

A simplified four-year calendar for the class entering in 2007 is illustrated below:

The Foundations courses are co-taught by basic scientists and clinicians.  There are no department-based courses; medical professionalism, ethics, history of medicine, and principles of public health and biostatistics are taught in an integrated manner via clinical cases presented as part of the Foundations curriculum and during the longitudinal, out-patient experience.  Building on its success in our previous curriculum, students spend one of their very first weeks in medical school in a popular “Week on the Wards” rotation.  This allows new students of medicine an opportunity to both “try on” their new role as a physician, and for the last time, observe the patient and physician interaction from “outside” the system of healthcare.  Students undergo clinical instruction in the art of the history, patient-doctor communication, and physical examination skills during those early weeks and in October enter a longitudinal Primary Care clinic in Family Medicine, Internal Medicine, or Pediatrics.  The students spend one afternoon every other week in their Primary Care Clinic for the next 12 months, under the guidance of a primary care physician. 

The Foundations Phase begins with a four-month section on the “Healthy Human,” a section designed around the human life cycle and emphasizing healthy human activities:  Neural Function (including cognition), Exercise, and Nutrition.  Basic science concepts including cell biology, genetics, biochemistry, physiology, embryology, histology, reproduction, and human development are covered during the Healthy Human section.  By beginning with the “Healthy Human” approach, the curriculum emphasizes: 1) the important role that behavior plays in health and disease; 2) that the approach to the patient must include consideration of the community, environment, family, and the “whole” of the person; and 3) the importance of healthy human activities, such as exercise, nutrition, procreation, and cognition/creativity as foundational to human well-being.

The Healthy Human is followed by Prologue II, a section designed to prepare students for the Human Disease Section.  Prologue II introduces the principles of microbiology, pathology, immunology, and pharmacology.  The Human Disease section consists of organ block sections.  Human Anatomy, including cadaveric dissection, is completed during the first five months of the Human Disease Section, and where possible, will correlate with the organ system being taught.  The organ system blocks begin each week with a simulated or real case presentation.  Approximately two hours of class and two hours of small group each morning are augmented with longer small groups/skills sessions on Tuesday afternoons; the primary care clinic will continue one half day weekly.  Normal human function is revisited during the Human Disease section as applicable.  Clinical cases drive the week’s learning objectives, including social topics such as cultural competency, addiction, homelessness, etc.

The Foundations Phase and Step I of the USMLE are completed within 19 months, allowing students to begin the Applications Phase during the middle of Year 2.  Students complete the Applications Phase in the middle of Year 3, at which time an individual student may move directly into five months of Discovery, or may choose to take clinical electives in sub-specialty fields.  This will afford students the opportunity to choose their research area within their expected field of residency, if desired. 

The Applications Phase includes “clerkship” training in the core clinical areas of medicine, including Internal Medicine, Surgery, Obstetrics/Gynecology, Pediatrics, Psychiatry and Neurology.  During the Applications Phase, one-week inter-sessions prior to each block of clinical rotations highlight basic science knowledge, clinical skills, and ethics.  During clinical rotations, students operate as full members of a medical care team.  While core clinical knowledge is learned, patient-directed learning is emphasized.  This patient-directed learning is the best preparation for the engaged life of a practicing, inquisitive physician/learner.

The mandatory Discovery Phase is new for Emory but coincides with an enormous growth in research at the University level.  Approximately 80% of Emory medical students currently participate in a research project, the majority of those experiences occurring between the first and second year and lasting 8-10 weeks.  When designing the new curriculum, faculty and students strongly supported the concept of a longer, more in-depth Discovery Phase.  The Discovery Phase may be spent in any field, but must be related to medicine, closely mentored, and result in a final product approved by the mentor.  The time period for this phase may be extended to 9 months by using elective months available during the Translations Phase.  Alternatively, students may choose to spend an extra year in research, either at Emory (tuition-free) or at another institution (e.g. CDC or NIH).  A year or more of study may allow a student to obtain a Masters of Medical Science degree.  The new curriculum provides extra time for projects and field experiences for the MD/MPH dual degree program.  While it is anticipated that most students will spend their Discovery Phase in a basic science lab or on a clinical science or public health project, students may also choose to spend this time in matters of the medical humanities, medical anthropology, medical sociology, etc. 

The Translation Phase includes four required rotations: Intensive Care Unit (ICU); Emergency Medicine; a Senior Clerkship in Medicine, Surgery, or Pediatrics; and a Capstone Course.  The ICU month reinforces essential basic science concepts and ethical precepts.  The Capstone month occurs the final month as an Emory medical student and will include team training, standardized patient cases, instruction in the art of clinical teaching for “soon-to-be” residents, and important didactic material relevant to medical-legal, ethical, and communication issues.  

The New Emory University School of Medical Education Building Opened in 2007
Simultaneous to Launch of the New Curriculum

The new curriculum is only possible due to the completion of our new Medical Education Building.  This accomplishment is a cause for much excitement and celebration by the faculty, staff, and students in the School of Medicine, and a landmark event for Emory University.  This $60 million building, with 162,000 square feet of space, is the first building built specifically for medical education in the history of the school and is one of the finest medical education facilities in the United States.  This new building contains state-of-the art facilities including:

• Three 160-person classrooms
• Four 40-person classrooms with faculty offices to serve the needs of the new Societies system
• 19 Small Group rooms
• A 4-room Simulation Suite
• A 16-room Objective Structured Clinical Exam (OSCE) Suite
• A cadaveric and fresh tissue dissection space with computer access at each dissection table, lockers, and laundry facilities
• Two 75-person computer/teaching laboratories
• A student lounge, with café and coffee bar
• Showers, for those who commute by run/bike or after mid-day exercise
• Administrative space for the Dean’s office

The building was planned and built with the new curriculum in mind.  It serves as a home for medical students, but also provides space that will allow for bringing students from the School of Nursing, Physical Therapy Program, and Physician’s Assistant Program together with medical students, so that health sciences students can learn and train together, thereby mimicking the “real” world of team-based health care.  Furthermore, the building is designed to facilitate student/faculty/resident interaction via small group teaching and informal interactions as faculty utilize the simulation lab and the fresh tissue space. 

The Bottom Line

At the heart of any medical school curriculum are excellent and committed faculty, residents and fellows who have time to teach and who are both appreciated and rewarded for their abilities as teachers and mentors. The new curriculum includes on-going faculty and house staff development workshops that will enhance teaching, mentoring and assessment skills.

The momentum that develops from the implementation of the proposed curriculum and the opening of our new building assures that teaching will continue to be highly regarded and an honored equivalent to the other missions of the school.  This enables the Emory University School of Medicine to produce the best physicians possible for the changing times—women and men who are prepared to become the future leaders of American medicine.

Come and make medical history with us at
Emory University School of Medicine!