Medicine Develops Innovative New Curriculum
UCSF faculty at the Center for Health and Community have received two grants to assist the
School of Medicine in a radical redesign of the medical school curriculum. The CHC is
taking the lead to add emphasis on culture and behavior to the curriculum, a change that
UCSF faculty hope will enhance students' educational experiences and better prepare them
for the world of medicine, said Nancy Adler, PhD, director of the CHC and chair of the
The curriculum is being redesigned in fundamental ways, said Adler, who explained that
the School of Medicine wanted to create a curriculum which promotes integration of
disciplines, allows for an early introduction of clinical concepts, and expedites
students' entry into the patient care setting.
The grants from The California Endowment and The California Wellness Foundation to
Adler and Melanie Tervalon, MD, UCSF assistant clinical professor of anthropology, history
and social medicine, will provide 18 months of funding to revamp the curriculum. The old
curriculum came under review beginning in 1996, and the new one will be finalized by the
fall of 2001.
Though there have been incremental enhancements in the UCSF School of Medicine
curriculum in the last three decades (including reduction of class lecture hours in the
first two years, increased use of small group learning, and creation of interdepartmental
courses), this endeavor marks the first radical redesign of the curriculum since 1969.
To support curriculum reform, the UCSF School of Medicine has established the Academy
of Medical Educators, the first medical school organization in the country to encourage
interdisciplinary approaches, provide funding for innovative educational programs, sponsor
faculty development, and facilitate mentoring of teachers, said David Irby, UCSF vice dean
of education in the School of Medicine.
Molly Cooke, professor of medicine, was recently named director of the Academy of
The UCSF School of Medicine is a national leader in the way it is designing its new
curriculum, said Irby. The traditional structure, consisting of two years of basic
sciences plus two years of clinical rotations, will be replaced by a new model divided
into three stages: the essential core, the clinical core and advanced studies and will
span four years.
The first two years of basic science classes will be replaced by courses taught in
integrated blocks, each centered on clinical cases. Cases will illustrate not only
clinical manifestations of disease, but also basic science, as well as cultural and
behavioral concerns, he explained.
"The redesign is an opportunity to introduce culture, community and behavioral
issues into all levels of medical student education," Adler said. "From the
start students will conceptualize and integrate cultural, social and behavioral factors
into their understanding of biomedical and clinical issues."
In the new curriculum, students will spend less time in the classroom (about 24 hours
per week) and lectures will be de-emphasized so students can experience more independent
Internet-based and small group learning. Similarly, exams will incorporate problem sets,
presentations and projects, all designed to provide more opportunities for active
Students will begin their first year with a prologue, a case study of a motorcycle
accident patient who will gradually regain consciousness. This paper-based case study
(enhanced by live-action and videotaped scenarios) will provide students with brief
overviews of anatomy, histology, pathology, biochemistry and pharmacology to give a
general understanding of the human skeleton and the circulatory, respiratory and digestive
systems. By the end of the prologue, Adler explained, students will have a foundation in
the anatomy of the entire body, preliminary physical examination skills, and an
understanding of cultural/behavioral factors such as prevention and stress and wound
healing. She added that more detailed information about anatomy and other topics will be
taught in future blocks wherever relevant.
Susan Masters, PhD, UCSF professor, department of cellular and molecular pharmacology
and chair of the core essentials planning committee, explained that this new model allows
for more integrated learning.
"In the current curriculum, faculty tend to teach from their own perspective in
their own disciplines. In the new curriculum there are established channels for bringing
people from diverse disciplines together to develop and implement curriculum." She
adds that this interdisciplinary approach, combined with more emphasis on clinical cases,
makes the first two years of medical school more relevant and exciting.
The third year curriculum will encompass 44 weeks of clinical clerkships and four weeks
of inter-sessions, an important innovation in the new curriculum. The inter-sessions will
provide time for students to leave clinical rotations and come back as a class to explore
connections between the basic and behavioral sciences in the context of their clinical
experience, explained Irby.
The general plan in year four, the advanced studies portion, is to give students a wide
selection of elective choices. These include the opportunity to return to basic science,
more time for independent scholarly and creative pursuits, the opportunity to gain
teaching skills, and opportunities for sub-specialty rotations.
The UCSF School of Medicine is also among the first to provide stronger support
services for medical students. The new model includes a plan to divide students into
societies or smaller groups to enhance advising and guidance throughout medical school,
Student response to all these changes has been positive, according to Masters, who
explained that more than 30 first and second year students have volunteered to work on
committees to shape the new curriculum. Some dedicated students are working through the
summer and/or taking a year off from their medical studies to help with the redesign, she
The California Endowment and The California Wellness Foundation grants (in the amounts
of $487, 331 and $25,000 respectively) will fund the salaries of those CHC-affiliated
faculty working on the curriculum redesign with expertise in multicultural health and
"The grants were given in recognition of the importance of preparing students to
treat an increasingly diverse population," said Adler. "Social, cultural and
behavior factors are key contributors to health and illness and have been given relatively
little attention in traditional curricula."