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Curriculum 2.0 represents a broad restructuring of the UME program, based on the assumption that an inflexible, classroom-based curriculum cannot prepare our graduates to function expertly in a complex, changing and contingent environment. Curriculum 2.0 is not a static sequence of courses, but is instead a dynamic healthcare system of learning that adheres to competency-based principles, situates learning in the workplace, generates and incorporates evolving health care knowledge, and responds to changing needs of patients, populations and learners. Unique features of Curriculum 2.0 include:
1. A focus on workplace learning, with a pre-clerkship phase called Foundations of Medical Knowledge (FMK), that is limited to one year. FMK will fully integrate biomedical, behavioral, social and systems sciences, medical humanities, and physical diagnosis, using a case-supported format that promotes self-directed learning and critical thinking skills.
2. A Continuity Clinical Experience (CCX) that introduces students to workplace learning in the second month of medical school. After initial skills sessions in the simulation center, every student will be placed at a clinical site, where she/he will function as a member of the care team one afternoon a week throughout medical school. Continuity occurs with the clinic site and its microsystem, with the interprofessional care team at that site, and with a patient panel initially accrued at that site and subsequently followed across multiple care settings. While students will practice fundamental clinical skills during CCX, its primary purpose is to provide a "learning laboratory" for systems of care, with an emphasis on quality, safety, improvement and outcomes.
3. Learning Communities (LCs), situated within our four Advisory Colleges, will meet each week. Components will include the Colloquium (readings-based discussions of metacognition, ethics, medical humanities, and healthcare policy), and the Symposia (leadership and service learning). LCs will provide a safe environment for students as they begin to mold their professional identities.
4. A required research course that introduces students to domains of health-related research, principles of study design, and research methodologies. This will prepare students for a 3-6 month research project in the Immersions phase.
5. A core clerkship phase, Foundations of Clinical Care (FCC), occurring in the second academic year. FCC will consist of six clerkships over a 41-week period. A Diagnostics and Therapeutics (D&T) course running throughout FCC will emphasize cost effective diagnostic approaches for a set of 25 presenting problems, known as the Vanderbilt Core Clinical Curriculum (VC3). D&T will employ a flipped classroom strategy, with online modules providing required content that students will apply to their own patients during small group discussions. FCC will also include two 2-week electives.
6. The highly individualized Immersions phase will follow, offering a variety of course formats designed to advance fundamental knowledge in the context of clinical settings selected by students based on personal interests and learning needs. Interdisciplinary Immersion Courses (IICs) will use a hub and spokes model in which faculty teams deliver core content to clusters of students using multiple approaches, including case-based tutorials, online modules, journal clubs, small group discussions and self-directed learning projects. Students will select their concurrent clinical experiences from a menu of related disciplines. For example, students taking an Obesity IIC would learn core content with faculty from Molecular Physiology and Biophysics, Endocrinology, General Pediatrics, Gastroenterology, Psychiatry and Surgery, and could obtain clinical experiences in adult or pediatric diabetes clinics, bariatric surgery, or the Vanderbilt Weight Management Clinic. This phase will also include advanced clinical electives (ACEs) and acting internships (AIs) that embed students within clinical teams and promote increasing responsibility for patient care. Finally, we will continue several "longitudinal" courses that currently thread throughout the senior year, such as the Shade Tree elective, based at our student-run free clinic. In this elective, fourth year students serve as mentors for more junior students during clinic shifts, attend a seminar series on community health and the medically underserved, and perform a clinic-based quality improvement project.
7. A competency-based approach to learning and assessment with explicitly defined milestones for each major competency domain, and an assessment system "fit for purpose."1
8. A system for individualized learning that includes evidence-based self-assessments, personalized learning plans, faculty coaching, and curricular flexibility, all facilitated by a comprehensive electronic learning portfolio.
9. A rich informatics and technology infrastructure that collects learner experience and assessments in the learning portfolio, aggregates and displays performance data in a way that facilitates interpretation and decision-making, directs learners to knowledge and information resources, and has the potential to measure the impact of educational interventions through associated patient outcomes.
1Van der Vleuten CPM, Schuwirth LWT, Driessen E, Dijkstra J, Tigelaar D, Baartman LKJ, van Tartwijk J. A model for programmatic assessment fit for purpose. Med Teach, 2012; 34(3): 205-214.
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