Champion of Change
Change has been a constant in Bonnie Miller’s 36-year career at Vanderbilt University School of Medicine.
Her presence on campus has been reliable, steady and impactful since completing her surgery residency in 1987 while her roles have been ever evolving: general surgery attending physician, associate dean for Medical Students, associate dean for Undergraduate Medical Education, senior associate dean for Health Sciences Education and Executive
Vice President for Educational Affairs; and professor of Medical Administration and Clinical Surgery.
Miller retired from her leadership positions in 2019, and in July she will transition to emerita status. As she ponders her future away from medical education, she reflects that perhaps her most significant role has been that of facilitator, with a knack for motivating those around her to take big ideas and run with them.
Chief among those visions was transforming the decades-old medical school curriculum — two years in the classroom absorbing massive amounts of information followed by two years in clinical rotations — and turning it on its head. The result was Curriculum 2.0, which was fully implemented 10 years ago. The first discussions about a major curriculum revision began 10 years prior to that. Seeing it to fruition has occupied much of Miller’s career and her colleagues’ time and dedication.
“I think that if you look at a couple of pretty basic indicators [of success], No. 1 is that we could do it, that it actually happened,” Miller said.
In short, Curriculum 2.0 condensed the classroom-based learning into the first year of medical school, allowing students to engage in their core clinical clerkships in the second year. This is followed by the immersion phase, two years of flexible learning and research based on students’ interests. Running concurrently through the curriculum are longitudinal elements that emphasize professional identity formation and health systems science, with all performance assessed using a competency-based approach.
“The fact that you could have a single pre-clerkship year, and students would still do well on tests of basic science knowledge was really very reassuring,” Miller said. “I think the idea that they continue to learn basic science in clinical contexts was something that we were able to show as well.”
Miller is quick to give credit to a talented team of colleagues and to Jeff Balser, MD, PhD, CEO of Vanderbilt University Medical Center and Dean of the School of Medicine, who embraced Curriculum 2.0.
“If you don’t have the dean behind you, it’s never going to go anywhere,” Miller said.
Miller expresses gratitude to the faculty who enthusiastically worked on the logistics of overhauling the curriculum and rolling it out in phases, particularly Kim Lomis, MD, Lourdes Estrada, PhD, Bill Cutrer, MD, MEd, and Neil Osheroff, PhD, whom Miller credits with garnering support among the Basic Sciences.
“Bonnie did an amazing job of helping lead us through two major curricular revisions. Curriculum 2.0 established Vanderbilt as a national leader in medical school education,” said Osheroff, John G. Coniglio Professor of Biochemistry, former director, Academy for Excellence in Education, and co-leader, Foundations of Medical Knowledge Phase. “More importantly, Bonnie changed the educational culture in the School of Medicine. Before Bonnie, we were fragmented, siloed in departments, and saw ourselves as either PhDs or MDs. After Bonnie, we were all on the same team, supporting each other and working together.”
Moving the medical school
Curriculum 2.0 relies heavily on collaborative teaching and learning in teams, and it became obvious that the location of the School of Medicine in outdated Light Hall would not be an adequate environment in which the students, faculty and the new curriculum could thrive. Recognizing that the adjacent Annette and Irwin Eskind Biomedical Library (EBL) could be the ideal location for a new learning center, Miller and a team of like-minded colleagues, including Bill Stead, MD, set about promoting the idea to leaders at both the Medical Center and University.
“We had started thinking about moving the school into the library back in 2010 and went to Stanford to visit their medical education building. It was a very similar four-story building, and was a pretty smart building, technologically, and we came back and thought about whether we could replicate that in EBL. We felt that our medical school needed a place to call its own,” Miller said.
The Annette and Irwin Eskind Family Biomedical Library and Learning Center opened July 18, 2018, after a yearlong, multimillion dollar renovation with infrastructure improvements and updates to support the continuing evolution of medical education. The redesign incorporated the University’s research, learning and teaching goals and included features that complemented Curriculum 2.0 while also meeting LEED Silver certification standards.
“The shift to Curriculum 2.0 transformed Vanderbilt’s undergraduate medical education from a four-year sequence of courses to a career-long system of learning. Bonnie recognized that we did not have optimal physical spaces to support the shift to small group and self-directed learning,” said Stead, McKesson Foundation Professor of Biomedical Informatics and Medicine. “She pressed ahead, launching Curriculum 2.0 in existing facilities. The lessons from this experience, with the generosity of the Eskind family, resulted in the perfect ‘new home’ for the School of Medicine.”
Spearheading large projects like this that relied on buy-in and support of faculty members and leadership helped establish the School of Medicine’s culture of collaboration and opened up numerous teaching and leadership responsibilities for colleagues, something Miller said she is particularly proud of.
“The faculty community that’s been built is really very special. People have had amazing career opportunities because of Curriculum 2.0 — creating wonderful integrated science courses, serving as portfolio coaches, master clinical teachers and college mentors, to name a few,” she said. “The quality of what the faculty are accomplishing, and their creativity and thoughtfulness, are exciting and impressive.”
All aspects of education appeal to Miller, including continuing medical education. She helped establish the Center for Advanced Mobile Healthcare Learning and served as senior adviser on the development of VUMC’s proprietary QuizTime app, which provides a practical workplace learning paradigm for educators and learners. Learners gain access to relevant material in small “micro-chunks” at a time most convenient for them, and content can be distributed at a scale impossible to achieve through traditional face-to-face, classroom-based education.
She has most recently turned her attention to another big idea, which is racing at warp speed into the hands of providers and laypeople — artificial intelligence (AI); the implications for health care both excite and concern her. Miller and VUMC researchers collaborated with IBM Watson Health to engage experts from around the country in defining a set of AI-related clinical competencies for health care professionals. The group’s competency statements and research report appeared recently in Academic Medicine.
“I think there’s reason to be excited about AI and in both clinical and research settings,” she said, “but there are substantial risks as well, for amplifying misinformation, bias and injustice. People need to know how to use it wisely, ethically and equitably.”
As to whether there will be Curriculum 3.0, Miller said that’s always been the intent.
“The faculty know that it must continue to evolve,” she said. “It makes me happy that they’ve got this growth and improvement mindset. The curriculum can’t be carved in stone. Medical education must evolve to reflect evolving knowledge and needs in learning, health and health care. I think that’s a good thing.”