Bill Cutrer, MD, MED, remembers his first day of medical school in the late 1990s well. He and his fellow scrub-clad classmates, many of whom had never seen a dead body before, somewhat apprehensively assembled at the gross anatomy lab. The room was thick with the smell of formaldehyde and lined with sheet-shrouded steel tables, ready for students to choose a scalpel and begin their first cadaver dissection.
“That’s certainly one way to be welcomed to medical school, but I think the way we frame the first week of medical school now is far more effective,” said Cutrer, associate dean for Undergraduate Medical Education (UME) at Vanderbilt University School of Medicine (VUSM). “They’re going to have plenty of months to learn the foundational science, and rather than having them dive right into that on the first day, we really want to help them pull up the perspective of why are we doing this? We’re doing it for the patient.”
In 2010, VUSM faculty leaders began tackling the revamping of medical student training, creating a new blueprint — Curriculum 2.0 — that supported new instructional methods, reworked learning environments, relied upon novel information technology systems, and established innovative ways to track learning progress and capture feedback from both students and faculty. The continual feedback has already been beneficial in further fine-tuning the curriculum.
Now, more than six years after VUSM launched Curriculum 2.0, a total restructuring of medical school training into a system of lifelong learning, Cutrer said he’d give the curriculum revision an Honors mark, the highest on the post-clerkship grading scale.
“There are so many things that we’ve done remarkably well that set our students up to succeed,” he said. “At the same time, we will continue to push, with the students’ help, to make it even better.”
Curriculum 2.0 is divided into three distinct phases of learning — Foundations of Medical Knowledge, Foundations of Clinical Care, and Immersion — and allows students countless opportunities to individualize their training.
Compared to the prior curriculum in which students spent the majority of their first two years in didactic, lecture-based learning and then fulfilled their core clinical clerkships — surgery, medicine, pediatrics, obstetrics/gynecology, neurology and psychiatry — during their third year, VUSM students now complete these rotations during their second year. This allows students to take on progressively more meaningful clinical roles earlier in their training and better correlates their course instruction to clinical care. It also creates two personalized years rather than only one, allowing students to more deeply investigate areas of interest.
“I really didn’t expect how many different ways students would use the Immersion phase to explore what they wanted to do,” Cutrer said. “We purposefully designed it to give them the ability to make their schedules individualized, but now as we’ve looked at it, we’ve seen that no two students have taken all of the same courses in the same order. Functionally, its 100 different curricula each year as students go through. It’s been fun to see how creative students have been with how they use that time.”
VUSM leaders had begun taking a critical look at the curriculum as long ago as 2004, acknowledging that it hadn’t been structurally changed in any significant way for decades, said Bonnie Miller, MD, MMHC, former Senior Associate Dean for Health Sciences Education. In 2007, the first curriculum changes were implemented to restructure instruction into an organ system approach that grouped related or interconnected biological systems in the same learning block.
“I don’t know that we conceived of it that way at the time, but that change turned out to be a bridge to what we ended up doing with Curriculum 2.0,” Miller said. “It did some pretty important things. It got the faculty to work more closely with each other, with team teaching, team accountability and shared responsibility for different parts of the curriculum. Without that change in both structure and culture, it would have been difficult to successfully bring about something as disruptive as Curriculum 2.0.”
VUSM’s Curriculum 2.0 is part of a larger paradigm shift in medical education to better educate the next generation of physicians. Traditional structure/process education has been increasingly replaced by a competency-based medical education (CBME) approach that incorporates more hands-on learning to ensure students develop the skills needed to provide the best patient care.
According to a 2018 survey by the Association of American Medical Colleges (AAMC), 19.1% of U.S. medical schools responding had implemented a major curriculum change in the past three years; 30.6% had a curriculum change in progress; and 34.7% were in the planning stage of a curriculum change.
“Our overall goal for Curriculum 2.0 was to create a physician leader, someone who — though we didn’t have the terminology then — would be a master adaptive learner,” Miller said. “We live in a very dynamic health care environment, and we really had to create a qualitatively different kind of lifelong learner who knows how to respond to things they haven’t seen before, who has the skill to learn rapidly in the workplace, and who has a different kind of mindset, which is an improvement mindset.”
In 2013, just before Curriculum 2.0 was launched at VUSM, the American Medical Association (AMA) selected the school to receive a $1 million grant as one of the nation’s top medical schools transforming medical education. The grant, part of the AMA initiative Accelerating Change in Medical Education, added VUSM to a consortium, now with 37 medical school members, to rapidly disseminate best practices in medical education across the country.
“In the RFP [request for proposal] for the grant, everything we were doing with Curriculum 2.0 was right there, so it was a tremendous validation of what we wanted to achieve,” Miller said. “I’d say the publicity around what the AMA was promoting, the strong support for innovation in medical education and the recognition of all these trends on a national level really put a lot of wind in our sails. And it also validated Curriculum 2.0 for our students; to be able to say we’ve got this big grant and this big organization behind us was really very helpful.”
In academic year 2015-2016, Curriculum 2.0 was further refined with the addition of Integrated Science Courses (ISCs) that combine rigorous training in the foundational sciences with meaningful clinical experiences. These courses made use of a wide variety of instructional methods and included quantitative and qualitative (competency-based milestones) student assessments.
Eli Zimmerman, MD, assistant professor of Neurology, completed his medical degree at VUSM in 2010 under the old curriculum. He returned to Vanderbilt in 2015 to join the neurology faculty. He now serves as the Department of Neurology’s director of Medical Student Education and teaches more than 200 medical students each year. Zimmerman directs Brain, Behavior, and Movement (BBM), the final block of the first year, and he teaches much of the neuro-related portion of the class.
He also directs the required second-year neurology clerkship and the two neurology Advanced Clinical Experiences (ACEs) for third- and fourth-year students. In 2019, Zimmerman received the Shovel Award, from the graduating medical school class to the faculty member who had the most meaningful impact on their medical education.
“I was apprehensive about the changes that were made with Curriculum 2.0 because it was just so different from what I was used to,” Zimmerman said. “Now, four and a half years later, I love it. It really does a nice job of preparing our students to be independent learners and thinkers.”
Zimmerman is also appreciative of the bright, open learning spaces at the Annette and Irwin Eskind Family Biomedical Library and Learning Center.
“The space is really stunning,” he said. “Everyone would rather drive a 2020 Jaguar versus a 1980 Datsun, and I think being in a learning environment that is pretty and bright is really a meaningful change for both the faculty and students.”